Blogs

A Placement in Patient Safety Research: Reflections from Research & Implementation Assistants

Written by Lily Clarke and Samara Wright, undergraduate Psychology students at the University of Leeds.

For the past 10 months we have had the incredible opportunity to work as Research and Implementation Assistants at the Yorkshire & Humber PSRC. This placement has given us the chance to contribute to real-world research that has the potential to improve patient safety and healthcare, while developing skills and gaining experiences that simply would not have been possible through our degree alone.

Throughout our time here, we have completed almost 100 tasks across several impactful projects. One thing that really stood out to us at YQSR was the emphasis on qualitative research. Most of the research we had encountered during our degree had been quantitative, so it was incredibly insightful to learn about and gain hands-on experience with qualitative methods.

We gained experience observing and conducting qualitative interviews across two research studies. The first explored whether the W45 intervention had been successfully implemented and whether it had improved ambulance handover delays. Through this project, we learnt how to code qualitative data using the CFIR Framework and were delighted to receive authorship and acknowledgements for our contributions. The second study, which is still ongoing, explores the training and support provided to carers and patients with tracheostomies during the transition from hospital to home. This project involved using thematic analysis and gave us the opportunity to work collaboratively within a research team, learning how different perspectives can strengthen qualitative data analysis.

Another highlight of our placement was getting involved in a range of community engagement events. We had the opportunity to help facilitate sessions at the Leeds Older People’s Forum and Community Researcher Training Sessions, where we worked directly with members of the public and supported discussions around research. These experiences strengthened our ability to communicate research to diverse audiences, adapt our communication style to encourage participation, and grow in confidence when working in community settings. They also reinforced our interest in public engagement and inclusive research, highlighting the importance of making research accessible to everyone. Overall, these events broadened our understanding of the many ways research can positively impact different groups within society, and we are incredibly grateful to have experienced this firsthand.

One achievement we are particularly proud of was chairing an Equality, Diversity and Inclusion (EDI) working group meeting during Mental Health Awareness Month. Our session focused on wellbeing and stress management, where we presented a revised Researcher Wellbeing Support Model that we had developed in collaboration with another member of the team. We invited feedback from colleagues to further refine the model before introducing an adapted version of the Wheel of Privilege. We tailored this activity to make it as relevant as possible to our team, encouraging reflection on how different forms of privilege can influence wellbeing and stress management, while linking these discussions back to the Researcher Wellbeing Support Model. Chairing this meeting significantly strengthened our confidence in leading professional discussions and presenting to colleagues. It also reinforced the importance of promoting equality, diversity and inclusion, and wellbeing in the workplace, which are values that have become increasingly important to us throughout our placement.

Throughout our placement, we also had the opportunity to attend a variety of outreach and networking events that gave us a well-rounded understanding of what working as a patient safety researcher involves. These included the annual Patient Safety Symposium, where we networked with researchers and learnt about innovative patient safety projects, a team Away Day that strengthened relationships across the centre through team-building activities, and a PhD showcase, where doctoral students shared their research and provided valuable insight into what our own future careers could look like.

The final highlight of our placement has been working on the centre’s social media accounts. Over the past 10 months, we have created more than 50 posts and videos, gained over 300 followers, and achieved more than 36,000 views. Through our content, we have shared a wide range of research projects and promoted opportunities for patients, members of the public, and healthcare professionals to get involved in research. Creating this content has strengthened our ability to communicate complex research in a clear, engaging, and accessible way for a variety of audiences. Alongside this, we have developed our digital and creative skills through using platforms such as Canva and learning how to create and edit engaging video content. Overall, working on the social media accounts has been one of the most rewarding aspects of our placement. It has allowed us to develop our communication, creativity, and digital skills while working closely with colleagues across the centre and helping to make research more accessible to a wider audience.

We feel so incredibly grateful to have been a part of such a supportive team. Our time here at YQSR has allowed our professional skills to flourish during this placement, and this would not have been possible without the collaborations we made with everyone involved in this lovely team. We want to say a great big thank you to everyone we were lucky enough to learn from, and we are so excited to see where our careers will lead us from this point onwards. We’ll be sure to keep in touch!

Lily & Samara

Sofia Bibi In Blogs, Patient Involvement in Patient Safety, Patient safety, Safety Culture

My PSRC Patient Safety Development Award – A Critical Care Outreach Nurse’s Experience Of Learning From Formative Evaluation Of Martha’s Rule

Critical Care Outreach Teams (CCOTs) have existed in UK NHS hospitals since around 2000. In the 800-bed NHS Hospital Trust where I work, we are a small team, usually consisting of one or two nurses per shift, providing 24-hour, seven-day cover.

Our role is to support hospital staff in recognising and managing acute deterioration in adult patients. I believe CCOTs help bridge the hierarchy that still exists between nurses and doctors in hospital settings. As a team who responds to any adult speciality area, we are uniquely placed to observe how patients are being managed across the organisation.

We bring critical care skills beyond the walls of the critical care unit into adult inpatient areas. Our aim is to identify and intervene before patients require admission to a critical care unit. Sometimes, applying our knowledge and skills enables ward-based interventions that reverse acute deterioration. At other times, we help staff recognise when critical care is not appropriate. In many cases, our focus is on facilitating timely admission to critical care, where complex organ support can be delivered safely.

