Systems Don’t Care. But Do We?

In safety science, human factors and ergonomics, and related fields, we often use the word system. We talk about systems thinking, apply systems approaches, and try to understand how outcomes emerge from interactions within sociotechnical systems over time and at scale. We do this to understand complex problem situations, and to apply this understanding to help inform interventions.

I wonder how much our choice of subject reflects the potential to help those affected and prevent future harm, how much reflects professional incentives such as academic publishing or conference talks, and how much is intellectual curiosity driven by the combination of accident rarity and salience. These motives can, of course, coexist. There are also practical attractions of a familiar and highly publicised case, often a detailed investigation report, and eventually an established literature within which to embed one’s own contribution. Together, such factors may help explain why some problems remain objects of sustained professional interest while others struggle to become objects of interest at all.

We also make choices about where to direct our attention. The choice of problem situations in disciplines and professions is interesting in itself, and something that we could spend more time reflecting on. Where the prevention of harm is concerned, we in systems and safety disciplines often turn to major accidents. Sometimes, we return to the same events many years after they happened. There are good reasons for this: analysis can unearth interactions and latent conditions that were previously difficult to see or were ignored, and new approaches and applications can reveal something that earlier investigations missed. I have invested considerable time in understanding the train derailment at Santiago de Compostela which resulted in the deaths of 79 people and harmed hundreds more (e.g., Shorrock, 2013, 2024), while the legal proceedings are not fully resolved (La Región, 2026).

The question I want to consider in this article is: if we distributed our effort according to its potential to prevent harm or improve people’s lives, would we spend so much of it on the same sorts of cases? And if not, what else might come into view if we zoomed out?

The Varieties of Human Care

This reflection on attention brings me to care, what we mean by care, and what we really care about. In safety science and human factors, we often discuss performance, safety, risk, reliability and, more recently, resilience. Care seems far less prominent and explicit as a concern, even though human wellbeing is one of the twin aims of HF/E (International Ergonomics Association, n.d.).

It might seem that attention and care necessarily go together, that we attend to things we care about, and attention and care will covary. But we know from everyday experience that the relationship is more complicated. We can devote considerable attention to something because it is intellectually interesting, methodologically convenient or professionally rewarding. But to what extent is our attention useful to the people affected? What relationship is there between our professional interest in harm, and our commitment to those experiencing it? What does care really mean if it is detached from people?

To get a better understanding of this, we probably have to distinguish between different ‘varieties of human care’, or the different senses in which we might ‘care’. We can care about a topic or issue, do our work with care, care about people, and care for people. These overlap, but one does not necessarily imply another. We might be deeply interested in an accident and careful in our analysis, while remaining distant from the people affected, and have no direct or known influence on any party to the accident. In many academic contexts, those affected may never know that the systems analysis even exists.

Such distinctions have a history in care ethics (probably the approach to ethics that best fits how I try to live my life). Nel Noddings (1984, 2013) distinguished caring-about from caring-for, examining the relationship between concern and the encounters through which care is given. “Caring-for”, she wrote, “describes an encounter or set of encounters characterized by direct attention and response. It requires the establishment of a caring relation, person-to-person contact of some sort. Caring-about expresses some concern but does not guarantee a response to one who needs care.” (Noddings, 2013, p. xiv). Noddings noted that one might, for example, care about civilians living in fear during civil strife, but not follow up on this expressed concern.

More recently, Ira Chadha-Sridhar (2026) distinguished care as action (trying to meet someone’s needs); attitude (caring about someone or approaching their care attentively and respectfully); and disposition (a cultivated tendency to act carefully). Someone can provide care without personal attachment, while caring well requires attention to people’s needs, respect for their understanding of those needs, and careful response.

Joan Tronto’s work takes us further into the responsibilities involved. In Moral Boundaries (1993), drawing on earlier work with Berenice Fisher (Fisher & Tronto, 1990), Tronto distinguished four phases: caring about involves recognising a need; taking care of involves assuming responsibility; care-giving involves doing the work; and care-receiving concerns the response of those receiving care. These involve attentiveness, responsibility, competence and responsiveness. Tronto later added caring with, connecting care to justice, equality and democratic participation (Tronto, 2013). The concept of care therefore raises questions about how responsibilities and resources are distributed, as well as what happens between individuals.

