Restorative Justice as Cultural Practice in Medical Malpractice: Face-Work, Institutional Trust, and Social Learning in Healthcare Organizations

Abstract

This article examines restorative justice as a cultural practice within healthcare, focusing on how apology, accountability, and institutional learning are shaped by context, norms, and trust. Drawing on a scoping review of nineteen studies across different jurisdictions, it analyzes Open Disclosure, Communication and Resolution Programs, and clinical mediation as post-incident frameworks that extend beyond liability management toward moral and relational repair. The findings show that similar procedures operate through distinct cultural scripts: in some systems, apology is protected by law, while in others it is grounded in social legitimacy and mediated harmony. Success is most likely when clinicians participate, claims are moderate, and dialogue occurs in psychologically safe environments. By contrast, cases involving severe harm or contested standards of care require hybrid models that combine restorative and formal legal processes. The analysis integrates the concepts of face work, legal consciousness, and institutional trust to explain how openness and empathy can transform defensive institutions into reflective ones. When embedded in cultural and legal systems that safeguard candor, restorative practice enables not only fair resolution but also sustained social learning within healthcare organizations.