When a hospital patient deteriorates, the signs are often present hours beforehand. In my experience, it is true that the systems we rely on to recognise and escalate deterioration do not always go far enough. Martha’s Rule is a patient safety initiative born from hospital failures to recognise deterioration and escalate concerns appropriately. Martha Mills’ parents had voiced their concerns about their daughter Martha’s deterioration but were not listened to. As a result, Martha’s Rule serves as an escalation pathway but also represents a cultural shift towards responding to concerns of patients and families about acute deterioration.

In 2025, I had the opportunity to work alongside the NIHR Yorkshire and Humber Patient Safety Research Collaboration (YQSR) team on the ‘Formative evaluation of the implementation of Martha’s Rule’, supported by a six-month Patient Safety Research Development Award. This opportunity was particularly significant to me. During my career, few patient safety cases have had as profound an impact as those of Martin Bromiley and Merope Mills. Their insight and eloquence in exposing unsafe practices and cultures have deeply influenced how I think about patient safety. To contribute to the evaluation of Martha’s Rule — an intervention specifically designed to improve recognition and escalation of deterioration — felt both meaningful and timely.

Through this experience, I built on previous skills developed during an MSc in Acute Medicine. I learned how to structure a systematic review exploring systems that involve patients and families in escalating in-hospital deterioration. I gained practical experience in screening literature, assessing study quality using the QUATSDD tool, supporting the synthesis of extracted data from papers, and coding qualitative interview data — including the use of NVivo software. Drawing on my insights from coding as well as my clinical experience, I contributed to team discussions of the analysis of qualitative data gathered from patients, families and staff who had experience of Martha’s Rule in hospitals across England. I was able to observe presentations of the findings and given opportunity to provide my insight and perspective.

My experiences have been invaluable in developing foundational and transferable research skills. Beyond that, observing research in action within the YQSR team has given me unique insight as a CCOT nurse into how Martha’s Rule is being implemented nationally. Like many CCOTs across England, my colleagues and I have absorbed the responsibility of implementing and responding to Martha’s Rule calls from patients and families, finding our way as we go.

At my own Trust, where we remain in the early stages of implementation, I have found it immensely helpful to learn from the experiences of others — particularly when educating patients, families and staff about Martha’s Rule. Themes identified elsewhere in England strongly resonate with my own experience: both as a nurse involved in rolling out Martha’s Rule locally, and as someone on the frontline receiving calls — most often from families — who feel compelled to use the service.

For me, this award has not only developed research skills but also deepened my understanding of how patient safety initiatives take root in complex healthcare environments. As a CCOT nurse, I work at the interface between ward teams, critical care, patients and families. Being involved in the evaluation of Martha’s Rule has given me a wider lens through which to view that work — and a greater appreciation of the importance of listening, learning and adapting as implementation evolves. We have an opportunity not just to respond to deterioration more effectively, but to reshape the culture in which deterioration is recognised.

Esther Taylor photo Esther Taylor (CCOT Nurse), Feb 2026.

Sofia Bibi In Blogs, Patient safety

The Journey to Research

Written by Emily Paget, Research Midwife

I began my career in Midwifery in 2009, after working as an adult nurse in intensive care and completed my midwifery degree at De Montfort University, Leicester. After qualifying, I moved to West Yorkshire, undertaking my preceptorship at St James’ University Hospital in Leeds before working as a Band 6 rotational midwife at Calderdale Royal Infirmary. Here, I gained experience across a range of settings, including triage, induction suite, the birth centre, labour ward and the antenatal/postnatal wards.

In December 2019, I started working as a lecturer in midwifery at the University of Leeds. Three months later, the COVID-19 pandemic hit and disrupted everything including both clinical practice and education. This experience shaped my research interests, particularly in how digital technologies can support meaningful learning and influence learner behaviours in midwifery education.

In August 2021, I started working at the University of Bradford as an Assistant professor in Midwifery. Here I co-created a postgraduate module in Enhanced Maternal Care and led on a £1 million Midwifery Simulation Project to transform the existing teaching facilities. The project created opportunities to further embed simulation supported by digital technologies across programmes, improving the range of midwifery teaching and student experience.

This led me to my research focus- understanding how immersive simulation, facilitated by digital technologies, can influence patient safety behaviours and how this impacts clinical practice.

My journey with NIHR began last year with an NIHR Patient Safety Research Collaboration (PSRC) Development Award. During this time, I undertook a pilot study using a small educational grant which focused on learner engagement and barriers to implementation of VR/AR simulation in undergraduate healthcare education. The findings of this study found some key implementation factors relevant for wider doctoral research which included digital literacy, infrastructure challenges and how this modality could impact on learning. The experience also helped my continuing development as a researcher in designing and conducting research, gaining feedback and adapting to mitigating factors.

The PSRC award has also enabled meaningful Patient and Public Involvement (PPI) and development of my own personal skills in this area, leading to the development of a regional stakeholder group. Ongoing work with this group, including focus groups with recent maternity service users, ensures the research remains grounded in lived experience and what matters most to those receiving care.

Following the PSRC award, I began an NIHR Pre-Doctoral Fellowship to develop as a mixed methods researcher. Within this I have had the opportunity to undertake a bespoke training programme in mixed methods research including masters courses, training, international conference attendance and to build on the ongoing development from my PSRC award. I have also submitted my first peer reviewed academic paper with two further studies currently in progress. One of these focuses on the use of immersive simulation in midwifery programmes in higher education across the UK and the other is looking at the relationship between immersive simulation supported by digital technologies and patient safety behaviours. The findings of these will shape my NIHR doctoral application.

