Starting to implement the harmed patient pathway: Preliminary thoughts for healthcare professionals

The Harmed Patient Pathway sets out a range of commitments about how healthcare organisations should respond to patients and families after harm in ways that prioritise healing, honesty, trust and just relationships, and seek to prevent second or compounded harm.

This paper offers some initial, practical considerations for healthcare professionals and leaders who are beginning to think about how the Pathway might be implemented in their local context.

1. Recognising the Pathway as an approach, not a checklist

A key starting point is recognising that the Harmed Patient Pathway is not a rigid process or linear route. It is an approach grounded in restorative values and patient-centred care, designed to support individualised responses to harm, shaped by what matters to the patient and their family.

Implementation is therefore going to require cultural as well as procedural considerations as part of any changes. While policies and guidance are important, the Pathway will ultimately be experienced by patients through day-to-day interactions, conversations and behaviours which they experience from the staff they interact with. Staff are bound to therefore need support, but the benefits to them in terms of their wellbeing should be realized and considered also.

2. Implementation can happen at any level

The Pathway does not need to be implemented across an entire organisation at once. It can be introduced at different levels, including a single service or specialty, a particular area of practice, or a whole trust.

Starting at a smaller scale can allow teams to test approaches, learn what works in practice, and build confidence before wider adoption across other services.

3. You do not need to implement all six commitments at once

The Pathway consists of six core commitments. Whilst it would be helpful to consider all six commitments, it may not be realistic to implement all six simultaneously.

A phased approach may be more achievable. For example, you may choose to begin with commitments relating to communication, openness and compassionate engagement, and then build in additional commitments over time.

4. Developing staff capability: restorative practice and difficult conversations

A recurring theme within the Harmed Patient Pathway is the central role of how staff communicate after harm. Even well-intentioned processes can cause further distress if conversations feel defensive or overly procedural. The importance of having curiosity cannot be under-estimated. Asking patients questions about what they need, acknowledging the harm caused and listening are essential but too often get missed.

Key considerations include training staff in restorative principles and supporting staff to have honest, compassionate and sensitive conversations, while recognising the emotional impact on everyone – staff and patients – involved in incidents of harm. By providing effective training and support, staff should, over time, feel the benefits of the adoption of a Pathway approach.

5. Reviewing systems and processes through a harmed patient lens

You may find it helpful to review existing systems and processes by asking what the experience feels like for a patient or family after harm, and where processes might unintentionally contribute to compounded harm.

6. Starting with communication as a foundation

You may find that communication is the most accessible place to start. Early improvements might include agreeing expectations about communication and avoiding unnecessary delays or silence. Often, communications is an after-thought in the delivery of a healthcare service whereas our experience shows that what can make a vital difference when there is avoidable harm is effective and timely open dialogue and communications with the patient and their family.

7. Learning and improvement over time

Meaningful involvement of harmed patients and families is not optional; it is core to delivering the Pathway as intended. You should therefore give active consideration to how you involve harmed patients and families as partners in this process, recognising their lived experience as essential to preventing compounded harm and improving responses for others. The sooner this can be considered in any plans around implementing the Pathway, the better.

Conclusion

The Harmed Patient Pathway offers an important opportunity to reshape how healthcare responds when harm occurs, with a focus on healing, dignity and maintaining trust. By starting at a manageable level and building over time, organisations can begin to make meaningful progress while learning and improving as they go.

If you would like a follow-up conversation about how you might go about implementing the Harmed Patient Pathway, please fill out the form below and we will provide as much support and insight as we can.