In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified as predictors of intent to leave the health professions. To address the mass exodus of HCPs, it will be necessary not only to train emerging providers in a way that changes the culture, but also to address attrition in the current healthcare workforce.
This three-stage, exploratory sequential mixed methods research study merged the health and social sciences by piloting restorative justice (RJ) practices in healthcare settings. First, through conducting semi-structured interviews of 12 HCPs, the deleterious impact of workgroup mistreatment was thoroughly explored and interpreted using a restorative framework. Next, through piloting two RJ interventions in academic medicine and academic nursing settings, respectively (n = 333), the feasibility of implementing RJ in healthcare was determined. Finally, through evaluating the RJ interventions via multivariate survey (n = 87), statistical outcome data quantified the benefits of using an RJ approach to address climate concerns in healthcare.
What emerged was a clear imperative to use RJ in healthcare settings to ameliorate the impact mistreatment has on HCPs’ mental health, job satisfaction, and quality of communication and teamwork. Furthermore, quantitative data indicate early adoption success of using RJ to (a) help build and strengthen relationships, (b) foster a sense of belonging, (c) improve the climate, (d) improve teamwork, and (e) improve work intentions. Thus, a new leadership paradigm, the Restorative Accountability in Healthcare Model (RAHM) is proposed. These findings have clinical, administrative, and policy implications for healthcare leaders, healthcare systems, medical learning institutions, and for preceptors and clinicians more broadly.
","abstract_html":"<p>In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified as predictors of intent to leave the health professions. To address the mass exodus of HCPs, it will be necessary not only to train emerging providers in a way that changes the culture, but also to address attrition in the current healthcare workforce.</p> <p>This three-stage, exploratory sequential mixed methods research study merged the health and social sciences by piloting restorative justice (RJ) practices in healthcare settings. First, through conducting semi-structured interviews of 12 HCPs, the deleterious impact of workgroup mistreatment was thoroughly explored and interpreted using a restorative framework. Next, through piloting two RJ interventions in academic medicine and academic nursing settings, respectively (n = 333), the feasibility of implementing RJ in healthcare was determined. Finally, through evaluating the RJ interventions via multivariate survey (n = 87), statistical outcome data quantified the benefits of using an RJ approach to address climate concerns in healthcare.</p> <p>What emerged was a clear imperative to use RJ in healthcare settings to ameliorate the impact mistreatment has on HCPs’ mental health, job satisfaction, and quality of communication and teamwork. Furthermore, quantitative data indicate early adoption success of using RJ to (a) help build and strengthen relationships, (b) foster a sense of belonging, (c) improve the climate, (d) improve teamwork, and (e) improve work intentions. Thus, a new leadership paradigm, the Restorative Accountability in Healthcare Model (RAHM) is proposed. These findings have clinical, administrative, and policy implications for healthcare leaders, healthcare systems, medical learning institutions, and for preceptors and clinicians more broadly.</p>","abstract_has_math":false,"creators":["Flores, Pedro L."],"institution":null,"degree_name":"PhD Leadership Studies","degree_level":"Dissertation: Open Access","degree_discipline":"Leadership Studies","degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2022,"date_issued":"2022-04-21T07:00:00Z","date_published":"2022-04-21T07:00:00Z","updated_at":"2026-07-24T05:41:42Z","subjects":["Restorative Justice","Leadership","Healthcare","Culture","Workgroup Mistreatment","Nursing","Academic Medicine","Health and Medical Administration","Leadership Studies","Medical Education","Medical Humanities","Medicine and Health Sciences","Organizational Behavior and Theory","Social and Behavioral Sciences","Social Justice"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://digital.sandiego.edu/dissertations/944","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Flores, Pedro L."]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2022-05-10T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Leadership Studies"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Dissertation: Open Access"]},{"key":"thesis:degree_name","label":"Degree Name","values":["PhD Leadership Studies"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Restorative Justice","Leadership","Healthcare","Culture","Workgroup Mistreatment","Nursing","Academic Medicine","Health and Medical Administration","Leadership Studies","Medical Education","Medical Humanities","Medicine and Health Sciences","Organizational Behavior and Theory","Social and Behavioral Sciences","Social Justice"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://digital.sandiego.edu/dissertations/944"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified as predictors of intent to leave the health professions. To address the mass exodus of HCPs, it will be necessary not only to train emerging providers in a way that changes the culture, but also to address attrition in the current healthcare workforce.
