The team at NT Health work to achieve the best health and wellbeing for all Territorians through the development, management and performance of the public health system.

 From international evidence to local system change in remote and Indigenous health services

Fiona Wake, executive director for clinical excellence and patient safety, commissioning and system improvement at Northern Territory Health, believes that the learnings gained from attending the International Forum on Quality and Safety in Healthcare were associated with refinement and scaling of the work. Exposure to international evidence and peer systems where consumers define quality and accountability was consistent with international evidence and comparable models, and supported its expansion across multiple sites. 

Sessions led by consumer advocates challenged traditional reporting frameworks that prioritise organisational metrics over patient experience, leading to greater emphasis on patient-defined indicators such as cultural safety, interpreter use and self-discharge. Comparable community governed models from Broome, Alaska and Canada demonstrated the applicability of these approaches for remote and Indigenous health services.

“The Forum helped us see that consumer-defined quality is not aspirational, but practical, measurable, and already happening in systems like ours.”

Fiona Wake, executive director for clinical excellence and patient safety
Commissioning and system improvement, Northern Territory Health, Australia

The early success of the Communicate study shows that effective change happens when Aboriginal patients and communities help shape how care is delivered, rather than commenting on it as an afterthought. It places Aboriginal voices at the centre of decisions about safe, effective care.

This view mirrors the discussions that took place at the International Forum on Quality and Safety in Healthcare in Canberra 2025, which emphasised the role of patient-defined measures in assessing and improving care quality. 

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.

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.

Bring your work to the Forum and start the conversation

Share early findings, practical lessons and unanswered questions at the International Forum on Quality and Safety in Healthcare to connect with peers who can help turn local improvement into wider change.

The BMJ Case Report, “Scurvy – a re-emerging disease with the rising cost of living and number of bariatric surgical procedures”, arose when a man in his early fifties presented to Sir Charles Gairdner Hospital in Western Australia with a painful rash on his legs, haematuria, and anaemia.

Investigations for vasculitis, autoimmune disease, and haematological malignancy were normal, and his symptoms continued to worsen.

Maternal medicine specialist Dr Sivanthi Senaratne reviewed the case and recommended a nutritional screen, informed by similar presentations seen in pregnant women after bariatric surgery. Bariatric surgery has risen sharply in Australia, particularly among women of reproductive age. International data show that almost 60 per cent of women undergoing bariatric surgery are aged 20 to 44 years, and a national survey of Australian antenatal clinicians reported that women of childbearing age now form the largest surgical group.1

Large cohort studies show improved fertility outcomes after surgery, but micronutrient deficiencies remain common after sleeve gastrectomy and gastric bypass. Financial pressures can further limit access to fruit, vegetables, and supplements.2

Further history showed that, because of cost pressures, the patient had stopped taking supplements and was consuming little vitamin C rich food. His vitamin C level was undetectable, and other micronutrients were low. Symptoms began to resolve within 24 hours of high dose ascorbic acid.

Lead author Dr Andrew Dermawan said the convergence of rising bariatric surgery, financial pressures, and a preventable deficiency made the case important to share.

Once the BMJ Group press release embargo lifted, extensive media interest was immediate. More than 100 outlets covered the story, including ABC News, the Guardian, and broadcast features on Sky News, LBC News, and international radio and television networks.

Ranked in the top 5 per cent of all research outputs scored by Altmetric

Widely disseminated, with coverage across more than 100 news outlets, multiple blogs, broadcast media, and social platforms

Cited in international peer reviewed journals, including review literature on vitamin C and dermatological disease

Prompted routine dietitian referral and micronutrient screening for post-bariatric inpatients

Highlighted an emerging risk for patients after bariatric surgery

“Having an unusual case and exposing it to the medical fraternity is important, and I love it that BMJ Case Reports does that. It became a big issue in Australia. I hope this report raises awareness on nutritional deficiencies and encourages clinicians to screen for them in patients with risk factors.”

Dr Andrew Dermawan
General Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia

The Queensland Clinical Senate is an advisory body for Queensland Health that brings clinicians together to examine how the health system is working in practice. At the Adolescent to Young Adult Care: Doing Better meeting in December 2020, clinicians were clear that the system was falling short in terms of adolescent and young adult care. The Senate called for a co-designed strategy to address these gaps and improve care.

In response, Brianna McCoola, principal project officer for adolescents and young adults with the Queensland Child and Youth Clinical Network, led a nine-month co-designed process to close this gap.

McCoola and colleagues’ BMJ Open Quality article, “Co-designing recommendations to improve adolescent and young adult healthcare in Queensland”, documents the methodology and thematic analysis of consultations with clinicians, health professionals, leaders, non-government organisations, young people, and families.