This journey to become a midwifery researcher, reflects how experiences across clinical practice and education can shape passions, develop interests and refine a research focus over time. International Day of the Midwife is a day which highlights the strength of the midwifery community, bringing people together across practice, education, and research with a shared commitment to women, babies, and families.

Emily Paget

Sofia Bibi In Blogs

Women in Healthcare: Celebrating Impact and Confronting Inequality

Written by Lily Clarke and Samara Wright

In honour of Women’s History Month this March, and International Women’s Day on the 8th, we wanted, as patient safety research and implementation interns from the University of Leeds, to highlight inspirational women who have shaped healthcare and to reflect on ongoing inequalities affecting women’s health today.

Inspirational Women in Healthcare

Annie Brewster – One of the first Afro‑Caribbean nurses to work in Britain. Nicknamed “Nurse Ophthalmic” for her expertise with elderly patients losing their sight, she dedicated her life to care while challenging racial inequalities within the profession.

Marie Curie – The first woman to win a Nobel Prize and the only person to win in two scientific fields. Her discoveries in radioactivity paved the way for key medical innovations, including cancer radiotherapy and diagnostic imaging.

Dr Özlem Türeci – Co‑founder and Chief Medical Officer of BioNTech, she played a central role in developing the first approved COVID‑19 mRNA vaccine, which has saved millions of lives globally.

Mary Seacole – A pioneering nurse who faced significant racial prejudice, Seacole set up the “British Hotel” and provided essential care to sick and wounded soldiers during the Crimean War.

Dr Omon Imohi – An NHS GP specialising in sexual and reproductive health, and founder of Black Women in Health, a national organisation promoting diversity, equality, and visibility for Black women across the healthcare workforce.

Mary Putnam Jacobi – The first woman to graduate from a U.S. School of Pharmacy and a leading advocate for women in medicine. Her scientific work famously disproved claims that menstruation limited women’s intellectual or physical capabilities.

Farah Kabir – Co‑founder of Hanx, a sexual‑wellness brand focused on empowering women through sex‑positive products and education. She advocates for better funding, research, and support for women’s health, especially for women from minority backgrounds.

Andrea Berchowitz and Dr Rebecca Love – Co‑founders of Vira Health, a digital health company improving menopause care. Their work aims to make personalised, evidence‑based menopause support accessible to all, contributing to better long‑term health outcomes for women.

These women represent only a fraction of those who have shaped, and continue to shape, healthcare. Recognising their contributions not only honours their achievements but also inspires the next generation of women to innovate, lead, and drive meaningful change in healthcare services.

Healthcare Inequalities

In the current political climate, it is as important as ever to draw attention to areas in healthcare and research where women’s impact and experiences are undervalued or worse, completely omitted. Being researchers ourselves, we hold the responsibility to amplify the voices of the women around us and ensure that they are being meaningfully represented in policy, in research and in practice.

Women’s health has historically been under-researched and underfunded. As a result, there is limited understanding of conditions that only affect women, such as menopause or endometriosis, which leads to delayed diagnoses and misdiagnoses. For instance, it takes an average of 8 years for a woman with endometriosis to receive a diagnosis.

There is also limited support for women who are struggling with female-specific health issues. For example, one in ten women have left employment due to menopausal symptoms. This negatively impacts both the economy and women’s overall health and well-being.

Furthermore, despite women in the UK living longer than men, the UK has the largest female health gap in the G20 and is the 12th largest globally, with women spending three more years in ill health and disability when compared to men. Moreover, erectile dysfunction (which affects 19% of men) is studied in research five times more often than PMS, (which affects 90% of women). This emphasises the scale of inequality within healthcare research.

Recent concerns in maternity care further expose these inequalities, as the number of women who have died during pregnancy is the highest it’s been in 20 years, with on average 13.41 deaths per 100,000 pregnancies. Additionally, black women are four times more likely to die during pregnancy and childbirth. This demonstrates that not all women experience healthcare equally, with persistent disparities affecting women from ethnically diverse backgrounds, as well as disabled women.

In response to these issues, the government introduced the Women’s Health Strategy in 2022, informed by a national Call for Evidence in which 84% of women reported not feeling listened to when raising health concerns. Many described having symptoms dismissed, for example, being told that heavy and painful periods are “normal” and that they will “grow out of it”.

The governments 10-year plan therefore aims to improve women’s health by:

creating women’s health hubs for better access to reproductive and menopause services,

Placing greater emphasis on listening to women’s experiences,

increasing female participation in research and addressing gaps in research,

improving how healthcare professionals are trained in women’s health.

However, a recent Women and Equalities Committee (WEC) Report highlights limited progress following the implementation of the Women’s Health Strategy. The report finds that many women are still not being heard in practice, with young women having symptoms dismissed or ignored, being told they’re “too young” for conditions like endometriosis and receiving hormonal medication without proper investigation. The WEC therefore argues that the renewed strategy must address these issues, include a clear plan for delivering education on women’s health, and tackle racial and disability inequalities through compulsory training for healthcare professionals.

