The Ministry of Health, in collaboration with other health sector agencies, is continuing to progress work on the actions agreed in the report Hearing and Responding to the Stories of Survivors of Surgical Mesh published in December 2019.
Evaluation of Hearing and Responding to the Stories of Survivors of Surgical Mesh
The Ministry of Health commissioned the Diana Unwin Chair in Restorative Justice at Victoria University of Wellington to evaluate the project ‘Hearing and responding to the stories of survivors of surgical mesh: Ngā korero a ngā mōrehu – he urupare’, which used a restorative approach to listen to the stories of people adversely affected by surgical mesh. The project was conceptualised in terms of the individuals and relationships affected and helped the Ministry of Health to listen and understand the lived experiences of New Zealanders affected by surgical mesh in order to inform reparative action and prevent future harm.
The aims of this descriptive evaluation were to ascertain whether good practice was demonstrated by the project delivery team; to understand people’s experiences of the process; to find out whether the project objectives were met; and to assess whether the approach was transferable to other health contexts.
A health impact assessment framework was chosen to assess the process and immediate impacts of a restorative approach. Participatory methods were used to design the research approach and data collection tools. Consumers, health professionals, responsible parties and workshop attendees were invited to participate. The COVID-19 pandemic delayed data collection, which eventually took place during May- July 2020. Ethics approval was granted by the Victoria University Human Ethics Committee.
The process evaluation determined that a restorative approach supported substantive, psychological and procedural needs to be met during the Listening and Understanding phase of the project. The preservation of dignity, validation of experience, and respectful communication was experienced by most people. The use of proactive and reactive restorative Circles and meetings were particularly effective. Inclusion of multiple methods for storytelling ensured that a safe and supportive environment was experienced by the majority. The impacts of surgical mesh harm were understood, and hearing the effects inspired responsible parties to collaborate and act for repair and prevention.
Consumers were largely unaware of progress on the 19 actions that resulted from the Planning and Acting phase of the project and wanted a swifter response. For these reasons, many consumers were unsure if their substantive needs would be met or if safer healthcare would occur in the future. Meeting the individual substantive needs of mesh injured consumers is essential to restore wellbeing. Apology and the provision of compensation and psychological support is vital to prevent compounded harm and restore relationships and trust. Restoring trust and confidence in the therapeutic relationship is essential for patient safety.
The COVID-19 pandemic delayed the delivery of the 19 actions agreed during the Planning and Acting phase of the project. Some actions, such as an ACC apology and initial review of declined claims, have occurred since data were collected. The results of the impact evaluation which aimed to determine the success of the Planning and Acting phase of the project and the extent to which the approach restored wellbeing and relationships should therefore be interpreted with the impact of COVID-19 in mind.
Restorative approaches and practices are potentially transferable to other health contexts if the critical success factors are met. Conflict resolution, adverse events, treatment injuries and consumer complaints were identified as key areas for exploration. Restorative approaches have the potential to meet substantive, psychological and procedural needs following an episode of healthcare harm in ways that many current approaches do not.
Healing after harm is possible when approached within a relational framework and this should be embedded alongside existing regulatory structures, policies, and procedural responses. The procedural adaptations enabled by a restorative approach should provide the person-centred approach expected. A collaborative approach to design, which distributes leadership amongst communities, advocates, and agencies, will promote success and build trust. Restorative approaches resonate with the relational approach of Te ao Māori and have more to offer Aotearoa New Zealand than traditional investigative methods.
The New Zealand Health and Disability System Review provides an opportunity to transform responses to healthcare harm in New Zealand. Ongoing testing and refining of restorative approaches in different contexts will be important to understand what works for whom, in what contexts and how. The identification of mechanisms that enable the success of a restorative approach in the context of the New Zealand health system is necessary if their potential is to be realised.
Progress since the previous update
Recommendation 8
Specialist multi-disciplinary centre(s) are required – a group will meet in January 2020 to advise the number of specialist centres required to ensure equity of access, the model of care, and team required
Status: In progress
A small team have assessed the proposals, which included ACC and consumer representation. An equity review of the proposals is currently being commissioned, however, incremental establishment will continue alongside this. Additional resource has been secured within the Ministry to lead the incremental implementation in early 2022.
Recommendation 9
Establish a credentialing committee by the end of January 2020 to recommend national standards for individual practitioners and services commencing with urogynaecology procedures – minimum standards for insertion, renewal, repair, and removal of surgery and native tissue repair will be included
Status: In progress
The final draft of the credentialing framework has been shared with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Urological Society of Australia and New Zealand for feedback, and international peer review will follow. It is now expected the framework will be published in early 2022, alongside which a new credentialing committee will be established to carry out its implementation.
Recommendation 10
The Ministry of Health will lead, supported by ACC, interdisciplinary education and build the capability of the required technical skills to prevent future harm and reduce the severity of existing harm. This action intends to also support the provision of removal surgery.
Status: In progress
Two more workshops were held in October with the primary health care working group to finalise the service specification for the primary health care education package.
ACC and the Ministry are working together to progress development of the secondary and tertiary care packages.
Recommendation 17
National information resources for mesh-related procedures should be created with consumers and include informed consent processes. Information should incorporate the product safety profile, outcomes and risks, alternative treatments available, and the informed consent process.
Status: Ongoing
The Health and Disability Commission also wrote to Private Surgical Hospital Chief Executives in September 2021 asking for an update on surgical mesh procedures in their hospitals, and what resources are used to support informed consent processes. Indicatively of the private surgical Hospitals where surgical mesh procedures are being performed, 17 out of 24 are routinely using the national patient resource.