By Misbah Mahmood, CXIO & Clinical Safety Officer, Bradford District Care Trust, (Former digital midwife at Leeds Teaching Hospitals and long-standing K2/HHA customer and collaborator)

Across the NHS, digital governance is frequently misunderstood.

It is often seen as a bureaucratic necessity or a technical, administrative process that becomes invisible once a system goes live or as a barrier to innovation when services are under pressure to change quickly.

However, digital systems do far more than document care. They shape how care is delivered, how risk is identified and interpreted, and how clinical decisions are made.

When systems are well designed and well governed, they support clinical judgement and safe practice.

When they are not, the impact is felt directly at the bedside, as illustrated by recent concerns over an AI discharge summary tool trialled at Chelsea and Westminster.

Here, unresolved questions about regulatory status and assurance exposed the consequences of deploying clinically influential technology without sufficient clarity or oversight.

In maternity services in particular, care is complex, unpredictable, and deeply dependent on context. Rapid decision making and information continuity across settings are essential.

As digital systems increasingly influence day-to-day practice, the way they are designed, governed, and used can either reinforce safe care or quietly undermine it.

Digital governance distinguishes technology that protects women and babies from technology that introduces hidden risk.

The myth of “invisible infrastructure”

When people hear the word “governance”, they often think of forms, meetings and compliance. For clinicians, it can feel like a tick box exercise that sits in the way of getting things done.

But governance decisions show up at the most critical moments of care, often without being named as such.

As clinicians, we instinctively understand safety in physical terms. If a blood pressure machine stops working, that’s immediately recognised as a patient safety issue. It gets escalated, reported and fixed.

But for a long time, digital issues have not been treated the same way. Slow systems, unreliable access, or inability to view the EPR were often accepted as “just one of those things”. Yet the impact on safety can be just as significant.

If you can’t see the record, you can’t see the risks. If you can’t trust the system, you start working around it.

Electronic patient records are no longer passive repositories of information. They influence what clinicians notice, how quickly they escalate concerns and what decisions they make.

That means the way these systems are governed, and how they are designed, tested and introduced, has direct consequences for patient safety.

A good example of this is central foetal monitoring. Used well, it can support situational awareness. But without clear governance and shared understanding, it can also create a false sense of security.

Being explicit that central monitoring does not replace bedside assessment or escalation is essential. If staff assume “someone else is watching”, the technology has unintentionally weakened safety.

Why safe digital infrastructure matters more than ever in maternity

Maternity care is non‑linear. Risk changes rapidly, and plans change, as women move between community and hospital settings.

Many digital systems are built around rigid templates and linear workflows that do not reflect this reality. When systems don’t fit practice, practice adapts.

Parallel notes, paper diaries, and reliance on free text are not resistance to digital tools; they are practical responses to keep care safe.

Operational realities add further challenge. Community midwives work across geography with unreliable connectivity, making offline access a safety requirement rather than a technical convenience.

Systems that support secure offline working reduce rushed documentation and missed safety checks.

Misbah Mahmood

On the labour ward, pressures intensify. Emergencies escalate quickly and staff are often fatigued. Here, usability becomes inseparable from safety.

Systems that add unnecessary steps increase cognitive load precisely when attention must remain on the patient. At four in the morning, design can either support safe decision‑making or work against it.

When the safest decision is saying “not now”

Digital governance is as much about preventing unsafe change as enabling innovation. Not every system that is technically ready is clinically ready.

Introducing change during periods of strain, limited training, or inadequate testing increases risk.

Pausing a rollout is rarely comfortable as delivery pressures create momentum to proceed. Effective governance, however, gives organisations permission to prioritise safety over speed.

Delaying implementation to allow further testing or clinical engagement often leads to safer adoption and greater staff trust.

Saying “not now” is not resistance to change. It is a mature safety response, as introducing change at the wrong time can cause harm that is far harder to undo.

Co‑design, not configuration: new models for supplier partnerships

Safe digital transformation depends on genuine partnership between NHS teams and suppliers, with shared responsibility for clinical risk.

 Effective collaboration starts early, with meaningful clinical involvement, transparency about system constraints, and shared understanding of risk.

It continues through testing in real clinical environments and shared accountability for safety outcomes after go‑live.

Working with Harris Health Alliance and the K2 maternity tool made these conversations more effective.

Responsiveness to safety feedback was faster, and small design changes, such as surfacing critical risk information or adding validation checks to reduce error under fatigue, had significant impact on usability and safety.

Every change, however minor it appears, is a clinical safety decision. Digital governance provides the structure to recognise this and ensure changes are designed and implemented accordingly.

People, process and technology are an interdependent system

Technology does not fail in isolation. Risk emerges when people, processes, and digital systems are misaligned. Even the most sophisticated EPR will struggle if staff are unsupported, processes have not evolved, or workflows do not reflect clinical reality.

Technology can also obscure risk by embedding unsafe or outdated practices into systems that appear efficient when governance focuses only on technical delivery.

Effective digital governance recognises that patient safety depends on the interaction between people, processes, and technology.

Skills, confidence, and behaviours matter, as do evidence‑based, consistent processes and systems that are usable, reliable, and aligned with real clinical work.

Safety improves when these elements are deliberately aligned and governance focuses on learning rather than blame.

Design matters and systems must be fast, predictable, and forgiving of human fatigue. The same principle is evident in data quality.

A yes/no field relating to cord prolapse produced alarming figures due to human factors rather than practice.

Introducing a simple validation check prompting confirmation improved data quality and reduced risk by addressing system design, not individual behaviour.

This is digital governance in practice. It is recognising where design and reality collide and fixing the system rather than blaming clinicians.

From invisible to essential 

Digital governance should no longer be invisible. It must be recognised, valued, and treated as a core component of patient safety.

That means involving clinical safety expertise from the outset, listening to frontline concerns, designing for real-world conditions, and being willing to pause when something does not feel safe.

The absence of incidents does not mean the absence of risk; often, it means the system has not yet failed under the wrong circumstances.

Maternity services, with their complexity and sensitivity, have much to teach the wider NHS about safe digital transformation.

When governance is shared, practical, and grounded in real clinical experience, digital systems can genuinely support safer care and not just record it.