Women in Leadership

According to the House of Commons, women accounted for 77% of jobs in health and social care and 71% of those in education by the end of 2025. Without a doubt, women dominate the healthcare sector, yet we remain massively underrepresented across decision-making positions in this workforce.

In the UK, only eight of the current 100 CEOs in the FTSE 100 are women, a statistic that has stagnated since 2021. In the NHS, women are estimated to hold just 25% of leadership roles. When women outnumber men across the healthcare workforce, from education to practice, how can it be possible that we remain underrepresented in positions of real influence? This clear lack of representation is not only an issue of equity, but also a missed opportunity to value the unique contributions that women bring to leadership positions.

Arguably the most valuable thing that we as women offer in this way are diverse perspectives to an ever-evolving National Health Service. There is a strong body of evidence demonstrating that gender diversity in the workplace boosts both productivity and wellbeing. For instance, in their Diversity Wins report, McKinsey & Co. write how ‘companies in the top quartile of gender diversity on executive teams were 25% more likely to experience above-average profitability’, an effect that is further amplified when considered through an intersectional lens.

It is imperative that we create spaces for women to lead: this must include providing mentorship and sponsorship, both for and by women. Real change depends not only on challenging institutional norms as and when they arise, but on reshaping systems to recognise leadership potential in order to ensure that women’s voices influence decisions across all healthcare domains.

By highlighting these inequalities, we advocate for more equitable systems where women’s experiences are appropriately addressed across all areas of healthcare research, and our skillsets are meaningfully recognised in the workplace.

During our placements, this is something we have been lucky enough to experience firsthand: the leadership qualities held by women across our team has thoroughly enriched our experience here at YQSR. Working amongst women who lead with confidence has made our placement feel like a space where we could grow, and this opportunity has provided us with a model of what work environments should look like when an effort is made to embed inclusion and equity into workplace culture.

Seeing women in senior roles within our own team has been especially empowering during our placements. We have had the pleasure of collaborating with Professor Rebecca Lawton, our Director; Professor Beth Fylan, our Deputy-Director; and Dr. Jenni Murray, our Programme manager, and we greatly value their willingness to offer feedback and share their own career journeys in order to help shape our professional development. In addition, our supervisors, Dr. Jessica Rich and Dr. Qandeel Shah, as well as Sobia Bibi, have all provided us with support and openness, which has contributed positively to our wellbeing and overall ability to thrive within the team.

References

Acuna Ocana, N. (2022, December 13). Why aren’t there more women in senior leadership roles? Www.linkedin.com. https://www.linkedin.com/pulse/why-arent-more-women-senior-leadership-roles-nicky-acuna-ocana/

Department of Health and Social Care. (2022). Women’s Health Strategy for England. GOV.UK. https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england

Dickinson, E. (2025, February 5). Women health sector leaders good for a nation’s wealth, health, innovation, ethics – BMJ Group. BMJ Group – Helping Doctors Make Better Decisions. https://bmjgroup.com/women-health-sector-leaders-good-for-a-nations-wealth-health-innovation-ethics/

Dixon-Fyle, S., Dolan, K., Hunt, V., & Prince, S. (2020). Diversity wins: How inclusion matters. McKinsey & Company. https://www.mckinsey.com/featured-insights/diversity-and-inclusion/diversity-wins-how-inclusion-matters

Fawcett. (2022). Menopause and the Workplace. The Fawcett Society. https://www.fawcettsociety.org.uk/menopauseandtheworkplace

Francis-Devine, B., & Hutton, G. (2024, March 4). Women and the UK Economy. House of Commons Library; UK Parliament. https://commonslibrary.parliament.uk/research-briefings/sn06838/

Gale, C. (2022, March 7). Women in Healthcare: 10 Pioneers throughout History. Medbelle. https://www.medbelle.com/blog/medbelle-news/women-in-healthcare-10-pioneers-throughout-history/

Gregory, A., & Thomas, T. (2024, January 11). Number of women in UK who die during pregnancy rises sharply. The Guardian. https://www.theguardian.com/society/2024/jan/11/number-of-women-in-uk-who-die-during-pregnancy-rises-sharply

Health state life expectancies in England, Northern Ireland and Wales – Office for National Statistics. (2024, March 26). Www.ons.gov.uk. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/between2011to2013and2020to2022

Health, S. for. (2025, March 8). Inspirational Women in Healthcare: Past and present | Skills for Health. Skills for Health. https://www.skillsforhealth.org.uk/article/inspirational-women-in-healthcare-past-and-present/

Improving menstrual health must be prioritised in Women’s Health Strategy and wider NHS reforms, WEC says – Committees – UK Parliament. (2019). Parliament.uk. https://committees.parliament.uk/committee/328/women-and-equalities-committee/news/212280/improving-menstrual-health-must-be-prioritised-in-womens-health-strategy-and-wider-nhs-reforms-wec-says/

Kennedy, H. (2020, March 6). The business benefits of a gender-balanced workplace. WorkNest. https://worknest.com/blog/international-womens-day-how-greater-gender-balance-enables-businesses/

More work needed to tackle “shocking” racial pregnancy outcomes – report. (2023, November 29). BBC News. https://www.bbc.co.uk/news/uk-england-london-67551871

Norton, W. (2025). Addressing the gender health gap: Where are the women’s voices in

research? The Royal College of Nursing. https://www.rcn.org.uk/news-and-events/Blogs/addressing-the-gender-health-gap-where-are-the-womens-voices-in-research-300425