McCoola explains that clinicians were “really worried about the safety of care for young people”, noting that most had “no dedicated training in youth healthcare” and that 15 to 17-year-olds often received care in adult services.

 Young people also reported that they often did not “feel believed, heard, [or] understood”.

Attending the International Forum on Quality and Safety in Healthcare over several years shaped both the development of the manuscript and McCoola’s confidence to publish it. She described her first Forum as the point at which hearing presentations “made it crystal clear to me as a clinician” that quality and safety offered the correct framing for a system-wide response to youth care. 

Successive Forums also supported her professional progression. After presenting a poster and then partaking in the closing plenary in Brisbane in 2024, she said the experience “helped me realise the calibre of what we did and what we produced”. Presenting the next phase of her work, subsequent to the strategy, in Canberra in 2025, co-designing a practice guide with young people showed her how the findings may be taken up beyond Queensland. In the post-presentation discussion, she recognised that “there were people in the room that might pick this up and use this in their clinical spaces”, which demonstrated to McCoola how the work is transferable across healthcare settings.

The Forum also provided evidence of its influence in practice. Hearing that colleagues had already seen and used her co-designed resources “has really inspired me to think about what can continue to be done as next steps”, and has shaped the direction she intends to take in her future policy work.

McCoola’s current focus is to “improve Queensland’s health response in the Youth Justice sector”, carrying forward the principles developed through the original study.

What is already known on this topic

Developing health service improvement initiatives, underpinned by co-design methodology with health professionals, patients and their families, leads to fit-for-purpose safe and quality sustainable improvements that have lasting positive effects on service delivery.

What this study adds

Adolescents and young adults are often not included in opportunities to participate meaningfully in improving health services, and are often classified as a hard-to-reach population. This study demonstrates the value of engaging with young people and their families, elevating what they need from health services to access safe, quality care that meets their needs.

How this study might affect research, practice or policy

This study outlines the methodology employed to engage young people in a meaningful project to co-design a statewide strategy to improve the quality and safety of healthcare. It also demonstrates the rich qualitative data the authors gathered using these methods, leading to a publication that discusses advanced adolescent and young adult healthcare in Queensland.

Jorǰa Campbell and Brianna McCoola from Queensland Health about their collaborative experience in creating a Practice Guide to Adolescent and Young Adult Care. Discussing around the project’s development, the co-creation process, and the importance of involving young people in healthcare projects.

Jorǰa and Brianna discuss the inception and execution of the book, which has significantly influenced practice changes within the Queensland health system. Sharing insights into the co-creation process with young people, the challenges faced, and the strategies used to ensure flexible and meaningful consumer engagement. Also, discussing their efforts to engage university departments and health networks, ensuring the guide is widely accepted and practically applied in healthcare settings.

Under the theme “The Power of Us: Strengthening Systems and Deepening Resilience to Improve Quality in Health and Care,” the programme brings together global leaders, innovators, and practitioners to share learning and drive real-world improvement.

Across three dynamic days, you’ll discover new formats, fresh insights, and practical tools to build resilient systems, foster collaboration, and improve outcomes for patients and communities worldwide.

The BMJ 2025–26 appeal: supporting Médecins Sans Frontières (MSF) in Gaza, Sudan and more than 70 countries worldwide. Please donate if you are able: https://msf.org.uk/bmj-annual-appeal-2025  

Over the next eight weeks, The BMJ will be showcasing MSF’s extraordinary work through reporting, opinion articles, and photography. Our coverage will highlight teams responding to complex and fast-moving humanitarian emergencies in a handful of the more than 70 countries where MSF operates, including Gaza, Sudan, and Nigeria.

As Dr Natalie Roberts, MSF UK’s executive director, notes in her piece for us, MSF treats millions of people every year for injuries, malaria, cholera, or malnutrition in war zones, refugee camps, and areas hit by natural disasters. The charity’s independence allows its teams to act fast and reach the people who need medical care the most.

Most MSF staff are locally recruited. One of them, Palestinian doctor Mohamed Abu Mughaisib, has spent almost 800 days working in Gaza. His interview with our correspondent Elisabeth Mahase offers a stark account of how medical staff are bracing for winter as Israeli attacks and aid restrictions continue.

Please donate if you are able: https://msf.org.uk/bmj-annual-appeal-2025

BMJ Group has partnered with the National Institute for Health and Care Research (NIHR) to strengthen how people and communities are involved in medical research.

Varied Voices, a free online course developed by NIHR and supported by BMJ Learning, helps healthcare professionals understand how inclusion and diversity improve the quality and impact of research. It offers practical ways to engage underrepresented groups and create more inclusive research environments.

 This collaboration reflects how BMJ Group and NIHR are working together to increase the reach and real-world impact of health and care research.

