Restorative Practices,Freedom of Expression,and Executive Leadership: An Innovative Application of Restorative Practices in Academic Medicine

Abstract

Introduction:

Although proponents suggest that restorative practices (RP) could foster community in academic medicine, few published reports describe their application.

Method:

Our executive leaders partnered with RP and Freedom of Expression (FOE) teams to apply RP circles to challenges related to U.S. government Executive Actions (EAs). Follow-up surveys assessed RP-FOE linkage.

Results:

In early 2025, 152 individuals participated in 31 circles. In post-circle surveys, participants (>90%) felt able to express opinions and understand others’ perspectives. EA-related themes generated institution-wide strategies, including town halls and community-engagement toolkits.

Conclusions:

RP circles allowed participants to speak freely, understand others, and provide leadership feedback.

Introduction

On January 28^th, 2025, the Medical College of Wisconsin’s (MCW) executive leadership (consisting of the provost, president, medical school dean, and designees) addressed the MCW community regarding recent Presidential Executive Orders and Agency Actions, specifically their potential impact on daily operations and the four institutional missions: clinical care, research, education, and community engagement. This meeting evoked various emotions and perspectives. Consistent with MCW’s Freedom of Expression (FOE) principles, ¹ MCW planned restorative practice (RP)-based listening circles to assess the perceived and actual results of the execution of the federal actions.

MCW’s leadership, RP, and FOE teams viewed RP as a natural tool to demonstrate how to put MCW’s FOE principles into practice while receiving important feedback from constituents. All teams believed that the plan mitigated perceived downsides for all three teams’ processes: specifically, that great ideas discussed in RP circles would not be shared beyond the circle, ² FOE principles do not guarantee that all feel free to speak, ³ and leadership can be siloed in an echo chamber. When woven together, we believed that leadership goals, RP, and FOE could mediate the existing circumstances and build a synergistic foundation for future work (Fig. 1).

FIG. 1.

Synergy between restorative practices, freedom of expression, and executive leadership at the medical college of Wisconsin.

Restorative Practices

RP builds community through facilitated, focus-group-like “circles” that uplift voices through multi-partial discussion.^4,5 “Multi-partial,” distinct from neutral or impartial, indicates equal partiality to all, empathizing with each party. Typical steps in an RP circle include (1) checking-in, (2) offering a mindfulness moment, (3) sharing guidelines for interacting in circle, (4) using a talking piece (physically passable object) to host several rounds of speaking to specific questions, and (5) closing. ⁴

RP has been successful in K-12 and undergraduate education ⁶ and shows promise for use in academic medical environments. ⁷ RP has also been used to facilitate healing after crises, but direct linkages to leadership and FOE principles are much less common. ⁷

Freedom of Expression

In 2023, MCW committed to fostering a community that supports meaningful and constructive exchange of ideas and charged a 17-member committee to develop principles of FOE on campus and recommend strategies for integrating those principles into MCW culture, balancing MCW’s core values with its role as a place where uncomfortable ideas can be discussed and vigorously debated. ¹ MCW’s FOE principles include (1) encouraging multiple perspectives, (2) civil discourse, (3) free debate of ideas, (4) deliberate engagement with difference, and (5) recognizing appropriate restrictions of expression to promote excellence in patient care. ¹ At MCW, FOE aims to create not “safe” or “comfortable” spaces, but “brave” spaces, in which people can take risks in an atmosphere of support, and where civil dialogue can flourish. ⁸ RP and FOE are natural partners—FOE sets out principles and goals for interaction, while RP demonstrates how those principles can be operationalized in a welcoming environment.

With the advent of federal EAs, the executive leadership team engaged the FOE and RP teams with the following goals:

Executive Leadership: Empower community voices to speak in ways that enhance executive leadership’s understanding and action, while supporting and building community.

RP: Create supportive and inclusive spaces for people to share their thoughts and concerns, while providing tools to use outside circles as participants engage with others.

FOE: Foster active listening and the creation of brave spaces, with the goal that people feel heard in an atmosphere of dignity ⁹ that endorses engagement with difference.

Method

MCW’s RP team trained six facilitators utilizing externally offered, 2-day, basic RP-circle training, followed by an MCW-developed, 2-hour training that focused on facilitating in the medical environment (e.g., navigating academic power dynamics). First-time facilitators began by working with a partner, debriefed after each session with a senior facilitator, and all circles were followed with surveys that ensured continued facilitator quality. RP community-of-practice meetings and ongoing RP training opportunities encouraged facilitator improvement and engagement.

In February and March 2025, EA-focused circles were offered to faculty, staff, and learners and in both virtual and in-person formats. Note-takers participated in each circle to track general thoughts. Before circle closing, the note taker shared the captured themes with the circle participants, confirming that it was acceptable to share those anonymized themes with executive leadership. The identity of individual participants was not shared outside the RP circles. Circles were not offered to address specific details regarding executive orders or MCW’s response to those orders; circles instead offered an opportunity for sharing and understanding. Scripts of circle questions can be found in Supplementary Data S1.