Randhawa, M., & Newitt, S. (2022, July 18). The Circles programme: leadership development for women. The King’s Fund. https://www.kingsfund.org.uk/insight-and-analysis/blogs/circles-programme-leadership-development-for-women?gad_source=1&gad_campaignid=23444862604&gclid=Cj0KCQjwve7NBhC-ARIsALZy9HUIrnrjSqUggdirTAiTI3D38r_1nqmLVsNEaQuwVvvGOaa1E4fsfIYaAvYnEALw_wcB

Sanderson, L., & Combe, E. (2026, January 26). Number of women CEOs in FTSE 100 at same level as 4 years ago amidst record global CEO turnover. Russellreynolds.com. https://www.russellreynolds.com/en/about/newsroom/number-of-women-ceos-in-ftse-100-at-same-level-as-4-years-ago

UCAS. (2025). Ucas.com. https://www.ucas.com/data-and-analysis/undergraduate-statistics-and-reports/statistical-releases-daily-clearing-analysis-2025

Why do we still not know what causes PMS? (2016). Researchgate.net. https://www.researchgate.net/blog/why-do-we-still-not-know-what-causes-pms

Winchester, N. (2021). Women’s health outcomes: Is there a gender gap? House of Lords Library. https://lordslibrary.parliament.uk/womens-health-outcomes-is-there-a-gender-gap/

Women’s Health Strategy: Call for Evidence. (2021, March 8). GOV.UK. https://www.gov.uk/government/calls-for-evidence/womens-health-strategy-call-for-evidence

Sofia Bibi In Blogs, Patient safety, Workforce Engagement

Getting redeployment right

This blog post was written by Dr Jayne Marran, Research Nurse at YH PSRC, for the RCNi, and shared with their subscribers:

Redeployment of nurses happens on a day-to-day basis to cover short-term and more prolonged staffing gaps due to staffing shortfalls and other pressures.

Yorkshire Quality and Safety Research Group patient safety research nurse Jayne Marran, who co-developed evidence-based resources for best practice when implementing nurse redeployment, shares recommendations to support nurses and managers in daily and larger scale redeployment plans.

What opportunities for development can redeployment offer?

· Learning new skills in a supported way.

· Meeting new colleagues and being able to develop new professional and support networks.

· Gaining insight into other people’s work and new ideas for your home area.

· Plugging skill gaps through training.

What can I do to prepare if I am redeployed?
Have conversations with colleagues about redeployment and talk to your line manager to ensure you are prepared for and understand the need for redeployment, and any adjustments that might be necessary. Ask the person making the redeployment decision whether they, or a nominated other person, can help with introductions to the new area.

What strategies can I use to maintain accountability when working in a new location?

· Speak to the nurse in charge on arrival, or before redeployment, and tell them about any tasks you feel less comfortable with or for which you need additional support.

· Ensure you have a buddy or a go to person for the period of redeployment.

· Induction cards that include key information about the ward or department can be used to support orientation and safe practice.

· Look after staff coming to your area – that way they are more likely to want to come back and work with you.

· Line managers should undertake well-being checks on the nurse being redeployed, particularly if it’s for longer than one shift.

If you have a comment or question about this update, you can email me at Jayne.Marran@bthft.nhs.uk

Sofia Bibi In Blogs, Safety Intelligence

Using AI for Patient Safety: Learning from the BCS SGAI International Conference on Artificial Intelligence

A PhD student in our Rethinking Safety for Intelligence theme recently attended the British Computing Society’s Specialist Group on Artificial Intelligence’s (BCS SGAI) International Conference on Artificial Intelligence in Cambridge. In this blog, they share their experiences of the conference and introduce their research, which explores the use of large language models to make better use of data to create patient safety learning.

Written by Jacob Cooke.

I recently attended the BCS SGAI International Conference on Artificial Intelligence, where I had the opportunity to connect with other PhD students and academics who share may passion for artificial intelligence, in healthcare and beyond.

Day One: PhD Networking Event

The first day of the conference brought together PhD students interested in artificial intelligence (AI). We connected with senior academics in the artificial intelligence field to discuss the current state of artificial intelligence research and receive advice on getting a PhD in the field, focusing on writing a thesis, publishing papers, and the viva process. I gained tips and tricks for success in my PhD, while being warned about common pitfalls.

I made new connections with PhD students with interests in conducting theoretical research into AI, as well as applying the technology across industries. I look forward to reconnecting with them at future artificial intelligence conferences to hear about their developing research.

Day Two: Generative AI Workshop

The second day of the conference involved a set of workshops which combined presentations on the state-of-the-art of artificial intelligence research with collaborative discussions on prominent issues.

The first workshop discussed generative artificial intelligence (Gen AI) technologies. These are a type of computer system which mimics the human ability to create content such as language, images, and videos. They typically do this by learning the patterns in very large datasets of the target, enabling the production of new content based on our instructions. Large language models (LLMs), like Chat-GPT, are a form of Gen AI which can generate human-like language based on the patterns it has learnt from written text.