For those of us working in safety and systems fields, these distinctions might raise some uncomfortable questions. How does our concern for the quality of an analysis relate to our concern for the people whose lives it describes? What responsibility follows from recognising harm and describing the conditions contributing to harm? And what happens when people tell us that the ‘care’ they receive is harming them, or that they have been neglected or abandoned?

Care-receiving seems particularly relevant to scandals that continue for years or decades, while those affected struggle to be heard, and are harmed psychologically, emotionally and physically. An institution may describe its services as ‘care’, and practitioners may administer ‘care’, while those receiving the ‘care’ experience neglect or abuse. Whether we have followed a process and provided a service is one question. Whether people’s needs have been understood and met is another question entirely.

Celebrity and Cinderella Cases

It’s interesting, and perhaps revealing, to consider the cases to which we apply systems thinking and complexity science. A ‘systems approach’ is not morally or ethically neutral. It involves choices about what and who deserves attention, whose knowledge, experiences and other contributions are seen as reliable and valid, where we draw ‘system boundaries’ to determine what and who is ‘in’ and ‘out’ of our scope of attention, and what outcomes are important to us.

In my experience and following exploratory searches of the HF/E and safety science literature, two contrasting patterns of attention seem to emerge. One concerns what we might term celebrity cases, which are prominent in research. Another concerns what I will call Cinderella cases, which receive little attention, despite the scale of harm. Cook et al. (1998) contrasted widely publicised ‘celebrated’ accidents with ‘uncelebrated’ but well-researched cases that revealed deeper systemic vulnerabilities. My distinction is different, and concerns the attention we give within our own research and practice communities: a case can be widely known, prominent in the news, even extensively investigated elsewhere, while the prolonged harm experienced by those affected receives little attention from us. Conversely, extensive academic systems analysis of a famous accident is not typically reflected in the news.

Celebrity cases include accidents that have become widely known and have been subject to substantial investigations or public inquiries. Such cases give us a date, a location, a distinctive and known outcome, and – in time, accessible evidence, such as an investigation report. They are typically newsworthy, and give us a familiar starting point for teaching, developing methods, and conducting and comparing analyses.

These cases often initially attract what Cook et al. (1998) called first stories. Such explanations appear quickly after an event, focus on a short time period, are highly personalised, focus on components or individuals, and give little attention to context and complexity. For these reasons, they are highly newsworthy (see Shorrock, 2019).

First story explanations can persist in the public consciousness (Gantt & Shorrock, 2017), and systems methods usefully deconstruct them, developing richer accounts of the conditions and interactions through which events unfolded. This is valuable work, particularly when simple explanations remain influential long after an investigation.

But our attention can remain with these events for decades. For instance, to give just a few examples, Bhopal, in 1984, features in Marais and colleagues’ (2006) work on system safety archetypes. The 1987 Herald of Free Enterprise disaster appears in Hollnagel’s (2012) book on FRAM and in Tian and colleagues’ (2016) subsequent application of an extended method. Slater (2023) revisits the 2010 Deepwater Horizon disaster using FRAM. These publications appeared around 22, 25, 29 and 13 years after the respective events.

Some research uses familiar accidents to examine the methods themselves. For example, Goncalves Filho et al.’s (2019) paper compares four analyses of the 2014 Sewol ferry disaster using AcciMap and STAMP. Evaluating methods is an important part of research and practice. But the extent of work on methods invites a question about how we distribute our limited resources: what might we learn by developing, testing and using our approaches on problems that have received little or none of our attention?

The Cinderella cases I have in mind involve prolonged institutional neglect, including dismissal, discrediting and abandonment of particular populations. They concern absent, inadequate or unsafe care. They may unfold across and between organisations and professions, and span generations. They often lack a single date or location, and there may be no agreed point at which an investigation should begin or end. Yet large numbers of people experience harm over decades.

