Moving Beyond Sorry: The Acknowledge-Repair-Prevent (ARP) Framework for Colleague Apologies in Medicine

Patient apologies are institutionalized in medicine through training, legal protections, and institutional programs. Colleague apologies remain rare despite frequent harms from hierarchy, bullying, and dismissal. This perspective examines why institutions mandate patient apologies but ignore colleague harm, despite evidence that unaddressed workplace conflict drives turnover, worsens burnout, and fractures the communication essential for coordinated care. Studies show that a majority of clinicians report that conflicts affect care quality, with nearly half perceiving possible harm to patient survival in intensive care settings. Existing apology models restore immediate dignity but lack prevention components. The proposed Acknowledge-Repair-Prevent (ARP) framework adds concrete prevention steps as systemic quality improvement measures and emphasizes restorative over retributive justice. Implementing ARP requires addressing structural barriers, including hierarchy and ego. The framework could rebuild the internal trust that sustains patient safety culture.