The Gen AI workshop covered topics such as the application of Gen AI in robotics, methods to improve the training processes for LLMs, and guardrails to prevent LLM attacks. For me, the highlight of this workshop was a talk on Safety and Trustworthiness of Gen AI, delivered by Dr Mark Post of the University of York. He argued that, as the performance of LLMs has increased in recent years and they seem to be acting more like humans, we are becoming overly trusting and reliant on them. He concluded that need to alter our expectations of LLMs and use them to complement, rather than replace, human thought, creativity, and work.

Day Two: Safe Use of AI in Healthcare Workshop

The second workshop that I attended considered the safe use of AI in healthcare. We discussed the regulatory landscape for healthcare AI, the implementation of AI scribes, and the need for end user evaluation of AI in healthcare.

Discussing the regulatory landscape of healthcare AI gave me insight into the process for gaining regulatory approval for healthcare AI in the NHS and the future direction of these processes. Currently, healthcare AI goes through the same regulatory processes as any other medical device, like surgical equipment. There is need to adapt regulatory processes to meet the demands of AI. We took part in a roundtable discussion to generate ideas for how healthcare AI companies and products should be regulated going forward.

Prof Jeremy Wyatt of the University of Southampton delivered a talk on the need for end user evaluation for healthcare AI. As only around 10% of such tools are tested in real-world context, we need to rethink our approaches to developing and testing AI. Prof Wyatt argued that we need to use a human-in-the-loop model – where AI supplements human decision making – and conduct formative evaluations to guide the development of tools before testing their impact in randomised controlled trials.

The workshop provided me with crucial ideas and insights that will contribute greatly to the development of my research.

Introducing My PhD

My PhD aims to use LLMs to automatically analyse free text patient safety data, like online patient feedback and electronic patient records, to produce patient safety insights and learning. This research is essential due to the proliferation of free text data in healthcare in recent years. As our world has digitalised, the NHS has produced large quantities of data, which contains crucial patient safety information. Unfortunately, it is near impossible to manually analyse these datasets. This means that we miss out on patient safety learning which could improve the quality and safety of healthcare in the NHS.

I plan to create accurate and reliable LLM tools which can analyse these data sources to produce actionable patient safety learning. By teaching computers to understand patterns in written text, it may be possible to automatically detect early warning signs of problems in care or previously unnoticed harm and risks to patients. The same automated tools may be utilised to highlight where services are working well. Combining the automated detection of harm and positive practice could allow healthcare staff to act sooner to improve patient safety and the quality of care.

The LLM tools that I create will aim to support healthcare organisations in listening and learning more effectively from the voices of patients, carers, and families – making their insights a more meaningful part of improving the health system.

Conclusions

I had an excellent time spending two days in Cambridge discussing artificial intelligence with fellow PhD students, academics, and industry experts. The connections I made and the knowledge I built will support my research throughout my PhD. I hope to return to the conference next year to present some of my early findings in applying LLMs to produce patient safety learning.

Sofia Bibi In Blogs, Decluttering safely for safety

Learning the ABCs of Clinical Decision Support from Industry Experts

Written by Anna Taylor

Learning the ABCs of Clinical Decision Support from Industry Experts

Digital transformation is at the forefront of the healthcare agenda with the NHS 10-year plan describing how the NHS has not yet harnessed the power of modern technology. If done right, improving the use of technology could positively change the shape of how we deliver care to patients.

However, across the NHS in England, it’s common to find teams working with outdated versions of electronic healthcare record (EHR) software, unable to advance at pace, resulting in frustration with their digital tools rather than empowerment.

That’s where clinical decision support systems (CDSSs) come in. Increasingly CDSSs have enhanced digital capabilities, helping clinicians to make safer, faster, evidence-based and more equitable decisions about patient care. However, not all these digital tools deliver their promises – some are poorly designed, fail to fit into everyday workflows or, at worst, pose safety risks.

Securing an internship with a health technology company

I am undertaking a PhD research project titled “Rationalising the Use of Clinical Decision Support Systems” and my goal is to create a practical tool that helps to assess when they are likely to succeed. To gain understanding of how these systems are developed and implemented, I was fortunate to complete an internship with Ardens, a leading health technology company for primary care solutions.

I wanted to see the full lifecycle of CDSS development from the inside, how ideas become working tools, and where challenges arise. My focus was to learn what success looks like for developers, and how their perspective compares with that of clinical end-users.

Ardens example of CDSS features

The company’s approach to complex problem-solving

Ardens began with a handful of GPs who wanted to solve problems they faced in practice, specifically how to make better use of EHR data. Though the company has grown since then, that mindset remains. They are problem solvers, tackling the evolving challenges of healthcare delivery through digital innovation.

During my internship, I was able to see how the company tackles the complexities of digital innovation. What impressed me was their structured approach to design, every product is built around three core ‘ABC’ principles:

A – Accessibility, ensuring that tools are easy to use in practice.
B – Best Practice, incorporating up-to-date clinical guidelines.
C – Contracts, meeting the requirements of national frameworks.

A key strength lies in their multidisciplinary team, which includes experienced clinicians working alongside developers and data specialists. This blend of expertise helps them anticipate both current and emerging needs in primary care. The result is a range of products designed to support efficient, cost-effective, and evidence-based patient care, whilst aligning with national contracts, national and local clinical guidelines, safety alerts, and more.

