While we were sleeping, aeroplanes – not children – were made safer

Stop blaming the individual who does wrong or makes a mistake, and start thinking about the environment that leads to those wrongs and mistakes occurring in the first place. This is one of the take home messages from David Hemenway’s excellent book While We Were Sleeping, which catalogues success stories from the world of prevention.

And there are several dozen success stories that have saved the lives of several hundreds of thousands if not millions of children.
 
Take one illustration. In 1994 an estimated 23,000 infants were injured in baby walkers, mostly during a fall down the stairs. One could blame the parents. Who could leave their child unattended near a steep flight of stairs? How neglectful!
 
Or one could look for ways of changing human behaviour, altering the agent of injury or making a difference to the environment in which the accidents routinely occurred. One effective strategy was making the base of baby walkers too wide to fit through a doorway, or stairwell. There were others also. By 2001, the number of injuries had dropped by three-quarters to 5,100.
 
These ideas seem compelling. But how far can one take them? What about intentional injury to children, usually by parents? Extremely serious cases run at a steady 130 per year in England, with little change in the number over the last three decades. Blaming the individual, the parent who injures the child, or more commonly these days, the professional who failed to see that the parent would injure the child, is the most common response.
 
Could we shift the focus to the environment in which these injuries occur, and find ways of preventing their occurrence? I have previously commented on the relevance of prevention of airlines crashes to preventing avoidable serious child injury. Despite our residual fears airplanes are now many more times safer than other modes of transport, and the average yearly fatalities have dropped, in the United States for example, from 9.5 per million aircraft miles travelled to 0.2.
 
If only we could make such a difference in the field of child maltreatment. Hemenway examines the elements of this success. Some of the constituents are being applied in the child protection field. In-depth investigations of every accident, and of ‘near-misses’, by an independent agency for example. This happens to some extent in the context of serious injury to children. But investment in the prevention of plane crashes reflects how our interest in the subject.
 
Every mile travelled by an airliner results in $1.50 being invested in airline safety meaning that the US Federal Aviation Administration has an annual budget of $14 billion. One crucial difference between airline safety and child protection is the concept of blame-free reporting. If a pilot reports a near miss, they have some immunity from prosecution and their names are not identified in reports.
 
Reporting is voluntary. In addition experts often sit in the cockpit to observe flights. Again, data are kept confidential. They reveal that error is common. It is not unusual for the pictures and names of social workers and their bosses to be featured on the front page of national newspapers. It is hardly surprising that errors are hidden, that learning from mistakes is restricted and the number of avoidable child deaths remains more or less the same today as it did in 1950. David Hemenway’s While We Were Sleeping is published by the University of California Press.
 
His summary of the airline safety model can be further summarised as follows:
1. Every accident receives an in-dept investigation by an independent authority that is free from political interference, must make its findings public, does not assign moral responsibility and has no power to punish.
2. Analysis of mistakes and near-misses, including data from self-reports and observation by experts sitting behind and observing the experts, is used to provide solutions to problems that may lead to major accidents.
3. A confidential, non-punitive reporting system is used. It is voluntary but supported by professional organisations and in training of pilots. Reports do no name pilots.
4. It is accepted that error is common, and can be reduced.
5. Teamwork is seen as essential to flying an aeroplane, and better communication and cross checking as fundamental to identifying and rectifying common errors.
6. Pilots are trained using simulators that produce error-inducing situations.
7. Airlines take a systems approach to safety, recognising that accidents rarely result from a single failure or action.