Transformation Grant recipients

Detecting non-technical errors in surgical practice and implementing coaching to improve patient safety

This project aims to transform surgical safety by identifying deficiencies in non-technical skills (NTS) that contribute to preventable patient harm and implementing an evidence-based coaching program to improve individual and team performance. Although advances in surgical techniques, technology and perioperative care have substantially reduced technical errors, deficiencies in non-technical skills, including decision-making, communication, leadership, teamwork and situational awareness, remain a major contributor to adverse patient outcomes. Recent work by the investigative team has shown that non-technical errors contribute to approximately 64% of surgical mortality cases in Australia, highlighting a significant and largely unaddressed opportunity to improve patient safety.

Building on this foundation, the project addresses a critical gap in surgical quality improvement by embedding structured assessment of non-technical errors into routine clinical practice and linking these findings to targeted interventions. The study will utilise the Australian and New Zealand Audit of Surgical Mortality (ANZASM), together with prospective implementation across metropolitan and regional hospitals, to identify and characterise non-technical errors associated with surgical morbidity and mortality. The team's validated System for Identification and Categorisation of Non-Technical Errors in Surgical Settings (SICNESS) framework will be refined into the Non-Technical Error Assessment and Reporting System (NOTEARS), enabling structured identification of non-technical errors during routine morbidity and mortality meetings. This represents a significant advance over current approaches, which rely largely on unstructured discussion and do not consistently identify the underlying behavioural and system factors contributing to patient harm.

Information generated through NOTEARS will directly inform a structured coaching program designed to improve decision-making, communication, leadership, teamwork and situational awareness at both individual and team levels. By integrating assessment with targeted coaching and ongoing evaluation, the project establishes a closed-loop quality improvement process that moves beyond identifying errors to implementing measurable solutions. Importantly, the intervention is designed to be practical, scalable and readily incorporated into existing clinical governance processes, allowing rapid translation into routine surgical practice without requiring substantial new infrastructure or resources.

This multidisciplinary collaboration brings together nationally recognised experts in surgical quality, clinical governance, human factors, implementation science, surgical education and health services research. The investigative team includes Professor Guy Maddern (Lead Researcher), Associate Professor Philip McCahy, Associate Professor Kerrin Fielding, Dr Markus Trochsler, Professor Wendy Babidge, Dr Jesse Ey and Miss Ellie Treloar. Collectively, the team has extensive experience leading national clinical audits, multicentre implementation studies, surgical education programs and health policy initiatives. Their complementary expertise ensures the project is well positioned to deliver high-quality research while facilitating rapid translation into clinical practice, professional education and national policy.

Professor Guy Maddern will lead the project. As R.P. Jepson Professor of Surgery at Adelaide University, Director of Research at the Basil Hetzel Institute for Translational Health and Chair of the Australian and New Zealand Audit of Surgical Mortality (ANZASM), he has extensive experience leading national collaborative research programs that have directly influenced surgical quality improvement across Australia and New Zealand. He has authored more than 746 peer-reviewed publications, eight books and 31 book chapters, has an h-index of 77, and has supervised 44 higher degree research candidates to completion. His longstanding leadership of ANZASM and established collaborations with the Royal Australasian College of Surgeons, health services and policymakers provide a strong foundation for successful delivery of this project and widespread implementation of its findings.

The project builds directly on the team's recent high-impact research, including development and validation of the SICNESS framework, national studies demonstrating the burden of non-technical errors in surgical mortality, and evidence that structured coaching improves non-technical skills in both metropolitan and rural settings. By combining these complementary research programs into a single implementation study, the project will provide the first evidence-based, standardised and scalable framework for detecting non-technical errors, implementing targeted coaching and evaluating their impact on patient outcomes. The anticipated outputs, including the NOTEARS framework, coaching curriculum and implementation resources, have the potential to be adopted nationally through the Royal Australasian College of Surgeons and integrated into routine clinical governance, continuing professional development and quality improvement programs. In doing so, the project aims to strengthen surgical performance, improve patient safety and reduce preventable harm across the Australian healthcare system.

Dynamic adjustment of brain network activity to treat depression

The Black Dog Institute is advancing an innovative research program to develop a novel, non-invasive treatment for depression using closed-loop network modulation (CLNM), led by Dr Stevan Nikolin and a multidisciplinary research team.

As a runner-up of the Avant Foundation Transformation Grant, the project will receive funding to support a proof-of-concept efficacy study investigating CLNM as a potential new treatment approach for depression.

