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From the IFT source library

Zero Preventable Failure Model

Topic-specific explanations and research proposals developed from IFT source content. Local evidence, permissions, costs and results remain to be established.

Original source ↗

Understand the topic

What this means in daily life

Zero preventable failure is an improvement ambition that requires rigorous protected review. Serious incidents should trigger learning about warnings, response, evidence and support without assuming every harm was predictable or blaming the survivor.

An improvement ambition is useful when a protected review can identify an actionable service failure. The proposed model would separate what was known at the time from hindsight and follow whether the resulting correction is completed.

Data reference table

Evidence Snapshot

Read each value with its reporting period, population and limitations. A historical national reference is not a local baseline or proof that an IFT proposal works.

5 measurement records still need data and a review of their relevance.

Data references for Zero Preventable Failure Model
SignalReference ValuePeriod / PopulationHow to Read ItSource Status
Median and P90 response time

Not established

Data required — not zero

Reporting period: Information Required

Population and geography: Information Required

Proposed measure; no observed value is established here.

Limitations: Define the measure, unit, reporting period and covered population; obtain a traceable dataset and review its suitability for this topic before using a number.

Source organisation: Information Required

Direct source URL: not yet verified

Source publication date: not established

Verification status: Data required

Priority safety defects closed

Not established

Data required — not zero

Reporting period: Information Required

Population and geography: Information Required

Proposed measure; no observed value is established here.

Limitations: Define the measure, unit, reporting period and covered population; obtain a traceable dataset and review its suitability for this topic before using a number.

Source organisation: Information Required

Direct source URL: not yet verified

Source publication date: not established

Verification status: Data required

Emergency-to-care continuity

Not established

Data required — not zero

Reporting period: Information Required

Population and geography: Information Required

Proposed measure; no observed value is established here.

Limitations: Define the measure, unit, reporting period and covered population; obtain a traceable dataset and review its suitability for this topic before using a number.

Source organisation: Information Required

Direct source URL: not yet verified

Source publication date: not established

Verification status: Data required

Repeat-location incidents

Not established

Data required — not zero

Reporting period: Information Required

Population and geography: Information Required

Proposed measure; no observed value is established here.

Limitations: Define the measure, unit, reporting period and covered population; obtain a traceable dataset and review its suitability for this topic before using a number.

Source organisation: Information Required

Direct source URL: not yet verified

Source publication date: not established

Verification status: Data required

Women’s mobility and perceived safety

Not established

Data required — not zero

Reporting period: Information Required

Population and geography: Information Required

Proposed measure; no observed value is established here.

Limitations: Define the measure, unit, reporting period and covered population; obtain a traceable dataset and review its suitability for this topic before using a number.

Source organisation: Information Required

Direct source URL: not yet verified

Source publication date: not established

Verification status: Data required

Different surveys, administrative records, estimates and reporting years are not interchangeable. No combined IFT score is calculated from these rows.

10 ideas for this topic

What could be done — and what needs testing

These are proposals for research and local testing. They are not claims that a project has been funded, implemented or proved successful.

Idea 01

Review threshold

Define which serious service incidents require competent review

What to check: Keep review criteria distinct from judgments of legal guilt

Idea 02

Protected timeline

Reconstruct relevant events from authorised sources

What to check: Mark uncertainty and missing records explicitly

Idea 03

Warning interpretation

Examine what staff could reasonably know at the time

What to check: Avoid hindsight claims that every event was obvious

Idea 04

Complaint continuity

Review how repeated concerns were linked and assessed

What to check: Identify breaks between institutions

Idea 05

Response delays

Separate contact dispatch travel and reception intervals

What to check: Locate the responsibility for each avoidable delay

Idea 06

Evidence pathway

Ask competent teams to assess collection and handoff failures

What to check: Preserve confidentiality and fair proceedings

Idea 07

Support continuity

Examine whether requested protection and care continued

What to check: Avoid ending review at immediate emergency resolution

Idea 08

Corrective action

Assign a feasible change to a named institutional owner

What to check: Check implementation evidence by an agreed review point

Idea 09

Independent challenge

Have appropriate reviewers test causal conclusions

What to check: Retain alternative explanations and disagreement

Idea 10

No-blame publication

Share system lessons at safe resolution

What to check: Remove details that identify or fault the affected person

15 questions, answered clearly

Questions about Zero Preventable Failure Model

Does zero preventable failure mean all harm is predictable?

No. The ambition must not erase uncertainty or imply guaranteed prevention

Can a review blame the survivor?

It should examine institutions and context without assigning responsibility for harm to the affected person

Does an earlier warning prove staff could predict the outcome?

What was known then requires careful competent assessment

Can a review decide criminal guilt?

That belongs to lawful proceedings, not a system-learning record

Why separate response intervals?

Different stages reveal different service responsibilities and delays

What if records conflict?

Disagreement and uncertainty should remain visible to reviewers

Does writing a new protocol complete correction?

No. Actual functioning needs follow-up evidence

Why include continuing support?

Failures may occur after the immediate emergency

Can lessons be public?

Appropriate system lessons can be shared after protecting identities and sensitive proceedings

Who should challenge causal conclusions?

Competent independent reviewers who can examine alternative explanations

What would the “Evidence pathway” idea involve?

Ask competent teams to assess collection and handoff failures What to check: Preserve confidentiality and fair proceedings

What would the “Support continuity” idea involve?

Examine whether requested protection and care continued What to check: Avoid ending review at immediate emergency resolution

What would the “Corrective action” idea involve?

Assign a feasible change to a named institutional owner What to check: Check implementation evidence by an agreed review point

What would the “Independent challenge” idea involve?

Have appropriate reviewers test causal conclusions What to check: Retain alternative explanations and disagreement

What would the “No-blame publication” idea involve?

Share system lessons at safe resolution What to check: Remove details that identify or fault the affected person