Cops, EMT workers and court officials are no longer waiting to be told how to fix system flaws. In cities across the country, pioneering efforts at collaboration across once-solid silos resemble the skillful improvisations of a jazz score, writes a Boston defense attorney.
Turn on your local nightly news. Pick up the Metro section of your local paper. Several times each week, you’ll see cops and EMTs standing over a body.
Sometimes it will be a shooting victim; sometimes it will be a drug overdose fatality. Sometimes it will be a mental patient who, in a psychotic state, was driven to “suicide-by-cop.”
Cops and EMTs are tired of meeting that way.
Emergency room staffs are tired of greeting the ambulances that bring in the “likely to die” cases whom their frantic medical efforts can’t save.
A pair of recent meetings indicates that the frontline practitioners who confront these grisly scenes are making themselves felt in their professional organizations—that they are taking things into their own hands.
The program at the recent Orlando, Fl., meeting of the International Association of Chiefs of Police (IACP), for example, bulged with panels and presentations reflecting the perception of Burlington, Vermont, police chief Brandon del Pozo that “the job here is to keep people alive.”
IACP provides a collaborative platform that serves not just NYPD-size behemoths but also smaller departments from across a diverse range of jurisdictions: urban, suburban, and rural.
Representatives from those departments, often joined by the mental health providers, addiction specialists and social science researchers with whom they had worked on their home ground, presented accounts of their successes, their failures, and the challenges they still faced.
Later in the same month, the Fourth Annual Conference on Law Enforcement and Public Health (LEPH) was held in Toronto. International panels filled several days with lessons learned by police when they reached out to their health care counterparts and took a public health approach to opioid deaths, violence reduction, mental health interventions, and homelessness.
Again and again at the two conferences, pioneering police, driven by harsh experience to try something new, described glimmers of hope that their collaborative initiatives had revealed.
Something is happening here.
What you can see beneath the surface of these gatherings is the classical pattern of the diffusion of innovation described by Everett Rogers.
Innovators are attracting early adopters, and news of the relative advantages of their innovations is spreading in peer-to-peer conversations through peer networks.
There are elements of these particular diffusions that might herald a paradigm shift in criminal justice: a shift from a preoccupation with control (of crime on the one hand, of law enforcement intrusions on the other) to a focus on safety.
Or, maybe I mean Safety—everyone’s Safety: the community’s, the individual’s, and the cop’s too.
In this vision Safety means being safe from crime and criminals, but also being safe from iatrogenic (“from the treatment”) harms caused by excessive force, oppressive patrol practices, and massive levels of disruptive detention and incarceration.
The first thing to notice about the momentum behind this movement is that it is being generated from the bottom up: its origin lies in the traumatic lived experience of the people on the frontlines, not in the policy journals.
But it is also important to recognize the extent to which this frontline impulse is reinforced by the data.
When the careful Camden, N.J., effort to integrate health care and criminal justice numbers finds that 67 per cent of Camden’s arrestees also cycle through its hospitals, it makes it clear that the IACP’s and LEPH’s presenters are not reacting to idiosyncratic events; they are simply confronting reality.
The law enforcement and public health collaborations on display at IACP and LEPH have fostered an impressive array of local re-arrangements: new “best practices” and policies that are showing concrete results on the ground. These are unalloyed “Good Things.”
Still, if we apply the new Safety lens to these developments and to the environment that spawned them, we might be able to push further—and faster— and for a sustained period.
The Orlando IACP and Toronto LEPH gatherings both broke down the walls between neighboring territories—between professional silos that are often in contact, but within which the practitioners were used to going their own separate ways. Their new linkages will help all of the practitioners to be more effective in working together towards their common goals.
Safety experts argue that the horrific disasters and corrosive day-to-day harms these cops and healthcare workers are trying to avoid are never really single-cause events, produced by a lone sloppy practitioner or one defective practice or component; they are system errors.
Harms happen when small choices (none of which is enough to cause the outcome independently) combine with each other and with latent system weaknesses and conditions.