A new approach to treating depression

Depression is a leading cause of disability globally and places a substantial burden on individuals and healthcare systems. It is increasingly understood as a disorder involving dysfunction across large-scale networks of the brain.

One network of particular interest is the default mode network (DMN), which is involved in self-referential thinking, memory and internal thought. The DMN is consistently found to be overactive in people experiencing depression and is associated with rumination, brooding and negative patterns of thinking.

CLNM aims to address this dysfunction directly. Using electroencephalography (EEG), the system monitors brain activity in real time, detects elevated DMN activity and provides targeted feedback designed to disrupt maladaptive patterns and promote more adaptive brain functioning. Unlike traditional treatment approaches, CLNM is designed to respond to an individual's brain state and adjust the intervention accordingly.

The research

The project will involve a randomised, triple-blind controlled trial with 62 adults experiencing mild to moderate depressive symptoms. Participants will undertake a two-week intervention, receiving either active CLNM or a control condition.

Researchers will assess changes in DMN activity using EEG, alongside depressive symptoms, functional MRI measures, safety and participants' experiences of the treatment. The study will build on preliminary work demonstrating that CLNM can reduce DMN activity in real time.

A key component of the research is also exploring remote delivery using portable EEG devices. If successful, this could support a more scalable treatment that can be delivered beyond traditional clinical settings, potentially improving access for people living in rural or underserved communities.

Building towards future treatments

The runner-up funding will generate important preliminary clinical and neurophysiological data to guide further development of CLNM and support future applications for larger Phase 2 and Phase 3 randomised controlled trials.

The project represents a move towards more personalised approaches to depression treatment, combining brain monitoring, real-time feedback and targeted intervention. Rather than treating symptoms alone, CLNM aims to identify and modify dysfunctional neural activity as it occurs.

In the longer term, this research has the potential to contribute to a new generation of precision, non-invasive and technology-driven treatments for depression, complementing existing therapies and offering new possibilities for people who do not respond adequately to current treatment options.

Transforming intrapartum care through real-time artificial intelligence

Fetal asphyxia during labour remains a major cause of stillbirth, neonatal death, and lifelong disability. Although cardiotocography (CTG) is the global standard for fetal monitoring, outcomes have not improved proportionally due to subjective and inconsistent interpretation.

This research program, led by A/Prof Fiona Brownfoot at the University of Melbourne, addresses this gap by transforming how CTG data are analysed and applied. It is built on one of the world’s largest curated CTG datasets, linking raw fetal heart rate signals with detailed maternal and neonatal outcomes. Unlike traditional methods that rely on simplified traces, this approach uses minimally processed data to better capture the physiology of labour.

A key finding is that signal artefact - previously considered noise - has clinical value. Features such as fetal heart rate dropout and maternal–fetal signal coincidence predict perinatal asphyxia, challenging existing assumptions about CTG interpretation.

The team developed a hybrid human–AI model combining clinician-informed features with machine learning and deep learning. In multicentre retrospective studies, it improved detection of fetal asphyxia by 54% compared with clinicians, while maintaining equivalent specificity. The model is interpretable, supporting clinical decision-making.

This work is now being translated into real-time care through the REALM system (Real-time Ensemble Alerting and Learning Model), which updates risk predictions every 30 seconds during labour. By analysing labour as a dynamic process, it provides clinicians with actionable lead time - often over 40 minutes - to respond to fetal compromise.

Designed with clinician and consumer input, the system aligns with real-world workflows and regulatory standards. Scalable and vendor-agnostic, it can integrate into existing systems across diverse healthcare settings.

Overall, this research shifts fetal monitoring from subjective interpretation to real-time, data-driven decision support, with the potential to improve safety, reduce harm, and enhance consistency in intrapartum care.

Professor Russell Dale and Dr Shrujna Patel

Pioneering a new era: epigenetic therapies to transform neurodevelopmental disorders

A new era of epigenetic therapeutics is on the horizon - unlocking the potential for children with neurodevelopmental disorders to thrive

For over three decades, Professor Russell Dale has been on a mission to crack one of medicine’s toughest puzzles: how to better understand and treat neurodevelopmental disorders in children. Based at the University of Sydney and the Children’s Hospital at Westmead, this leading paediatric neurologist is pioneering research that could transform the lives of thousands of children and families.

