Applying Sentinel Event Reviews to Policing
Criminology & Public Policy, vol. 18, p. 705, 2019
U of Penn Law School, Public Law Research Paper No. 19-34
Duke Law School Public Law & Legal Theory Series No. 2019-63
37 Pages Posted: 6 Sep 2019 Last revised: 6 Sep 2019
Date Written: 2019
Abstract
A sentinel event review (SER) is a system-based, multistakeholder review of an organizational error. The goal of an SER is to prevent similar errors from recurring in the future rather than identifying and punishing the responsible parties. In this article, we provide a detailed description of one of the first SERs conducted in an American police department—the review of the Lex Street Massacre investigation and prosecution, which resulted in the wrongful incarceration of four innocent men for 18 months. The results of the review suggest that SERs may help identify new systemic reforms for participating police departments and other criminal justice agencies.
Keywords: criminal justice policy, systems approach, law enforcement, policing, procedural justice, quality improvement, root cause analysis, sentinel event review, organizational management
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