Saturday, 16 February 2013

Another Human Factors Skill for Child Protection - Assertiveness

The next non-technical skill I want to look at is Assertiveness. Sometimes this is considered as part of Communication, but I think it is so important that it merits its own section

Child protection professionals need to be assertive concerning issues of safety.

Being assertive isn't the same as being aggressive or being pushy. I suppose it might be better titled 'appropriate assertiveness' because it is about getting results - ensuring that someone else realises that there is something important which you wish to draw to their attention and persuading them to act on it.

Where professionals are not appropriately assertive there is a real danger that safety failings will not be drawn to the attention of those who can do something to put them right. The result is that more children will continue to be at risk.

There are several examples from the world of aviation in which lack of appropriate assertiveness appears to have been a factor in a major disaster. At Tenerife North in 1977 the flight engineer of the Dutch jet asked the captain a leading question that the captain just dismissed - "That Pan Am, is he not clear?" He did not say what he meant - "I think you are taking off while another plane is still on the runway." The captain continued the take-off and the two jumbo jets collided with huge loss of life.

Similarly passengers and cabin crew on the plane involved in the Kegworth disaster in 1989 heard the captain say he had shut down the right engine when they could see that the left engine was on fire. They were unable to challenge his decision. Some survivors reported thinking that the captain must know best. Obviously he didnt.

Does the same sort of thing happen in child protection? There is plenty of evidence that it does. Although school staff put up an argument against the decision by childrens social care that Khyra Ishaq was not a child in need of protection, they eventually felt obliged to accept the decision. Victoria Climbié’s social worker, who was recently qualified, did not challenge a consultant paediatrician about a fax she could not understand she just filed it. And the same social worker had not raised issues about the poor quality of the supervision she was being given - most probably because she did not feel confident enough to do so.

Following the Tenerife disaster, aviation safety experts began to realise that being able to make, and to receive, appropriate challenges was vital to airline safety. A long tradition of hierarchy (number of rings on the sleeve or the amount of scrambled egg on the hat) had to be addressed. Nowadays airline staff, even the most senior ones, are taught not only to challenge decisions and working practices, but also how to accept and embrace challenges from colleagues. And they are regularly assessed on how well they do it. An autocratic captain who dismisses the views of co-pilots or members of the cabin crew might well face having to be retrained, or even dismissed if s/he was unable to respond to the training.

There is a long way to go to bring this kind of openness to the world of child protection in Britain. Long established local authority culture is not particularly conducive to assertiveness and challenge. And in recent years top-down target setting has been prevalent, often with staff being required to continue pursuing the target despite it being obvious that the service, or the safety of service users, is being compromised.

An extreme example of this kind of situation arose at the Mid-Staffs hospital in Englands Midlands.  The chairman of the recent inquiry, Robert Francis QC, has concluded that patients at the hospital were routinely neglected to an appalling extent.  Management was preoccupied with cost cutting and targets and lost sight of its fundamental responsibility to provide safe care. Members of staff who spoke out were ignored and many were deterred from doing so through fear and bullying.

A little while ago I reported in this blog the words of an experienced child protection manager who was addressing a committee of MPs. She said: 
“There is an ongoing culture of fear amongst my staff – they do fear telling the truth and losing their jobs. They don’t feel whistleblowing works.” 
And I have just read an article by Amelia Hill in yesterday’s Guardian which makes my blood run cold  This recounts the stories of health and social care practitioners who have blown the whistle when they observed service users being abused or neglected by other staff. One woman reports that she was immediately seen as a troublemaker following her complaint and, as a result, she was targeted by managers. She felt they wanted her to resign and to drop her complaints. She was subjected to psychological abuse and to bullying by managers.  

Reform needs to start at the top as well as at the bottom. Local authorities, and the NHS, urgently need to create safety cultures in which people who draw attention to unsafe practices will be rewarded, not abused. And senior staff members who react adversely to being challenged need to face retraining, or even dismissal if they cannot adapt.   

The only way to create a safe organisation is to encourage members of staff to be confident to be assertive. Safety is too important to pass over in silence.  And managers must be required to listen attentively. Anything less is putting lives at risk.