There are several examples but I will point to three here. One is the vaginal mesh scandal, documented in the U.K. Independent Medicines and Medical Devices Safety Review’s First Do No Harm (2020). This review, chaired by Baroness Julia Cumberlege, examined the healthcare system’s response to concerns about pelvic mesh, sodium valproate and hormone pregnancy tests such as Primodos. It documented how failures to listen to patients, recognise harm and act on concerns allowed avoidable suffering to continue for decades, with the system’s response itself compounding the harm.

The second is the treatment of learning disabled and autistic people, documented in official reviews including the Mazars (2015) review of deaths of people with a learning disability or mental health problem in contact with Southern Health NHS Foundation Trust, and the Care Quality Commission’s Out of Sight – Who Cares? (2020). These reports contain accounts of failures extending across institutional boundaries. They also contain the testimony of people who have spent years trying to make those failures visible.

A third is the neglect of people with certain chronic and complex conditions, including myalgic encephalomyelitis, or ME/CFS. Here, there is considerable scope to examine how governments, funding bodies, insurers, research institutions, professional bodies, health services and clinicians interact.

Such cases raise many questions and invite systems analysis. For example: How are decisions at different system levels made, and how do they combine? What accounts become authoritative and influential? How are those accounts maintained or challenged? What happens when the experiences of people who draw on care or support contradict these accounts?

Bringing Neglected Harm into View

There are examples of applications that should be highlighted. Karl Dodd, Paul Salmon and colleagues at the Centre for Human Factors and Systems Science at the University of the Sunshine Coast have applied systems approaches to child sexual abuse in sport. Their systematic review used Rasmussen’s Risk Management Framework and AcciMap to examine the conditions enabling abuse (Dodd et al., 2024). Subsequent work examined investigative reports across five Australian sports, including football (Dodd et al., 2025), and used STAMP to model the safeguarding system in Australian football (Dodd et al., 2026). This is a programme of research addressing institutional conditions that enable continuing harm. The papers appeared in Trauma, Violence, & Abuse and Child Abuse & Neglect. These are appropriate outlets and demonstrate the interdisciplinary contribution of HF/E researchers, though the work may be less visible to readers who primarily follow HF/E and safety journals.

The Post Office Horizon scandal provides another example. Baber and colleagues (2025) used AcciMap to examine the technical, organisational and legal conditions behind the treatment of subpostmasters. As Editor in Chief of HindSight magazine, I edited and published Harold Thimbleby’s (2022) article that connected the Horizon case with the prosecution of nurses and the failure to question computer evidence. This was a sociotechnical critique rather than a formal application of a named systems method, but it brought prolonged institutional injustice directly to a safety and Human Factors readership.

There are also precedents within HF/E for understanding care and caregiving, rather than institutional neglect as such. Examples include Naweed et al.’s (2022) study of personal care attendants in aged care, and Werner and colleagues’ (2022) work on caregivers of people with dementia. It is encouraging that HF/E has precedents for understanding care, including care that is difficult, poorly supported and largely invisible.

These examples help show what is possible. In my experience, and in the exploratory searches behind this post, I have found repeated systems analyses of familiar accidents (performed many years after the accidents) far more readily than analyses of prolonged institutional neglect, dismissal or abandonment. The mesh scandal, the treatment of learning disabled and autistic people, and the neglect of patients with certain conditions involve interactions among institutions, professional assumptions, funding decisions, rules and everyday practices. These and other cases offer much scope for the approaches we advocate, perhaps in conjunction with other disciplines, especially health research and sociology. Research priorities affect what becomes known, what is taught and what help becomes available.

Do They Care?

In his Guardian column of 24 September 2026, George Monbiot reported that a freedom of information request to NHS England had revealed that only 74 practitioners had completed a learning module on ME/CFS guidance after a year. This figure does not tell us everything about what clinicians know or how they care. It may reflect all sorts of reasons associated with capability, opportunity and motivation, including whether practitioners knew about the module and had time to complete it. But it is a stark figure, and it raises questions about what happens between producing guidance and changing practice.