This three-stage, exploratory sequential mixed methods research study merged the health and social sciences by piloting restorative justice (RJ) practices in healthcare settings. First, through conducting semi-structured interviews of 12 HCPs, the deleterious impact of workgroup mistreatment was thoroughly explored and interpreted using a restorative framework. Next, through piloting two RJ interventions in academic medicine and academic nursing settings, respectively (n = 333), the feasibility of implementing RJ in healthcare was determined. Finally, through evaluating the RJ interventions via multivariate survey (n = 87), statistical outcome data quantified the benefits of using an RJ approach to address climate concerns in healthcare.
What emerged was a clear imperative to use RJ in healthcare settings to ameliorate the impact mistreatment has on HCPs’ mental health, job satisfaction, and quality of communication and teamwork. Furthermore, quantitative data indicate early adoption success of using RJ to (a) help build and strengthen relationships, (b) foster a sense of belonging, (c) improve the climate, (d) improve teamwork, and (e) improve work intentions. Thus, a new leadership paradigm, the Restorative Accountability in Healthcare Model (RAHM) is proposed. These findings have clinical, administrative, and policy implications for healthcare leaders, healthcare systems, medical learning institutions, and for preceptors and clinicians more broadly.
"]},{"key":"dc:title","label":"Title","values":["When \"First, Do No Harm\" Fails: A Restorative Justice Approach to Workgroup Harms in Healthcare"]}]}],"canonical_facts":{"dc:creator":["Flores, Pedro L."],"dc:date.available":["2022-05-10T07:00:00Z"],"dc:description.abstract":["In healthcare, workgroup mistreatment is a pervasive problem that begins during medical education (medical and nursing school) and becomes embedded in the “hidden curriculum of professionalism,” which dissuades and even punishes learners for talking about abuse they witness. Furthermore, the mistreatment of healthcare providers (HCPs) pervades all disciplines in the healthcare delivery chain due to a combination of cultural factors, systemic pressures, dysfunctional hierarchies, and leadership’s tolerance of intimidating and disruptive behaviors. Not surprisingly, 18% of U.S. HCPs have left the medical field since the start of the COVID-19 pandemic, and burnout, stress, anxiety, and increased workloads have been identified as predictors of intent to leave the health professions. To address the mass exodus of HCPs, it will be necessary not only to train emerging providers in a way that changes the culture, but also to address attrition in the current healthcare workforce.
This three-stage, exploratory sequential mixed methods research study merged the health and social sciences by piloting restorative justice (RJ) practices in healthcare settings. First, through conducting semi-structured interviews of 12 HCPs, the deleterious impact of workgroup mistreatment was thoroughly explored and interpreted using a restorative framework. Next, through piloting two RJ interventions in academic medicine and academic nursing settings, respectively (n = 333), the feasibility of implementing RJ in healthcare was determined. Finally, through evaluating the RJ interventions via multivariate survey (n = 87), statistical outcome data quantified the benefits of using an RJ approach to address climate concerns in healthcare.
What emerged was a clear imperative to use RJ in healthcare settings to ameliorate the impact mistreatment has on HCPs’ mental health, job satisfaction, and quality of communication and teamwork. Furthermore, quantitative data indicate early adoption success of using RJ to (a) help build and strengthen relationships, (b) foster a sense of belonging, (c) improve the climate, (d) improve teamwork, and (e) improve work intentions. Thus, a new leadership paradigm, the Restorative Accountability in Healthcare Model (RAHM) is proposed. These findings have clinical, administrative, and policy implications for healthcare leaders, healthcare systems, medical learning institutions, and for preceptors and clinicians more broadly.
"],"dc:identifier":["https://digital.sandiego.edu/dissertations/944"],"dc:subject":["Restorative Justice","Leadership","Healthcare","Culture","Workgroup Mistreatment","Nursing","Academic Medicine","Health and Medical Administration","Leadership Studies","Medical Education","Medical Humanities","Medicine and Health Sciences","Organizational Behavior and Theory","Social and Behavioral Sciences","Social Justice"],"dc:title":["When \"First, Do No Harm\" Fails: A Restorative Justice Approach to Workgroup Harms in Healthcare"],"thesis:degree_discipline":["Leadership Studies"],"thesis:degree_level":["Dissertation: Open Access"],"thesis:degree_name":["PhD Leadership Studies"]},"updated_at":"2026-07-24T05:41:42Z"}