“The good physician treats the disease; the great physician treats the patient who has the disease.” Sir William Osler

Who is it for
The course is suitable for all healthcare professionals involved in research, including:
GPs, GP trainees, hospital doctors, foundation doctors, practice and specialist nurses, allied health professionals, physician associates, medical students, and medical trainees.

What you will learn
After completing the course, you will be able to:

• Explain diversity, underrepresented voices, and public involvement in research

• Understand how inclusive practices improve the quality and relevance of health and care research

• Recognise barriers that discourage participation from underrepresented communities

• Apply strategies to make research more inclusive

• Evaluate how effectively your research promotes diversity and inclusion

This is a groundbreaking milestone—not just for transplant medicine, but for how AI can transform clinical research. It all began with a single BMJ publication, shaped by the journal’s exceptional editorial guidance.”

Professor Alexandre Loupy, MD, PhD
Director, Paris Transplant Group

“We desperately need new regulatory pathways that bring investment into transplantation. New therapies are essential to prolong the lives of transplant recipients and take the best care of the gift of life provided by our donors. This step is critical to enabling the dream of ‘One Kidney for Life’ to become a reality.”

Dr Karin Hehenberger
President of Lyfebulb patient engagement platform and a kidney and pancreas transplant recipient

For over 20 years, BMJ Group has championed underrepresented voices in research. Since introducing full article processing charge (APC) waivers in 2022, we’ve granted 70% more waivers to authors from low and middle-income countries (LMICs) compared to the three years before the policy began. In the past year alone, nearly 10% of the open access research we published came from LMIC authors. 

We also participate in the HINARI programme, part of the Research4Life (R4L) initiative, which provides free or low-cost access to its medical journals for institutions in low- and middle-income countries (LMICs). This partnership helps over 11,000 institutions across 125 countries access the best available, evidence-based medical content to support research, education, and clinical practice in these regions.

In August 2021, Dr Bruce Kirenga and his team at the Makerere University Lung Institute published a pivotal study in BMJ Open Respiratory Research on the efficacy of convalescent plasma for covid-19 treatment in Uganda. 

The study’s findings on the limited efficacy of convalescent plasma (CP) helped shape major treatment guidelines. In Therapeutics and COVID-19: Living guideline, the World Health Organization (WHO) strongly advises against CP for all severity levels of covid-19 due to limited benefit and potential safety risks. The National Institutes of Health (NIH) similarly recommends against CP outside of clinical trials, except in rare cases involving immunocompromised patients. The European Medicines Agency (EMA) also discourages routine use, supporting a shift towards more effective therapies like antivirals and monoclonal antibodies.

“Open access publishing ensures the publications are available to everyone, including scientists and policymakers in low-resourced settings.”

Dr Bruce Kirenga,
Chief research scientist and founding director of the Makerere University Lung Institute (MLI)

Compared to most publications in the biomedical and clinical sciences field, which usually receive 2-3 citations, this study stands out with 32 citations. Twenty-four policy documents and two clinical guidelines across four countries also reference it. These numbers highlight the significant impact this research has on evidence-based global health practices.

Dr Kirenga and his team chose open access to ensure their research reached a global audience without barriers, facilitating faster dissemination of critical findings. Making their work freely available enabled healthcare professionals and policymakers in LMICs to access the latest evidence on affordable and accessible therapies. 

When Dr Clara Maarup Prip, a urologist and gynaecologist at Aarhus University Hospital, Denmark, encountered a rare case of kidney swelling (ureterohydronephrosis) caused by a menstrual cup, it was unlike anything she had seen before.

The menstrual cup had been compressing the ureter where it enters the bladder, leading to a serious but rare complication. After searching the literature and finding only a handful of similar cases worldwide, Dr Maarup Prip documented the case and submitted the report titled, “Ureterohydronephrosis due to a menstrual cup” to BMJ Case Reports, choosing the journal based on its reputation and guidance from experienced colleagues.

We weren’t funded, and it didn’t take long to write. But the response shows just how much value a single case report can bring.”

Dr Clara Maarup Prip
Urologist and gynaecologist, Aarhus University Hospital, Denmark

Academic literature rarely cites case reports, but that doesn’t mean they lack tangible impact. It just means they need to be measured differently: not by how they affect a journal’s impact factor, but by the value they bring to clinical education, practice, and patient safety.

As deputy editor of this important journal from the BMJ Group, I can’t help but to stress both the educational importance of case reports, but also their role in shaping often important public health advices.

Rui Amaral Mendes
Professor of the Department of Community Medicine, Case Western Reserve University, Cleveland, Ohio, United States

“The submission process was straightforward, and the response was fast. I’d had other papers published with other publishers, and this was by far the smoothest experience.”

Dr Clara Maarup Prip
Aarhus University Hospital, Denmark