The Health Innovation Networks are a key partner supporting NHS trusts to implement Martha’s Rule across England. Siobhan Lanigan is a Critical Care Nurse at the Bristol Royal Infirmary on secondment to Health Innovation West of England as Senior Project Manager to support the local rollout of Martha’s Rule. In her latest blog, Siobhan reflects on a recent regional system event and the real opportunities it presented to share learning, navigate challenges together, and ultimately strengthen this very important programme.
Beyond the call: Martha’s Rule in action – a day dedicated to patient safety and empowering voices
On 9 July 2025, I had the privilege of co-hosting “Beyond the Call: Martha’s Rule in Action”, a celebration event with colleagues across the West of England of the patient safety improvement journey so far. It was a day filled with purpose, reflection, and a shared commitment to making healthcare safer and more responsive – not just for patients, but for everyone involved in their care.
The event opened with powerful remarks from Dr Alison Tavare, our clinical lead, who set the tone for a day grounded in collaboration, learning, and shared humanity.
I had the pleasure of leading our first activity, Association Cards, where attendees selected an image that represented their personal or organisational journey toward improving patient safety. This simple yet meaningful exercise opened the floor to deep, thoughtful conversations. People spoke from the heart about their growth, challenges, and the emotions that have accompanied them on this path. It was a reminder that behind every system or policy are people who care deeply.
Later in the morning, Jan Scott (Senior Programme Manager) and I co-led a session to celebrate the achievements we’ve collectively made so far. We paused to acknowledge how far we’ve come – and to recognise the energy, insight, and dedication that have driven that progress.
The impact of leadership, culture, and hierarchy on patient safety
A highlight of the day was hearing from Professor Greta Westwood CBE, CEO of the Florence Nightingale Foundation. Her presentation explored the profound impact that leadership, culture, and hierarchy have on patient safety. She reminded us that it’s often not a lack of knowledge that stops people from raising concerns – it’s fear, disempowerment, or feeling unheard. Whether it’s clinical staff, students, or family members, too many people still feel unsure or unable to speak up when something doesn’t feel right.
Professor Westwood shared findings from a qualitative study commissioned by NHS England’s Worry & Concern Steering Group, which highlighted how psychologically safe, inclusive cultures allow voices to be heard, and lives to be saved. The study’s recommendations really resonated with me: invest in leadership that models openness, break down professional hierarchies, support patients and families as active partners, and create systems where learning is constant and feedback is welcomed.
Building on that, she introduced the Leading, Creating & Sustaining Safe Cultures of Care Leadership Programme, a forward-thinking initiative from the Florence Nightingale Foundation that equips nursing and midwifery leaders with the tools to build safer, more inclusive environments. It was clear: silence, fear, and blame have no place in healthcare.
Looking back, moving forward
In the afternoon, I invited everyone to join in an activity called ‘Looking back, moving forward’. We reflected on what had brought us here, the successes, the detours, and the hard-earned lessons, and then looked ahead at what still needs to be done. These shared reflections grounded us but also fuelled hope and momentum.
Grace Smith from Health Innovation Wessex gave a fascinating overview of their work implementing Martha’s Rule. She spoke about piloting the Patient Wellness Questionnaire (PWQ), refining staff escalation processes, and how families are being empowered to raise concerns. Her insights into the evolving role of digital tools versus paper-based systems, and the emotional shift from ‘whistleblowing’ to ‘being heard’ were particularly striking.
Being part of the health innovation network is always valuable, but there’s something particularly impactful about working closely with neighbouring patches. It gives us real opportunities to share learning, navigate challenges together, and ultimately strengthen the programme.
Patient voice: or, why listening matters
One of the most moving moments of the day came from Tom Nutt, CEO of Meningitis Now, who delivered ‘Patient Voice: Or, Why Listening Matters’. His storytelling was unforgettable. Through the experiences of families like Simmy and Bobo’s, Paul and Izzy’s, and Sue and Alex’s, he brought home what’s at stake when concerns go unheard. His message was clear: patients, carers, and families must be empowered, and listened to. Equally, staff need the safety and support to challenge norms, speak across hierarchies, and uphold a culture of continuous learning.
Shaping the culture
Asha Dhany then introduced MOMENTS, a practical and research-backed tool from the SAPPHIRE Group. It’s designed to bring patient safety into everyday conversations, not just when something goes wrong. It helps teams reflect on their daily practices and surface the subtle dynamics that shape safety culture. What I love about MOMENTS is its simplicity. It’s a gentle yet powerful way to remind us that the ‘small things’ we do every day shape our culture in big ways.
We wrapped up with reflections from Alison Tavare, who skilfully drew together the many voices, insights, and aspirations we’d heard throughout the day.
Final thoughts
The overarching message from Beyond the Call was this: Martha’s Rule is a crucial lever in our mission to improve the safety and quality of care, especially when a patient’s condition is deteriorating. It’s not just about escalation protocols, it’s about recognising intuition, acting on concern, and creating systems where patients, carers, and staff feel safe, seen, and heard.
We’re not just preventing harm. We’re building cultures of leadership, compassion, and listening. This day reminded me why I do this work, and why the journey ahead matters just as much as the progress we’ve made so far.
Posted on July 18, 2025 by Siobhan Lanigan, Registered Nurse and Senior Project Manager
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