How is information and guidance communicated? How is learning supported? Who takes responsibility for implementation? What feedback reaches those who make decisions about care? What happens when people report that practice has not changed, that it is causing harm, or that their concerns have not been examined? These are familiar sorts of questions in high-risk sectors, and should be here, too. For a systems practitioner, these gaps and questions should prompt curiosity.

An earlier Guardian investigation by Emily Keen and Denis Campbell (2015) concerned learning from deaths. They sent freedom of information requests to 53 English mental health trusts providing learning disability services; 37 supplied data covering all patients. Only 137 of 397 unexpected deaths of learning-disabled patients had been investigated. For those of us working in safety, this raises uncomfortable questions about whose deaths become occasions for learning. We can return to a familiar accident decades later, applying another method or developing another explanation. But what happens when a death receives little scrutiny in the first place? What makes a death worthy of investigation? Who assumes responsibility, and what time, resources and support are available?

These stories concern different activities (completing training and investigating deaths). Neither finding, by itself, tells us whether individual practitioners care. But both should prompt us to examine the relationship between concern and organised attention and action, including how institutional arrangements support or frustrate the work through which care is expressed.

Who Do We Care About?

Perhaps these issues receive less of our attention because harm accumulates slowly, across separate lives and patient–clinician encounters, or the absence of such encounters. Perhaps it is relevant that many of those affected are women and disabled people, whose accounts have been afforded less credibility. Perhaps the problems seem too diffuse, too political or too far outside our professional remit. These are possibilities worth examining, including in relation to our own choices about what deserves attention.

Perhaps, too, we do not readily recognise these as ‘safety problems’ because we do not think of them as ‘accidents’. They may become known as ‘scandals’, but the interacting institutional and professional failures are sometimes familiar and recognisable. We do not have to call every prolonged injustice an ‘accident’ to consider it worthy of systems analysis in safety science and HF/E.

The International Ergonomics Association’s definition places interactions among people and other elements of a system at the centre of HF/E. For me, a humanistic approach is concerned with how people experience those interactions. A revealing question is “whose experiences?”. Another question is how we come to understand these experiences. Again, familiar accidents offer a sort of convenience: known outcomes, accessible reports, and established approaches to analysis in the literature. Understanding prolonged neglect may make novel demands of researchers and practitioners, including listening to people whose accounts have been discounted, understanding disparate and perhaps conflicting historical records, working across disciplinary boundaries, and generally working outside of our comfort zones. And there may be uncertainty about how much funding and attention such studies may ultimately attract. But I cannot escape the idea that whether we ask ourselves “whose experiences?” is a practical indication of what, and whom, we care about.

There are also questions at other levels. Complexity science may help investigate interacting biological processes, including those involved in post-exertional malaise (PEM), a hallmark feature of ME/CFS (National Institute for Health and Care Excellence, 2021). Systems thinking may help us understand the institutional conditions under which research is supported, translated into professional education, or reflected in care. The expertise, evidence and methods differ across these levels, but there is at least a shared opportunity to study interactions at scale and over time.

The people affected by these problems should help determine the questions. Once you have spent time in a community of such people, it becomes clear very quickly that they have knowledge and experience that is unavailable in the parallel professional world (see Ryan, 2017). There is already work by patients, families, campaigners, journalists and researchers upon which to build. People affected have collected evidence, identified patterns, built relationships, developed networks. and challenged institutional explanations long before many others such as politicians, journalists and investigating officials took an interest.

Do We Care?

Over the years, I have become personally interested in these questions. The reasons for this are personal interaction with people affected and, more recently, personal experience of some of the issues. In Laughing Boy: Love, Justice and Drops of Brilliance (Shorrock, 2024), I wrote about Connor Sparrowhawk, his family, and the play based on Sara Ryan’s (2017) book Justice for Laughing Boy. I became familiar with Connor’s life, his death and his family’s pursuit of justice via twitter. What I learned confronted me with questions that, until then, seemed outside of the boundary of my discipline and profession. This made me deeply uncomfortable professionally, but moreover affected me personally; I felt sorrow. I think about LB and his family often.

