On World Patient Safety Day 2025, the theme “Safe Care for Every Newborn and Every Child” highlights a simple truth: safety begins with listening, respect, and partnership. The World Health Organization (WHO) estimates that as many as 4 in 10 patients are harmed in primary and ambulatory settings, while up to 80% of this harm can be avoided. Unsafe care ranks among the top 10 leading causes of death and disability worldwide.
Source: WHO Patient Safety
Against this backdrop, the role of independent advocacy becomes more urgent. In Ireland, Georgina Cruise, National Manager of the Patient Advocacy Service, leads a team providing free, independent, and confidential advocacy to patients and families in acute hospitals and nursing homes. Her team supports people making complaints, navigating patient safety incidents, and regaining dignity in the aftermath of harm.
In this blog, you'll discover:
Why independent advocacy improves safety
Importance of making families real partners in safety
What patients are telling us
Frameworks, laws, and the gap in implementation
The future of advocacy
Why Independent Advocacy Improves Safety
At the heart of advocacy is the belief that patient voices matter. As Georgina explained in our interview:
“What we see within our service is that that piece of independent advocacy really does promote safer patient care, and it does that by giving patients a voice. We support patients in communicating their wishes, their needs, and expressing their fears. We ensure, and help them to ensure that their own voices are heard and that they're central to those decisions that are being made around their care.”
This empowerment model has real impact. Globally, WHO’s Patient Safety Action Plan 2021–2030 emphasises engaging and empowering patients as one of its seven key objectives.
Speaking of how they conduct their important work on behalf of patients, Georgina explains:
“As a service, we also look at the systemic advocacy piece. So the more data we collect, the more opportunity there is for us to identify themes and inconsistencies. And that could be a policy and procedural application. And it does give us the opportunity then to raise concerns with relevant stakeholders about potential safety issues, such as poor communications or problems with care delivery.”
In other words, individual complaints feed into system-wide learning. WHO and OECD studies show that without such mechanisms, complaints remain isolated events, with lessons lost. Independent advocacy turns them into drivers of change.
Real improvements have already emerged in Ireland through advocacy-supported complaints. As Georgina noted, cases have led to the introduction of emergency early warning systems, daily nurse manager rounds, improved note-taking systems, and updated communication training. Each of these interventions is not unique to Ireland — they mirror the World Health Organization’s global patient safety strategies, which highlight early detection, effective communication, and strong documentation as critical levers for preventing harm. By embedding these changes in local practice, patient advocacy is helping Ireland contribute to the broader international goal of reducing avoidable harm worldwide.
Making Families Real Partners in Safety
The WHO consistently highlights the need to involve families as equal partners in safety. Georgina has seen how transformative this can be:
“Having that compassionate, empathetic, open and transparent engagement is really vital in that process. Having the opportunity for the person to share their lived experience, feel listened to, and for that learning piece that follows from complaints or patient safety incidents. It really does go a long way to support that ongoing trust in the service and empower the person in their ongoing care.”
Practical steps include:
Asking families directly: “What matters to you?”
Providing jargon-free communication and easy-read materials.
Involving families in care planning from the beginning.
Creating safe, judgment-free channels for raising concerns.
Recognising cultural values and tailoring care accordingly.
These measures align with WHO’s call for patient and family engagement at all levels of health systems, from individual care planning to policy design.
What Patients Are Telling Us
In 2024 alone, the Patient Advocacy Service handled 2,100 inquiries, raising more than 6,500 separate complaint issues. Georgina described how they analyse these cases using a structured tool from the London School of Economics, breaking down issues by severity and type.
The findings?
“Communication is an element of about 60% of what we see. Staff spoke in a condescending manner, questions acknowledged and not responded to, or patients not involved in their care plan. Anxiety being acknowledged but not addressed is a huge issue. Patients not monitored properly, aspects of care plans being overlooked, and then patients provided information dismissed, which can all impact on the patient safety piece.””
These themes are not unique to Ireland. A 2023 analysis in Annals of Internal Medicine found that at least 10% of patient safety incidents worldwide stem from communication failures between healthcare workers, patients, and caregivers. Long waits, dismissive attitudes, and lack of involvement are reported across health systems, whether high-income or low-income.
By capturing data systematically and amplifying patient voices, the Patient Advocacy Service transforms frustration into learning. This is exactly what the WHO’s Global Patient Safety Observatory calls for: turning patient complaints into evidence-based policy change.
Frameworks, Laws, and the Gap in Implementation
Ireland has strong frameworks, from the HSE’s Framework for Improving Quality to the Open Disclosure Policy. But Georgina points to a familiar problem:
“Through our work, we’ve seen that there is room for improvement and it is around consistency of implementation of these frameworks and the legislation across all the services. And that’s about ensuring as well that they’re patient-centered and that there’s a proactive piece there rather than a reactive piece when anything goes wrong.”
Georgina’s observation reflects what has emerged in global patient safety research: legal and policy frameworks are increasingly common, but their effective, consistent application often falls short at the local or frontline level. The WHO Global Patient Safety Report 2024 reveals this gap clearly. Many countries have adopted national patient safety laws, strategies, or policies, yet far fewer report that these policies are implemented comprehensively across all health-care settings, or maintained with fidelity over time
The Future of Advocacy
The Patient Advocacy Service as a nationally commissioned independent advocacy service in Ireland is only five years old, but it is evolving fast. Georgina sees a stronger, more collaborative future:
“From the very start to now, we have seen that patient advocacy is evolving. And I think it’s evolving into a more empowering and collaborative bridge between patients and decision makers or service providers. It’s backed in some ways by the legislation and the frameworks and policies. … There is a greater focus on that person-centered care, that human rights-based approach, rather than that patriarchal best interest care. And I think that will improve safety as it goes along.”
She also points to current and upcoming developments:
Embedding the Assisted Decision-Making Capacity Act, which supports a person’s capacity in making their own — even difficult ones — promoting autonomy and self-determination.
The commencement of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 which introduces a legal requirement for Open Disclosure following a serious notifiable incident and will ensure that patients and their families are informed of any such incidents and are included in any subsequent investigations. The health or social care service is mandated to make an apology and provide information on what has happened.
The review of the HSE’s Incident Management Framework and “Your Service, Your Say” Complaints Policy.
New patient councils at regional and national levels, embedding patient voices in the HSE.
Greater visibility of advocacy in hospitals and nursing homes, so patients and families know where to turn when raising concerns.
Globally, this trajectory aligns with WHO’s goal of making patients co-designers of health systems, not passive recipients of care.
Final Reflection
On World Patient Safety Day, it is easy to focus on frameworks, checklists, and policies. But as Georgina Cruise reminds us, the patient voice is itself a safety tool.
“By empowering patients to advocate for themselves, we not only resolve issues — we create a safer, more respectful healthcare system for all.”
Independent advocacy bridges the gap between patients and systems. It turns individual complaints into collective learning. And when patients, families, advocates, and providers work together, safer care for every newborn, every child, and every person becomes not just an aspiration, but a reality.
If you are interested in discovering how MEG can support your organisation in embedding patient safety into everyday practice, our team is here to help.