After each circle, participants were encouraged to complete a brief anonymous survey, which included three prompts related to FOE principles. RP and FOE teams developed the post-circle survey tied to MCW FOE principles, ¹ specifically asking whether (1) participants were able to freely express themselves; (2) the circle process facilitated understanding other perspectives; (3) the facilitator actively encouraged participants to engage in dialogue (Supplementary Data S2).The RP team used descriptive statistics to analyze quantitative questions, EA circle-content themes were compiled and sent directly to executive leadership.

Results

On the day registration opened, the 80 available slots in 10 circles filled in 10 min. By the end of March 2025, 31 circles were completed with 152 participants, including staff and faculty, and areas as diverse as pediatrics, human resources, and our cancer center.

FOE-RP Survey Analysis

Sixty people answered the post-RP-circle survey (Supplementary Data S2) (response rate: 39%). Ninety-eight percent (n = 57) agreed or strongly agreed that they felt freely able to express their opinions; 93% (n = 53) agreed or strongly agreed that the circles helped them understand the views of others; and 97% (n = 56) agreed or strongly agreed that the circles facilitated active dialogue.

Response from Leadership

Focused RP questions enabled executive leaders to gain insights from an array of community members. EA circle content themes prompted leadership to take specific communication actions, which included sharing information through internal campus news stories and answering questions during institution-wide town halls. MCW also created an internal EA FAQ page, which included answers to questions prompted by circles such as, “How have the executive orders impacted clinical trials,” and “What guidance does MCW offer sponsored visa holders?”

Additionally, in response to the EA content theme, “Wondering what else we can do with advocacy, and a way to actively participate in the future resolution,” leadership created an online research education and advocacy toolkit that shared pertinent definitions (e.g., “what are direct costs”), useful facts and infographics, and “education and advocacy toolkits” for MCW community members who might want to share information with family, community, and elected officials, or via social media.

Limitation(s)

This small, self-selected sample from a single institution may not reflect experiences at other institutions.

Conclusion

We identified actionable steps to advance this work in the next phase of implementation.

Identify strategies for increased engagement with RP: Objections to attempting RP sometimes include: concerns regarding time spent, perceived limited direct translation to action; and the view that RP is closely tied to social justice issues. ² In our experience, combining RP with FOE and a compelling topic such as EA allowed us to leverage the power of supportive communication. Adding a promised feedback loop to leadership and action steps brought home the value of RP. Working forward, the RP team plans to apply RP (1) to understand increasingly complex topics (2) to approach new settings and areas; and (3) to engage additional members of the MCW community.

Encourage utilization of RP circle skillsets beyond RP circles: RP not only provides space to speak bravely, but it also demonstrates how people can interact while honoring one another’s dignity. In combination, RP and FOE created brave spaces and modeled best practices for discussions across differences. Our goal is that participants will take what they learn in RP—e.g., multi-partial advocacy and active listening—outside of circles and into their daily work interactions.

Build trust in the FOE process: The best-intended FOE principles are still insufficient for some to feel comfortable speaking and can be interpreted by others as permission to speak freely without regard to the dignity of others or the circle process.^3,9 While RP and FOE cannot guarantee that all participants will choose to share or be vulnerable, RP creates the conditions that effectuate the key aspects of FOE.

Expand RP-FOE partnership to other MCW areas and leaders: Executive leadership support provided critical communication opportunities and the underlying drive to promote initial success. Leadership has provided funds to train 15 additional basic facilitators and augment the training of existing facilitators to enable them to work with more complex problems and practices, such as expanding into work with Human Resources concerns.

Promote the RP-FOE-Leadership triad model for adoption by other institutions. The RP-FOE-Leadership triad is nimble: the RP team can be relatively small, basic circles are not time-consuming (60 min per circle), many in medicine already have facilitation skill sets, and the technique can be applied to many topics. In short, minimal resources can have a high impact. In these times of challenge for our national academic community, we believe that this innovative FOE-RP-leadership alignment shows early promise to build community, promote discourse, and inform leadership. The wider academic community could adopt this method as they work to engage their constituencies, improve communication culture, and address challenges.

Authors’ Contributions

E.H.E.: Conceptualization, methodology, resources, writing, visualization, data presentation, and supervision. J.LG.: Conceptualization, methodology, investigation, writing, and data presentation. J.S.W.: Conceptualization, methodology, and writing. A.H.: Conceptualization, methodology, investigation, writing, visualization, and data presentation. N.F.: Conceptualization, methodology, and writing. J.R.R.: Conceptualization and writing. C.A.M.: Conceptualization and writing.