News
The invisible infrastructure of patient safety and why digital governance matters
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.
Light exercise and less sitting may reduce pregnant women’s risk of serious blood pressure complications, according to a new study.
Researchers have proposed a daily activity and sleep guide that they say was linked to a nearly 30 per cent lower risk of hypertensive disorders of pregnancy.
The suggested pattern includes fewer than eight hours of sedentary time, at least seven hours of light physical activity, around 22 minutes of more intense activity and nearly nine hours of sleep.
The University of Iowa-led study examined the daily behaviours of 470 pregnant women across all stages of pregnancy.
Participants wore monitors that measured physical activity over 24-hour periods and recorded how long they spent asleep.
Hypertensive disorders of pregnancy include chronic high blood pressure, gestational hypertension and pre-eclampsia.
Gestational hypertension is high blood pressure that develops during pregnancy, while pre-eclampsia is a potentially serious condition involving high blood pressure and signs that organs may be affected.
Sedentary behaviour means being mostly inactive, such as sitting or lying down.
Light physical activity can include casual walking, moving around the home or standing.
Moderate to vigorous activity includes movement such as brisk walking, where breathing and heart rate increase.
Kara Whitaker, associate professor in the department of health, sport, and human physiology at Iowa and corresponding author of the study, said: “We are identifying the optimal composition of movement behaviours across the day associated with the lowest risk of developing HDP and the most improved health outcomes.
“This blueprint holds for each and every trimester of pregnancy.”
Study participants were enrolled at sites in Iowa City, Pittsburgh and Morgantown, West Virginia.
The women wore activity and sleep monitors for at least one week during each trimester of pregnancy.
Four in five participants were non-Hispanic white and nearly a quarter lived in rural areas.
The data showed a steep rise in risk among pregnant women who were sedentary for more than 10 hours a day.
Women who increased light physical activity to at least four hours a day reduced their risk of hypertensive disorders of pregnancy to 15 per cent from 30 per cent.
Whitaker said: “Just moving around more seems to have significant health benefits.
“And I think it also may be a more feasible target for women who are pregnant who are not exercising regularly.”
The researchers said they were surprised that longer durations of moderate to vigorous physical activity did not appear to provide additional benefit.
Sleep beyond a certain duration also did not appear to bring major further benefits.
Whitaker said: “Through this study, we are providing evidence that reducing sedentary behaviour and engaging in light physical activity are important, and maybe more important, when it comes to pregnancy and health.”
The findings may be relevant beyond pregnancy because clinical research has shown that women who develop hypertensive disorders of pregnancy are more than twice as likely to develop heart disease later in life.
Cardiovascular disease includes conditions affecting the heart and blood vessels, such as heart disease and stroke.
Whitaker said: “We know that cardiovascular disease is the number one killer of women, and if we can intervene in pregnancy and prevent women from developing a hypertensive disorder of pregnancy, we are putting them on a better trajectory, away from cardiovascular disease and toward more optimal cardiovascular health.”
The study was published online on June 10.
A second study, published online on May 27, looked more closely at the ratio and type of sedentary behaviour and light physical activity linked to a lower risk of hypertensive disorders of pregnancy.
Whitaker is a lead co-author on that study.
Co-authors in the June 10 study include Alex Crisp, Jaemyung Kim, Karina Smith, Donna Santillan, Mark Santillan and Bridget Zimmerman, from Iowa; Jacob Gallagher, from Iowa State University; Melissa Jones, from Oakland University in Michigan; Bethany Barone Gibbs, Katrina Wilhite, Alexis Thrower and Iqra Sheikh, from West Virginia University; and Sabera Rahman, Janet Catov, Christopher Kline and Maisa Feghali, from the University of Pittsburgh.
The National Institutes of Health, the University of Iowa Institute for Clinical and Translational Science, the University of Pittsburgh Clinical and Translational Science Institute and the West Virginia Clinical and Translational Science Institute funded the research.