Iterative improvement

Whilst they grow their comprehensive offering of clinical decision support, they must handle multiple challenges including:

Last minute communication regarding national programmes
Regularly changing goalposts of national contracts
Multiple new and updated clinical guidelines
Clinical risk management
Quantity and complexity of healthcare data
Reliance on existing EHR systems and functionality

They handle these challenges on behalf of their customers, saving them the burden of handling these at individual practices. They aim to develop products that are comprehensive and clinically safe whilst remaining user-friendly but even seemingly simple ideas often have layers of complexity to manage through the development process.

One of the company’s greatest strengths is its approach to support and training. Clients and end-users have open access to both. Every request that lands in their inbox gets attention, meaning that they review and respond to thousands of messages each month, feeding into a culture of iterative improvement. Every new feature reflects a blend of user feedback and continuous product development.

The value of the end-user

Ardens employs a team of clinicians, many of whom still practice in primary care, and use their tacit knowledge to inform product development. The focus on employing a group of target end-users may set them apart from other health technology companies in their ability to identify what features and functions of CDSSs are helpful in practice. Their clinical team help with problem solving, developing, testing, refining and validating their products, translating real problems into something that the developers can understand and solve to the best of their ability.

Of course, their open approach to end-user support brings with it some challenges. Managing the vast range of opinions, priorities and requests from thousands of users is no mean feat. Some suggestions have national significance, while others are incredibly niche. Whilst they have an in-house team of clinicians to review end-user requests with reasoned opinion, they can struggle with the balance of meeting the needs of the many whilst tailoring to individual requests.

Measures of success

Across the company, from clinicians to developers, one message rings clear: a successful product saves time. Whether helping clinicians reach the right decision faster or reducing the burden of administrative tasks, time saved is the most meaningful measure of success.

Reflection

Interestingly, improved patient outcomes are rarely cited as a direct measure of success. This may be because such outcomes are inherently difficult to measure, or perhaps it is simply assumed that enhanced workflow and clinical decision making will deliver patient benefits.

It raises an important question: could the industry benefit from more research in this space? I say, yes, absolutely. While companies may have a foundation of expertise and are responsive to user feedback, there is value in looking beyond development and into real-world evidence of how CDSSs perform over time once they’re in use. If the future of healthcare delivery is to be enhanced through modern technology, we must ensure the solutions are optimally designed and implemented to achieve the greatest impact on patient outcomes.

Sofia Bibi In Blogs, Decluttering safely for safety, Patient safety

The De-implementation Toolkit: Strategies for the safe reduction of low value practices in healthcare

Our De-Cluttering team are celebrating the launch of a recently developed a practical toolkit to guide leaders working in clinical settings through the de-implementation of low value practices. Low value healthcare practices offer little or no benefit to patients or staff. These practices often persist due to habit, policy, or emotional attachment, even when shown to cause harm or waste resources.

The De-implementation Toolkit was co-developed by researchers and healthcare staff, including experts in de-implementation, behavioural science, and patient safety from the Yorkshire and Humber Patient Safety Research Collaboration. The team has also partnered with researchers at Stavanger University in Norway as part of their work on improving healthcare resilience across Europe through promoting de-implementation.

The interactive toolkit offers a structured six-step approach to help leaders identify and safely remove, reduce, restrict, replace or rethink low value care:

Identify low value practices through staff and patient input.
Verify that the practice is truly low value using evidence and stakeholder perspectives.
Develop a strategy by understanding the beliefs and behaviours that sustain the practice.
Measure impact, including benefits, harms, and unintended consequences.
Solve problems by anticipating resistance and adapting plans.
Celebrate success and share learning to inspire others.

The toolkit builds on well-established frameworks for the de-implementation of low-value care (Norton et al., 2018; Grimshaw et al., 20XX), with the focus on developing strategies grounded in evidence-based behavioural models such as the COM-B (Michie et al., 2011). The toolkit introduces a new decision-making tool, the De-implementation Decision Grid (DDG), to help staff identify which practices are likely to be a priority for de-implementation.

Our tool promotes equity through encouraging inclusive stakeholder engagement and supporting continuous feedback and improvement.

We invite healthcare leaders to explore the De-Implementation Toolkit, apply it locally, and contribute case studies here.

Sofia Bibi In Blogs, Patient safety

Takeaways from this year’s Patient Safety Congress

A few members of the Yorkshire Quality and Safety Research Group attended this year’s Patient Safety Congress in Manchester and in this blog we have summarised the key takeaways.

Written by Jenni Murray, Martha Miles, Qandeel Shah, Brook Howells, Saima Noureen, Alison Bravington and Zuneera Khurshid.

The opening plenary was a fascinating series of high-level lightning talks about the history, current state and future direction of patient safety. References were of course made to the NHS 10 Year Plan and Penny Dash Review. Not all speakers aligned in their views about the way forward, which was refreshing and intriguing at the same time. Opening key messages were about shifting the focus from safety to quality and the need for greater efficiencies. The implications of this for patient safety research are unknown, but changes seem to be afoot. These messages were countered with tough questions about how to do more for less, with a dearth of learning opportunities for NHS staff and fears around delivering compromised care. There were stark messages about repeated failure to learn from past events despite many investigations and recommendations, alongside extensive clutter (particularly risk assessments) in the system. The roll out of Martha’s Rule was framed more positively with data on number of ‘calls’ made resulting in changes in care, but was arguably rightly challenged with a cautionary reminder of the need for a more nuanced exploration.

