Managing Deterioration and Martha’s Rule Programme

About the programme

The aim of the Managing Deterioration and Martha’s Rule Programme is to Improve the Prevention, Identification, Escalation and Response (PIER) to physical deterioration, through the implementation of Martha’s Rule.

Martha’s Rule is an initiative to support the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to and acted upon.

The two areas of focus for this year’s programme (2026-27) are to:

• Support the implementation of Martha’s Rule in all acute hospital sites (adult and paediatric inpatients)
• Support maternity and neonatal services to test and implement Martha’s Rule
• As lead for a national pilot we are also supporting Emergency Departments and other PSCs to test and implement Martha’s Rule.

Who we are working with

We are working with all 13 acute trusts in Yorkshire and the Humber.

Main deliverables

We are supporting the trusts to implement Martha’s Rule. Working collaboratively with the local Paediatric Critical Care Operational Delivery Networks (PCC ODNs) and Adult Critical Care Operational Delivery Networks (ACC ODNs), we are using a systematic approach to implement Martha’s Rule.

The model for support is agreed locally between us, the trusts and the local ODNs and we guide teams based on learning to date, supporting learning communities to share ideas and learning as it emerges.

We support by:

• Providing expertise and coaching in Quality Improvement (QI) methods.
• Maintaining effective stakeholder engagement with key colleagues.
• Bringing together teams and all relevant system stakeholders to nurture learning via a dynamic learning community, webinars, workshops and rapid insights sessions.
• Working with all those involved in this programme – site-based or system/region-based – providing a safe space to think, acting as a critical friend and mentor.
• Providing enhanced support where needed.
• Supporting systems to use methodologies for sustaining change and improvement and share the learning across sites, systems, regions and with the National Martha’s Rule and Manging Deterioration Programme team.
• Supporting systems to identify and understand the impact of Martha’s Rule using measurement methods.

How to get involved

Please contact Dr Lizzie Sweeting Managing Deterioration and Martha’s Rule Workstream lead elizabeth.sweeting@yhia.nhs.uk

 Martha’s Rule in Emergency Departments – national pilot

In addition to our work across Yorkshire and the Humber we have been delivering a pilot to understand how to implement Martha’s Rule in Emergency Departments.

This has involved working collaboratively with nine emergency departments across England, testing ideas and curating learning to understand both the challenges and enablers.

This work is continuing during 2026-27, working closely with the pilot sites and supporting all PSCs as they start to work with emergency departments in their regions.

To learn more about this work or to get involved, contact:

Mel Johnson on  melanie.johnson@yhia.nhs.uk