The former chief executive of Ramsay Health Care Australia explains why leadership responsibility is as important as compliance with national patient safety standards.
Carmel Monaghan is one of the most respected leaders in global healthcare. The former chief executive of Ramsay Health Care Australia, she spent 27 years with the group before recently joining Maulin Group’s global strategic advisory board. Here she talks to Healthcare Today about why clinical quality and patient safety are inseparable from operational or financial performance, the differences between the regulatory environments in Australia and the UK, and national reporting standards.
How have your experiences at the frontline of hospital performance shaped your views on what healthcare should look like in practice?
My experience has reinforced my belief that high-performing healthcare systems consistently share three core characteristics.
First, they are patient-centred – the patient always comes first, and when care is designed around patient outcomes and experience, everything else follows. Next, they are clinician-led. Doctors, nurses and allied health professionals are not just service providers but partners in care delivery. The strongest outcomes come when clinicians are actively involved in governance, feedback loops, medical and surgical committees and continuous improvement processes. A strong partnership between clinicians and management is critical.
Finally, the best systems make sustained investments in teaching, training and research. These are not just “nice-to-haves”, they are fundamental to delivering safe, evidence-based care and to continuously improving outcomes over time.
“I’ve always believed that clinical quality and patient safety are not in competition with operational or financial performance – they are inseparable.”
During your time at Ramsay, how did you balance clinical quality and patient safety priorities with operational pressures such as demand growth, workforce constraints and financial sustainability?
I’ve always believed that clinical quality and patient safety are not in competition with operational or financial performance – they are inseparable. Paul Ramsay, the founder of Ramsay Health Care, often said: “If you look after the patient, the rest will follow.” That philosophy guided my leadership approach. When patients receive safe, high-quality care and clinical risk is reduced, outcomes improve, staff engagement improves, and organisations become more sustainable.
This was especially evident during the COVID-19 pandemic. The business impact was significant, but our absolute priority was the safety of patients, staff and doctors. That focus enabled us to navigate extraordinary operational challenges while maintaining trust and performance.
Alongside day-to-day operational management, I deliberately invested in long-term quality and safety enablers – programs such as the Vanderbilt Speaking Up for Safety approach, participation in national and international clinical registries, and the expansion of teaching and research. These are sometimes viewed as costs, but in reality, they are investments that drive better outcomes, lower risk, and stronger performance over time.
What made you join Maulin Group’s strategic advisory team?
I am a strong believer in evidence-based, continuous learning, both at an individual and system level. Despite advances in healthcare, there remains enormous untapped potential to share learning more effectively across professions, facilities, sectors and jurisdictions.
Maulin Group brings together several complementary capabilities: medico-legal insight, indemnity, risk management, data, technology and a healthcare media network. That combination positions the organisation well to support learning from real-world experience, to identify emerging risks, and to translate insight into practical improvement.
At this stage of my career, I am particularly motivated to contribute to initiatives that help healthcare systems learn faster and safer, and Maulin’s integrated model provides a credible platform to support that ambition.
“The UK benefits from the scale and centralisation of the NHS, which enables powerful system-wide monitoring, benchmarking and policy evaluation.”
What specific gaps or opportunities in current UK/Australian systems do you think Maulin Group can address?
Healthcare is still highly siloed. There are further opportunities for shared learnings between professions, between public/private systems and across jurisdictions such as the UK and Australia that face similar challenges and operate to high clinical standards. That fragmentation limits the speed at which learning and development can occur.
I am particularly interested in the role of data-informed insight, using aggregated, real-world data to identify patterns of risk, variation in outcomes and opportunities for improvement. Organisations that can help translate complex data into practical learning for clinicians, managers and policymakers can make a meaningful contribution to quality and safety.
What differences do you see between the regulatory environments in Australia and the UK in terms of driving quality improvement and patient safety? Which elements from each system could be adopted cross-jurisdictionally?
Both Australia and the UK are world-leading in their use of clinical registries and data to drive improvement. Australia has long-established national clinical quality registries in areas such as joint replacement, cardiac care, trauma, bariatric surgery and cancer, with strong data linkage and academic research capability. These registries have materially improved outcomes.