As I have written about on this blog and on social media, I am also diagnosed with myalgic encephalomyelitis (ME/CFS) (Shorrock, 2026). In coming to understand the illness, I have become more aware of how the disease and the people who have ME have been systemically neglected at every level, from government policy to patient–clinician interaction (Sirotiak & Amro, 2026). People with ME/CFS can be severely affected: the Centers for Disease Control and Prevention (2024) estimates that up to one in four are homebound or bedbound at some point in their illness. Some are fully dependent on care in order to live. The ‘ME scandal’ is a very relevant case for systems methods, but in my searches of the HF/E literature, I have not found systems analyses of the institutional neglect of people with ME/CFS.

There is another understanding of ‘care’ that I have appreciated for years, partly in the challenge it poses. John McKnight, a pioneer of asset-based community development (ABCD), described care as “the freely given commitment from the heart of one to another” (2003, p. 10). He argued that institutions cannot mandate or manufacture this commitment simply by organising and providing services.

McKnight presents us with a tension between his version of care – uncurricularised, uncommodified, uncompelled – and the version that is embedded in professional, institutional and political responsibility and activity. Paid professionals can and do, of course, care. Institutions can provide facilities and resources, as well as continuity and accountability. But a system cannot experience concern for a person. Only people can ‘care’ in this way.

The word ‘care’ has developed over time, with meanings including an internal state, attention and action. Old English cearu encompassed sorrow, anxiety and concern. By around 1400, care also referred to attention directed towards safety or protection, while “take care of” is recorded from the 1580s (Harper & Felix, n.d.). These meanings accumulated so that we still speak of being burdened by cares, caring about someone, and taking care of them. In British health and social care policy, the late 1980s and early 1990s saw the formalisation of care management and assessment (Griffiths, 1988; Department of Health Social Services Inspectorate & Scottish Office Social Work Services Group, 1991), and new terms such as care pathways, care packages, care managers, etc. With these developments in usage and meaning, a service may meet its administrative requirements while the person ‘receiving care’ feels neglected or even harmed.

There will always be more suffering than any one of us can attend to, and none of us has unlimited time, resources, and space (Noddings, 2013), nor unlimited choice over our work. Then there is the emotional, psychological and physical capacity to consider (energy-limiting conditions certainly put a brake on this). What I have observed, in those affected by some of the scandals I have briefly mentioned, also brings to mind care’s older associations with sorrow, anxiety and burdens of mind. This is not the same as caring for someone, but it is a reminder of what people may carry while trying to obtain care for themselves or others. Within the choices available to us, and the time, resources and capacity we have, we might ask whose needs remain outside our field of concern: who is in, and who is out? We can do our work with care, while also examining what we choose to work on and who we include in that work with care.

Caring about people can shape our choice of subject, our relationships with those affected, how we gather and work with information, and what we do with what we learn. We can involve people in deciding what needs attention. We can make our work accessible to those affected. We can ask whether and how our arrangements make room for listening, for relationships, for judgement, for dignity and decency, and for changes prompted by the experiences of those affected. We can remain interested in whether it makes a difference after a paper is published, or a conference is over. So I wonder how we might bring such problems into our attentional field, build on the work already being done, and collaborate with other disciplines and professions.

I would like care to become a more explicit, more talked-about part of how we understand our responsibilities in the human space of safety and systems practice. We have developed expertise in explaining how harm emerges from interactions. What might happen if we devoted more of that expertise to people who are still waiting for their harm to be recognised, and allowed their needs to shape what we do next? Systems can’t care, but we can.

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How to Cite

Shorrock, S. (2026, September 30). Systems don’t care. But do we? Humanistic Systems. https://humanisticsystems.com/2026/09/30/systems-dont-care-but-do-we/