Recognising deterioration earlier by partnering with families

In 2020, Australia’s largest public health service, Monash Health, began work to improve recognition of paediatric deterioration by partnering more closely with parents and families. A co-design process with consumers and clinicians resulted in a single proactive question asked alongside routine vital signs: “Are you worried your child is getting worse?” Early testing in paediatric emergency and inpatient settings showed strong engagement from families. Over the following two years, outcome data demonstrated a clear association between parental concern and critical illness.

The work reached a pivotal point when preliminary findings were presented at the 2022 International Forum on Quality and Safety in Healthcare in Sydney. While the formal presentation created visibility, it was the informal discussions around the session that proved decisive.

“Someone who’d previously done a fellowship at Safer Care Victoria heard me speak [at the Forum] and introduced me at morning tea to the Chief Paediatrician of New South Wales, and out of that conversation a nationwide community of practice was started.”

Dr Erin Mills, paediatric emergency physician and quality advisor
Monash Health and clinical lead for Safer Care Victoria’s Safer Care for Kids ViCTOR Project

That single introduction at the Forum led to the formation of a national group of clinical leaders focused on scaling proactive patient and family escalation beyond a single service. Leaders from multiple Australian states began meeting regularly to share data, align approaches and test feasibility across different healthcare contexts.

This group evolved into a nationwide community of practice that has now met regularly for several years. It has supported collaborative research, shared implementation learning and coordinated rollout across jurisdictions, demonstrating the progression of the project from local improvement to system-level adoption.

The publication of the Monash study in early 2025 accelerated momentum, attracting widespread media coverage and significant international attention. Interest from the UK increased as Martha’s Rule was introduced, with the proactive involvement of families creating a clear point of connection between the two approaches.

By September 2025, New South Wales had embedded the proactive question as a vital sign for every child statewide. Victoria has also added the question to statewide paediatric observation charts, after Safer Care Victoria piloted the approach across multiple sites, demonstrating strong staff acceptability and reductions in deterioration events.

Forum-enabled collaboration helped trigger national discussions, including consideration by the Australian Commission on Safety and Quality in Health Care of whether proactive family escalation should be reflected in future safety standards.

The work continues to evolve. Adaptation for adult services is underway, and new international links have formed, including discussions with clinicians in New Zealand following conversations at the 2025 Canberra Forum.

This impact story demonstrates how the Forum functions not only as a place to share results but as a catalyst for connection. In this case, a single presentation, followed by an informal conversation, created the leadership network needed to translate evidence into national and internationally relevant change.

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