In 2020, Monash Health, Australia’s largest public health service, began improving recognition of paediatric deterioration by partnering more closely with families. Through a co-design process with clinicians and consumers, a single proactive question was added to routine vital signs: “ Are you worried your child is getting worse? ” Early testing in emergency and inpatient settings showed strong family engagement, and over two years, outcome data confirmed a clear link between parental concern and critical illness. The work reached a turning point when preliminary findings were presented at the 2022 International Forum in Sydney. Beyond the formal presentation, informal conversations proved decisive. That introduction led to a national group of clinical leaders sharing data, aligning approaches, and testing feasibility across states. Publication of the Monash study in 2025 accelerated international uptake. UK interest grew with Martha’s Rule, aligning around proactive family involvement. By September 2025, New South Wales had embedded the question statewide, and Victoria adopted it after successful pilots. 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 International Forum. From one question to global practice change How connections made at the International Forum on Quality and Safety in Healthcare accelerate international improvement
Someone who’d done a fellowship at Safer Care Victoria introduced me to the chief paediatrician of New South Wales, and out of that conversation a nationwide community of practice was started. Erin Mills Clinical lead for the Safer Care for Kids ViCTOR Project, Melbourne, Australia
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