Culture was a recurring theme across the Congress. Staff were described as the “sensors” of the system: in the absence of psychological safety, staff stay silent and opportunities for learning are lost. The call for maternity was clear: less conversation, more action! Speakers argued for increasing workforce in the community and co-production with staff and families, and grounding care in kindness, transparency and everyday relational working to facilitate true culture change. Campaigners for justice for those harmed by infected blood, sodium valproate, and vaginal mesh spoke about the ongoing challenge of getting reparations, but also the need to move away from blame and towards restorative justice. They also talked about creating systems that can identify risks early and mitigate them, to prevent the next scandal.

A hot topic that will keep getting hotter is AI in healthcare. We heard about the innovative use of AI in tumour diagnosis, which speeds up imaging analysis, saving clinician time. Importantly, AI in this context was seen as support tool rather than a replacement. Other caveats for AI included the need for robust governance, the risks of hacking and the environment impacts. There seem to be many opportunities for its application in low risk activities and to reduce administrative burden and clutter, such as using generated recorded summaries of bedside consultations.

There was a fascinating presentation on virtual wards in care homes. A randomised controlled trial of VWs in South East London reported a reduction in A&E visits, fewer admissions and GP referrals alongside a zero net increase in GP workload. Learning about use of Virtual Wards came from Canada, Australia, and Sweden, with key take home messages about the market being flooded with wireless devices that haven’t been tested on actual patients, and about the ethics of using continuous monitoring in the community where there may not be the capacity to respond.

Jeremy Hunt closed off the Congress with some reflections about the past and how change is happening. Specifically he talked about conducting and using investigations to kick start the system to create change rather than creating defensive practice and damaged morale. The move towards creating a central hub for the analysis and prioritisation of burgeoning lists of recommendations – with built in accountability – was seen as a potential solution to ‘elephantine bureaucracy’ and waste in the system. Finally, he spoke of the need to shift away from national targets and towards local improvement initiatives to enable a sharper focus on safety. The question we are asking is what this Congress with look like next year…the Patient Quality & Safety Congress?

Sofia Bibi In Blogs, Safety Culture

This is a great opportunity, you’ve got to take it! The unexpected doors that a PhD opens

As I near the halfway point of my PhD journey, it’s a great time to reflect on my experience so far. Thinking back to just before I started, I remember that I didn’t really know what to expect, except that it would be a solid three years of diving deep into a topic and I was confident that it would bring me joy. I also remember that when I asked my boss at the time whether I should go for this PhD, I was not expecting the passion in her reply that this was a great opportunity that I had to go for. She was so right – and this PhD has brought many more unexpected opportunities.

Becoming part of the research community

In my PhD I am exploring how different industries manage safety, and specifically how the use of proactive and systematic approaches known as “safety management systems” might transfer into a healthcare context. This project sits within the Safer Systems, Cultures and Practice theme of the NIHR Yorkshire and Humber Patient Safety Research Collaboration. I’ve had the opportunity to work with this team on some of their wider research, including a study with senior managers from a wide range of different safety-critical industries (https://psrc-yh.nihr.ac.uk/psrc_themes/safer-systems-cultures-and-practices/safer-systems-cultures-and-practices-study-5/). This has helped me progress my PhD as it connects my learning from my literature review with real life practice. It has also been a great way to learn about doing research and how studies can piece together into a bigger project.

My background is in human factors, so when an opportunity arose to help lead a network supporting researchers using human factors in patient safety research, I was straight in. This group (https://psrc-network.nihr.ac.uk/category/human-factors-ergonomics-working-group/) arranges online seminars and in person events to share best practice and encourage collaboration. This has been really enjoyable and also given me insight into the breadth of research across the patient safety space. We are hoping it will lead to more collaborative opportunities and to future research projects.

Presenting my own work on an international stage

The Healthcare Systems Ergonomics and Patient Safety Conference (https://www.heps2025.com/) was held in Dublin in June 2025 and I got accepted to present my state-of-the-art review into safety management systems. This was my first international conference and it was great to hear presentations about human factors from across the world. The Chartered Institute of Ergonomics and Human Factors (https://ergonomics.org.uk/ ) organised a meet-up for all its members so I made many new friends too. In fact, I had planned to do some sight-seeing but spent all my free time having lovely conversations with lovely people instead.

Developing skills for post-PhD

Although “post-PhD” feels a way off right now, I have been taking advantage of the training opportunities that being within the NIHR infrastructure gives me for longer term career development. This includes attending the NIHR Doctoral Research training camp in the summer of 2025. This annual camp is designed to help you learn how to write a grant application and now in its 16^th year it has a tried-and-tested formula; you are put in a team with people you’ve probably never met before and given less than 24 hours to design, write and ‘submit’ an application. You have to collaborate fast with people from very different research backgrounds, and the organisers put you under a lot of pressure, including throwing in the odd curveball. It was intense, you are pushed well out of your comfort zone and it was a lot of fun. Plus I now have confidence to tackle any post-PhD opportunities that involve a grant application!

My career to date has grown and developed in a somewhat rambling way, as I walk through doors that open in front of me. Embarking on the PhD was a step through one door and I didn’t realise it would lead to so many other opportunities. I am really enjoying the adventures that this PhD is bringing; the different doors I’ve been through already and the skills I’m developing to walk through new ones in future.

By Brook Howells