I spent about eight years of my medical carrier studying quality improvement in order to help others understand and do it. One of the basic ideas in that field of study is that the preponderance of poor quality in products (or services) is the result of systemic flaws in the creation of the product or rendering of the service rather than flaws in the individuals making the product or providing the service. Another is that quality control and quality assurance are suboptimal approaches to quality improvement. The former attempts to control variation in production after the product has been made or the service provided. The latter attempts to assess whether the product or service consistently meets expectations. Neither does anything to change the systems that produce subpar results.
I’ve been thinking about this ever since I heard of the egregious use of force in the case of Mr. Tyre Nichols. The Memphis police force was quick to assert that this young father’s murder at the hands of police officers was an aberration that reflected on the participants rather than the department. That seems quite unlikely to me. There are simply too many cases like Mr. Nichols’ fatal encounter with police every year.
A medical colleague of mine once said that “Every system is perfectly designed to create the quality of goods or services that it provides.” In other words, the policing deaths of people of color involved in traffic infractions is not some one-off aberration. It is what we get when we have the model of policing that we have. It is a model that incorporates certain principles, assumptions, and behaviors that all but guarantee that there will be Eric Garners, George Floyd’s, Breonna Taylors, Tyre Nichols’ and hundreds like them.
Real systems change, particularly in the provision of services such as policing, medical care, lawyering, and the like requires an in-depth of analysis of what goes into the decisions and actions that produce the service. One can’t just spray a patina of training on policemen or physicians or attorneys to address the rendering of substandard services – services that none of us would deem acceptable.
Do I have an answer? Not me, but I think that others might. Pilots (and increasingly surgeons) use checklists in real-time to ensure that their actions are appropriate; I doubt that police do. Physicians and attorneys know that they have a fiduciary responsibility to the individuals they serve as well as an ethical responsibility to the communities in which they provide their services. I doubt that all law enforcement professionals do. Physicians and attorneys have professional review processes that provide a modicum of accountability for poor performance. I suspect that the systems for accountability for law enforcement are tilted heavily in favor of the provider of policing rather than the general public or those harmed by poor policing. Implementing such measures in law enforcement would not be magic bullets, of course, but they are a start.
Medicine has a long way to go to eliminate racial bias in the provision of health services. Law enforcement has even further to go, I think.