Poppy Russell lived for just 12 hours. She died in April 2021 at the Princess Royal Hospital in Telford after suffering a brain injury during birth. An inquest concluded that her death was preventable.

Her parents, Neil and Katie Russell, then faced another ordeal: the hospital trust blamed Katie, alleging she had refused foetal monitoring. That allegation was found to be untrue.

Rather than walking away, Neil and Katie are now working with the hospital to improve care. Their initiative, Poppy’s Promise, is built around four principles: compassion, acknowledgement, respect and empowerment. The Shrewsbury and Telford Hospital NHS Trust is introducing it across approximately 8,000 staff.

Their work comes at a critical time. In June, Baroness Valerie Amos published the final report of the national investigation into maternity and neonatal services in England. Across the 12 trusts examined, women described being dismissed, excluded from decisions and left without answers when things went wrong.

A national action plan is expected in December. Poppy’s Promise offers a practical response to a question facing the NHS: how can listening become a routine part of care?

During pregnancy, Katie told midwives she had a fear of childbirth and wanted a caesarean section. According to her account, she was repeatedly told she could not simply request one.

During labour, she described being left without care for long periods, with inadequate monitoring and missed signs that Poppy was in distress. An emergency caesarean was eventually performed, but too late. The inquest concluded that Poppy would have survived had she been delivered an hour earlier.

There were serious medical failures, as well as problems with communication. But Katie’s experience illustrates why listening to patients matters: concerns that are dismissed can have devastating consequences.

Empathy is part of safe care

Empathy is often understood as being kind or reassuring. But research suggests it involves more than that. Healthcare empathy means trying to understand a patient’s perspective, asking questions and then taking useful action.

In Katie’s case, this would have meant exploring why she feared childbirth, what she needed to feel safe and what options were available. Depending on the circumstances, the response might have included a referral, a revised birth plan or closer attention during labour.

Sometimes the right action is reassurance. Sometimes it means investigating a symptom, reconsidering a decision or escalating a concern. Empathy helps healthcare professionals make better-informed decisions about patients’ needs and safety.

There is evidence that communication failures contribute to patient harm. My colleagues and I recently published a systematic review examining the relationship between poor communication and patient safety. Across 46 studies involving around 68,000 patients, poor communication was identified as the sole cause of roughly one in ten patient-safety incidents. It contributed alongside other factors in roughly one in four.

These failures occur between healthcare professionals as well as between staff and patients. A warning that is not passed on, a concern that is dismissed or a patient’s account that is not taken seriously can all have serious consequences.

This issue is personal to me. My first memory is of being two years old, when my baby brother Alexander died of cot death. At the time, parents were advised to put babies to sleep on their stomachs. This advice was later reversed after evidence showed that sleeping on the back reduced the risk of sudden infant death. Cot deaths subsequently fell sharply.

For 25 years, I have investigated whether empathy should be treated as an evidence-based part of healthcare rather than simply a desirable personal quality.

Changing the system, not just the individual

Even compassionate professionals struggle to provide good care when departments are understaffed, workloads are overwhelming or their organisations fail to listen to them. The Amos review highlighted chronic staffing shortages, burnout and excessive demand.

Telling an overstretched midwife to be more empathic or compassionate, without addressing the conditions in which they work, is unlikely to be enough. My colleagues and I have therefore argued for empathic healthcare systems that support better care through leadership, teamwork, working conditions and organisational priorities.

Poppy’s Promise takes a similar approach. Its implementation programme covers education, recruitment, staff training, interactions with patients and feedback, while also addressing leadership and workplace culture. The aim is to make listening part of how the hospital operates, rather than an extra task that disappears under pressure.

My colleagues and I have also been developing an approach to improve empathy across NHS maternity services. In a study published in BMJ Open Quality, we described the development and pilot evaluation of a programme involving healthcare professionals, teams, leaders and the wider organisation. A total of 177 maternity staff took part and 76% reported improvements in empathy.

The project also produced seven proposals for organisational change, some of which were implemented. But this was a small feasibility study in one NHS trust, without a comparison (“control”) group. It cannot establish whether the programme improved patient outcomes. We are planning a larger evaluation (with a control group) to investigate this.

Poppy’s Promise brings something research alone cannot: a family who knows the consequences of not being heard, and a hospital trust willing to change. Research can help identify effective approaches and test whether they make care safer. Problems of this scale need all the help they can get, from families, doctors, managers and researchers alike.

Success should not be measured by how many staff complete training. It should be measured by whether women feel heard, whether their concerns are acted on, whether staff feel supported and, ultimately, whether fewer mothers and babies come to harm.

That responsibility cannot rest with bereaved families or individual healthcare professionals working under extraordinary pressure. Healthcare organisations must create the conditions for empathic care.

Katie and Neil’s determination to protect other families deserves support. Empathy cannot replace medical competence, but it is an essential part of safe care. Poppy’s legacy could be a maternity system in which every woman is listened to and her concerns taken seriously.