We are excited to reveal the winners of the third annual Femtech World Awards.
The winners were announced at a virtual event this afternoon attended by shortlisted companies, along with sponsors and judges.
The event welcomed guests from the UK, Europe, Asia, Africa and North America.
Thank you to all 174 entries, as well as the sponsors for making the event possible.
See you in 2027!
Femtech World Awards 2026 Winners
Winner:
Shortlisted:
IVI RMA x Juno Genetics
Natural Cycles
Winner:
Highly commended:
U-Ploid
Shortlisted:
Hello Inside
Winner:
WISE HF, led by Prof. Mary Ryder
Highly commended:
Cardiac College for Women
Shortlisted:
Hyvelle Ferguson-Davis
CognitiveCare
Winner:
Highly commended:
Youterus
Shortlisted:
ŌURA
Winner:
Shortlisted:
LeanShield by ParrotPal Group
Perigen
Winner:
Shortlisted:
Body Moody
Looop
Winner:
Shortlisted:
Owning Your Menopause
Womeno
Winner:
Shortlisted:
The Blue Box
Celbrea
Winner:
Shortlisted:
HealCycle
Mor
Winner:
Shortlisted:
HRC Fertility
Mira
Pregnant women’s expectations about postpartum sleep may predict sleep quality after birth, outweighing prior sleep and psychiatric history, a study suggests.
The findings suggest attitudes and beliefs about sleep during pregnancy could be a modifiable risk factor for postpartum sleep concerns.
They also indicate that, among women expecting the poorest sleep, higher postpartum anxiety may further worsen sleep quality.
Sammy Dhaliwal, lead author is clinical health psychologist and research fellow in the department of obstetrics and gynaecology at the Perelman School of Medicine at the University of Pennsylvania.
Dhaliwal said: “Most pregnant women in our sample anticipated poor postpartum sleep before it occurred, and it was striking that those expectations predicted worse sleep outcomes even after accounting for factors such as prior sleep disorders, psychiatric history, and number of previous births.
“This suggests that attitudes and beliefs about sleep during pregnancy may represent a modifiable target for early intervention before postpartum sleep problems emerge.”
Sleep disturbance affects an estimated 60 to 80 per cent of postpartum women and is linked to a higher risk of depression and anxiety.
Researchers said it is often regarded as an expected part of life after childbirth rather than a health issue that may be addressed earlier.
The study enrolled 432 pregnant women at about 24 weeks of gestation, meaning around 24 weeks into pregnancy.
Participants completed measures of their expectations about postpartum sleep, current sleep quality using the Pittsburgh Sleep Quality Index, and mood using validated depression and anxiety scales.
Assessments were repeated at six, 12 and 24 weeks postpartum.
A subset of 49 women also wore wrist actigraphy devices at six to eight weeks postpartum.
Actigraphy uses a wearable device, similar to a watch, to estimate sleep and wake patterns based on movement.
The results showed that 70 per cent of pregnant women, or 301 of 432 participants, expected poor sleep in the postpartum period.
Researchers found that predicted sleep disruption during pregnancy was a significant predictor of postpartum sleep concerns.
Among first-time pregnant women without prior health concerns, those who expected greater sleep disturbance had significantly more disrupted sleep after birth, measured by both actigraphy and self-report.
Among women who expected the worst sleep quality, higher postpartum anxiety significantly worsened both measured sleep and self-reported sleep, independent of anxiety levels during pregnancy.
Dhaliwal said the findings point to two possible areas for intervention: addressing sleep-related beliefs during pregnancy and treating postpartum anxiety.
Dhaliwal said: “Postpartum sleep disruption is often treated only after problems develop, but our findings suggest there may be an opportunity to intervene earlier during pregnancy.
“Addressing sleep-related beliefs and postpartum anxiety during prenatal and postpartum care may help improve sleep and emotional well-being in new mothers.”
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