With 33 years of medical experience, 18 as a consultant neurologist and 10 as a professor, Professor Dale has witnessed a seismic shift in medicine. “We’ve moved from making a diagnosis based only on symptoms to understanding the biology behind disease,” he explains. His passion? Biomarkers, the biological clues that can unlock how diseases develop and how they can be treated. More specifically, his focus lies in the intricate dance between the immune system and the brain.

The developing brain is an extraordinary, ever-changing organ, shaping and reshaping itself from conception through to early adulthood. But when this process goes off track, neurodevelopmental disorders like autism, ADHD and Tourette syndrome can arise. These conditions affect 10% of children and carry a heavy societal burden—from healthcare costs to lost opportunities.

“What’s heartbreaking,” Professor Dale says, “is the families who watch their child lose skills, experience regression or face worsening symptoms after stress or illness, only to hear ‘there’s nothing we can do’.” This ‘medical nihilism’ leaves many families feeling unheard and hopeless.

Unlike rare genetic disorders with clear causes, most neurodevelopmental disorders result from a complex interplay of genes and environment. Factors like infection, stress and diet can influence gene expression through epigenetics—how genes are switched on or off without changing the DNA itself.

At the heart of Professor Dale’s research is chromatin, the structure that wraps DNA inside cells and controls gene activity. “When chromatin is tightly wrapped, genes stay silent; when it’s open, genes are active,” he explains. Dysregulation of this system, he believes, is a missing piece in understanding why some children develop neurodevelopmental disorders.

What makes this research exciting is its potential for intervention. Some existing therapies, like the ketogenic diet, produce metabolites (such as butyrate) that can ‘open’ chromatin and modify gene expression. Professor Dale and his team have developed a modified form of butyrate designed to reach the brain more effectively. Early lab tests show it can reverse inflammatory markers tied to neurodevelopmental issues.

Thanks to winning the flagship $1m Transformation Grant from Avant Foundation, this promising research is moving towards clinical trials. The goal? To deliver the first disease-modifying treatments for neurodevelopmental disorders, offering hope where few options currently exist.

This groundbreaking work is a team effort. Neuroscientists, clinicians, dietitians and bioinformaticians work side by side in the vibrant Westmead research precinct, home to the University of Sydney, Australia's largest children's hospital network, and top medical research institutes. “The clinician-scientist partnership is crucial,” Professor Dale emphasises. “We listen to families and bring cutting-edge science to the bedside.”

In the next decade, Professor Dale, and his scientific colleague Dr Shrujna Patel, envision a future where neurodevelopmental disorders are understood through biological markers, enabling personalised treatments tailored to each child’s unique profile. “It’s about moving beyond symptom management to truly modifying disease pathways.”

His work is a beacon of hope, not just for scientists and doctors, but for the families whose stories fuel this journey. “We hear you,” Professor Dale says. “And we’re working tirelessly to help kids reach their full potential.”

To see a video about this project and read our annual report, click here

Lead Researcher, Professor Stephen Jan and Tracey Johnson

Enabling the Quality General Practice of the Future: The case for investment and the pathway to implementation across Australia

The George Institute for Global Health: transforming general practice in Australia

The George Institute for Global Health is a leading research organisation dedicated to improving healthcare through innovative, evidence-based solutions. Central to its mission is strengthening primary care, especially general practice, which is the backbone of Australia’s healthcare system.

Professor Stephen Jan from the George Institute, along with Tracey Johnson, Chief Executive Officer of Inala Primary Care in Brisbane, lead a team of health systems researchers and representatives from primary care organisations across Australia to drive efforts to transform general practice nationally. Professor Jan is a health economist with expertise in advising how investments in healthcare resources can maximise population health. Tracey Johnson specialises in health economics and health sciences research, and draws on her experience in managing primary care services, to ensure that innovations in care are effectively adopted in real-world settings. The team also includes: Ray Messom, Non-executive Director and Co-founder of Healthicare, a not-for-profit organisation in Western Sydney; Dr Paresh Dawda, Co-founder, Director and Principal of Next Practice Deakin (Clinical); Dr Anne-Marie Feyer, Deputy Chair of the Western Sydney Primary Health Network and Director of the National Primary and Acute Care Data Linkage Project in Sydney; Dr Coralie Wales, a consumer representative based in Sydney; and Professor David Peiris, Anna Campain, Associate Professor Hueiming Liu and Dr Gill Schierhout – health systems researchers from the George Institute. This group will develop strategies to create a more efficient and sustainable primary care system in Australia.