In other words, Safety writers would challenge us to ask ourselves whether “Silo + Silo = System.”
They would say that the answer depends on whether we believe the criminal justice system we are entangled in is a “complicated” system or a “complex” system.
As Sidney Dekker explains this distinction, a jet airplane is “complicated”—an intricate mechanical system where the failure of a part can be seen as a “cause” because it has an inevitable and predictable result.
Fix the part, and the plane is fixed. If criminal justice is just “complicated,” and the part is in your silo, then you can fix the problem yourself.
But jet air transit in operation is “complex”: when you add the humans there are no longer inevitable Newtonian causes and effects; there are “influences.” They don’t dictate outcomes, but they do affect the probabilities.
A bad outcome doesn’t arrive via a simple, one-way, linear sequence; it emerges from a combination of influences: from workers trying to make sense of situations derived from the small decisions, acts and omissions of other workers, and from conditions dictated by budget-makers, legislators and policy-makers so far over the horizon that they often become invisible.
There are things in criminal justice that can be treated as “complicated,” and they can be remedied with a quick “best practice” fix. (“Don’t spill your coffee on the crime scene”) or a checklist (“remember to ask about allergies”).
But more often criminal justice encounters are complex. Neither the cops nor the doctors are “upstream” or “downstream” in the life course of the “frequent flyers” among the homeless, the battered, the addicted, and the mentally ill they encounter. The police and the medical staffs are always simultaneously upstream and downstream of each other.
And, since most of the civilians whom medicine and law enforcement encounter are court-involved, the cops and doctors are joined in their web of mutually reciprocal influences by prosecutors, defenders, courts, sheriffs, corrections officers, and probation and parole workers—even by families and communities.
A mentally ill misdemeanor defendant who de-compensated and had to be violently subdued (even killed) by the cops has been in contact with the hospital, the defenders, the clinic, the jail, and the re-entry program. Treatment opportunities were missed, or misjudged, or treatment was interrupted.
All of the frontline operators involved had Safety as their ultimate goal—although they may approach it from different orientations and with different tools, or express it in different terms—and all of them are simultaneously buffeted by an encompassing environment constructed by others.
As Safety commentator Ivan Pupulidy points out, the daily lives of these players aren’t like those of orchestral musicians trying to follow a score.
At 2:00 a.m. on the street, or in the emergency room, or late in the afternoon, when managing the 14th case on their 60-case misdemeanor arraignment lists, the practitioners are more like jazz musicians, improvising in a world of swirling inputs. Everyone’s work is affecting everyone else’s work.
Shifting Toward Safety
No single operator can produce Safety any more than a single molecule of H2O can produce wetness. The whole culture has to shift toward Safety.
The recognition that frontline life is dynamic and adaptive, not scripted, is at the heart of projects like the National Institute of Justice/Bureau of Justice Assistance “Sentinel Event Initiative.” The goal of the Sentinel Event demonstration projects (for which sites are currently being recruited) is to explore whether jurisdictions can develop the capacity for an all-stakeholders approach to these problems that improves on a “silo + silo” orientation by bringing everyone to the table to review not the performances of individuals but the system-based generation of events.
In the aftermath of tragedies there may be particular individuals who have to be held accountable for their performances, but everyone (and every organization) has to be held accountable for learning the all lessons of the entire complex event teaches and avoiding repetition.
There are tantalizing signs that the people on the frontlines are ready for this—in fact, are thirsty for it.
If you review, say, a random month of The Crime Report, you will see news of an individual criminal justice practice community that has re-oriented itself towards preventing avoidable harms every day.
To take one example, you will see organizations of prosecutors, of defenders, and of police each taking steps to cut the subset of unnecessary pretrial detentions that produce no impact on crime reduction and community safety.
The crucial question in our immediate future is whether they can all be convinced to pursue their goal together, not one silo—or even two silos—at a time.
James M. Doyle is a Boston defense lawyer and author, and a frequent contributor to The Crime Report. He welcomes readers’ comments.