Ruth has worked in North Cumbria since 2006, with an increasing role and commitment to medical leadership and quality improvement relating to patient safety. She is a Health Foundation GenQ fellow – and has become increasingly involved in promoting and leading a multi-professional networked approach to addressing the complexity of improvement for safety. She initiated training and work to implement and establish a systems based approach to Serious Incident investigation in North Cumbria from 2018, which now proves good preparation for introduction of new patient safety incident investigations. She is Head of School of North Cumbria School of Generalism – the first Health Education England “Enhance trailblazer” to launch in 2021, delivering a one year program of place based training to a multi-professional cohort. She recognises the value of networks and relationships build both within and beyond organisation to develop, share and sustain improvement.