The UK benefits from the scale and centralisation of the NHS, which enables powerful system-wide monitoring, benchmarking and policy evaluation.
There are opportunities for cross-learning. The UK could potentially leverage its vast datasets more flexibly for bespoke research and outcomes analysis, including greater linkage beyond NHS data where appropriate. In Australia, state-based governance can sometimes inhibit national consistency, and there is scope to further align approaches across jurisdictions.
Access to timely diagnosis and treatment is also critical. Australia’s mixed public-private system helps relieve pressure on the public sector and improves access for vulnerable patients. Evidence such as the CONCORD cancer survival studies demonstrates that faster access translates into better outcomes. Australia now has some of the highest five-year cancer survival rates globally because of this.
There is a huge drive from Australia to attract UK healthcare professionals – is this working on the ground?
Workforce shortages are a global issue and will only intensify as populations age. Not all clinicians want to relocate internationally, but for those who do, we should be making mobility simpler and more efficient – particularly between countries like the UK and Australia, where education and training standards are well aligned. There are still too many barriers.
In the UK, we see well-trained nurses unable to secure clinical placements and working outside healthcare altogether. In Australia, the cost, time and bureaucracy involved in bringing in UK-trained nurses and clinicians can be prohibitive.
Reducing unnecessary regulatory and administrative hurdles would benefit both systems and help ensure skilled professionals are able to work where they are most needed.
“Leadership responsibility extends beyond compliance.”
When you led Ramsay, how did you engage with national quality standards and reporting like the NSQHS safety standards in Australia? Are there any useful parallels for UK quality reporting mechanisms?
Australia’s national quality standards have evolved well over several decades and now provide a strong, appropriate baseline for safe care.
The introduction of short-notice accreditation against these standards was a particularly positive development in Australia. As a leader, it provided me with greater assurance that hospitals were meeting standards consistently, not just at accreditation time!
Adherence to standards alone is not enough, however. Leadership responsibility extends beyond compliance. At Ramsay, I ensured we had strong national and hospital-level clinical governance capability, including the appointment of a chief nurse and head of clinical governance. One of the most important roles of that function was driving shared learning and continuous improvement across hospitals. This approach was mirrored in our UK operations, and learnings were actively shared between countries to continually lift performance.
How do you ensure data generated at the point of care feeds back into operational decision-making and strategy rather than just meeting reporting requirements?
I have two examples of how data changed our strategy from my own experience.
The first is the expansion of clinical trials within Ramsay’s cancer services. They began after we observed that a single site running trials not only offered patients new treatment options, but also lifted overall care quality through stronger protocols, monitoring and clinical discipline. That insight informed a broader strategy, and Ramsay is now a leader in cancer care delivery in Australia.
The second was my exposure to outcomes data through an ICHOM conference in London. Evidence showed that participation in clinical registries was one of the strongest predictors of improved outcomes. From that point, Ramsay expanded registry participation wherever possible and established clinician-led national committees to review results and drive improvement.
In both cases, data-informed strategy, governance and investment, not just reporting.
Looking ahead, what changes or innovations in quality and safety do you think will have the biggest impact in Australia, the UK, or globally?
It’s hard to go past technology and specifically AI. When embedded thoughtfully into clinical workflows, AI can help detect errors earlier, reduce medication and diagnostic risks, standardise best practice, and reduce unwarranted variation. Just as importantly, it can reduce administrative burden and cognitive overload for clinicians, freeing up time for more personalised, human-centred care.
The key will be implementation – ensuring AI supports clinicians rather than replaces judgment, and that safety, transparency and governance remain central.
Where do you see the greatest opportunities for collaboration between public systems like the NHS and private sector innovators like Maulin?
Private sector organisations can often move more quickly – testing ideas, conducting bespoke research, and implementing innovation with less bureaucracy.
The greatest opportunity lies in collaborative models where public systems define the problems, and private organisations bring agility, specialist capability and data-driven insight to help solve them.
When collaboration is focused on shared goals – improving quality, safety and outcomes – rather than organisational boundaries, both sectors and, most importantly, patients benefit.