Australian general practice faces increasing pressures from an ageing population and rising chronic disease rates. Current care models are often reactive, with GPs receiving government funding through Medicare, based on service volume rather than patient outcomes. This limits their ability to provide comprehensive, preventive and coordinated services.

The George Institute advocates for greater targeted investment in infrastructure, workforce development and digital technology to enable high-quality, patient-centred care. The Institute emphasises integrated care teams, where GPs work alongside specialists and allied health professionals to better manage complex health needs for patients.

Digital tools and data analytics are crucial for supporting clinical decisions and tracking patient outcomes. Funding reforms that reward quality over quantity can motivate practices to focus on prevention and long-term health improvements. Additionally, enhanced training ensures the workforce can meet evolving healthcare challenges.

Through their research and advocacy, Professor Jan and Tracey Johnson provide a clear case for transforming general practice into a more sustainable and effective system. Their work supports improved patient outcomes, reduced hospitalisations and equitable access to care. The George Institute’s vision ensures general practice remains central to a responsive and strong Australian healthcare system.

To read our annual report and learn more about other grants, click here.

Lead Researcher, Professor André van Zundert

Improving anaesthesia recovery with patient-tailored anaesthesia reversal agents

The University of Queensland: leading innovation in health research

The University of Queensland (UQ) continues to affirm its position as one of Australia’s foremost research-intensive universities, dedicated to advancing knowledge and delivering real-world solutions. With a strong tradition of academic excellence, UQ has consistently ranked among the top 50 universities globally and is a founding member of the Group of Eight (Go8), Australia’s coalition of leading research universities.

In 2025, UQ maintains its reputation as a hub for cutting-edge innovation across a broad range of disciplines, with particular strength in medical and health research. The university is home to world-class research centres, state-of-the-art facilities, and internationally renowned scholars who are driving major advances in human health and clinical care.

One such leader is Professor André van Zundert, Chair of Anaesthesiology at UQ, and a senior consultant anaesthetist with five decades of clinical experience. Professor van Zundert is a recognised authority in anaesthesiology, both in Australia and internationally, and has published extensively on airway management, regional and obstetric anaesthesia, and patient safety.

In 2025, Professor van Zundert, and his interdisciplinary team, submitted a proposal for a highly innovative project titled ‘Improving Anaesthesia Recovery with Patient-Tailored Anaesthesia Reversal Agents’. The research seeks to address one of the most overlooked challenges in modern medicine: the absence of pharmacological agents to actively reverse general anaesthesia.

Despite the routine nature of general anaesthesia in modern surgery, recovery remains an uncontrolled, passive process. Currently, there is no ‘antidote’ for general anaesthetic drugs such as propofol (administered intravenously) and sevoflurane (delivered via inhalation), which are commonly used in combination. While most patients regain consciousness relatively quickly, others – particularly older individuals or those with cognitive vulnerabilities – may experience delayed or incomplete recovery of cognitive function.

While competitive post-synaptic ‘reversal agents’ are currently available for some specific agents, e.g. Flumazenil for most benzodiazepines, a universal, single, pre-synaptic agent acting on the syntaxin pathway, which would rapidly reverse any combination of anaesthetic agents, presents the anaesthesiologist with an entirely new universe in which to operate. To ‘wake up’ from an anaesthetic with a clear mind and no hangover could dramatically reduce complications such as postoperative delirium and cognitive decline, and render anaesthesia much safer and more pleasant for many millions of patients receiving an anaesthetic worldwide annually.

What makes this project particularly innovative is the use of bioengineered human neural cultures and neurocomputation platforms developed in partnership with the Melbourne-based biotech company Cortical Labs. These lab-grown networks of human neurons, derived from induced pluripotent stem cells (iPSCs), are capable of performing basic learning tasks within a closed-loop system that mimics brain-like cognitive processing. This advanced model provides a human-relevant, animal-free method to test whether reversal agents can rapidly restore not only neural activity but also cognitive function after anaesthesia.

Additionally, the team plans to use genetically diverse neuronal cultures that reflect real-world variability in how patients respond to anaesthetic agents. This patient-specific model aligns with the growing focus on precision medicine, allowing for the development of tailored reversal agents based on individual genetic profiles.

If successful, the project could fundamentally transform the practice of anaesthesia by introducing the first targeted reversal therapy for general anaesthetic drugs. It would also deepen scientific understanding of how anaesthetics work – a longstanding mystery in medicine – and pave the way for safer, more controlled surgical recoveries.

To read our annual report and learn more about other grants, click here.