Abstract / Summary
Background: Evidence is limited on how people experience government-commissioned inquiries, what they value about them, and the impacts of procedures. This study applies realist logic to examine the experiences of those designing and participating in a government-commissioned restorative approach to harm associated with surgical mesh use in Aotearoa New Zealand. Attention is paid to divergent perspectives about harm and responsibility, desired outcomes, and the multiple identities that shaped people's responses to the programme.
Methods: Using mixed methods, data were collected from documents, interviews, surveys and a research diary to test and refine programme theories. Context-Mechanism-Outcome configurations were used to develop theoretical explanations of what worked, for whom, and in what contexts to mitigate, ameliorate, or generate compounded harm.
Results: Compounded harm arises when the different ways individuals make sense of the cognitive, moral, and emotional significance of harm are overlooked. It may also arise when governments and providers do not proactively disclose the inherent risks of healthcare, or the trade-off between the ideal state and what is possible within constrained resources. Three mechanisms contributed to the restoration of dignity, wellbeing, and trust: collaborative and adaptive restorative design, dignifying storytelling, and responsiveness to the potentially traumatising nature of healthcare harm.
Discussion: Findings underscore the critical importance of acknowledging the prevalence and lived experience of harm, nurturing basic and relational trust, including diverse perspectives, and remaining adaptable if public inquiries are to be effective. Practical recommendations for those commissioning public inquiries emphasise restorative strategies that foster dignity, wellbeing, trust and adaptability while balancing complexity, dynamic human needs, and institutional responsibilities.
Lived experience and public contribution: Patients, families, whānau (extended family), and community representatives were involved in the design of the study, data collection tools, theory testing and refinement, development of the concept of compounded harm, and manuscript preparation.