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BMJ Qual Saf 21:576-585 doi:10.1136/bmjqs-2011-000603
  • Original research

Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety?

Open Access
  1. Naomi Fulop
  1. NIHR King's Patient Safety and Service Quality Research Centre, King's College London, London, UK
  1. Correspondence to Professor Naomi Fulop, Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; n.fulop{at}ucl.ac.uk
  1. Contributors JH was involved in the conception and study design; data collection, analysis and interpretation; and was the main author. RW contributed to the analysis and interpretation of the data and drafting the paper. NF was involved in the conception and the study design, and contributed to the data analysis and drafting the paper.

  • Accepted 27 March 2012
  • Published Online First 3 May 2012

Abstract

Introduction National Health Service hospitals and government agencies are increasingly using mortality rates to monitor the quality of inpatient care. Mortality and Morbidity (M&M) meetings, established to review deaths as part of professional learning, have the potential to provide hospital boards with the assurance that patients are not dying as a consequence of unsafe clinical practices. This paper examines whether and how these meetings can contribute to the governance of patient safety.

Methods To understand the arrangement and role of M&M meetings in an English hospital, non-participant observations of meetings (n=9) and semistructured interviews with meeting chairs (n=19) were carried out. Following this, a structured mortality review process was codesigned and introduced into three clinical specialties over 12 months. A qualitative approach of observations (n=30) and interviews (n=40) was used to examine the impact on meetings and on frontline clinicians, managers and board members.

Findings The initial study of M&M meetings showed a considerable variation in the way deaths were reviewed and a lack of integration of these meetings into the hospital's governance framework. The introduction of the standardised mortality review process strengthened these processes. Clinicians supported its inclusion into M&M meetings and managers and board members saw that a standardised trust-wide process offered greater levels of assurance.

Conclusion M&M meetings already exist in many healthcare organisations and provide a governance resource that is underutilised. They can improve accountability of mortality data and support quality improvement without compromising professional learning, especially when facilitated by a standardised mortality review process.

Footnotes

  • Funding The NIHR King's Patient Safety and Service Quality Research Centre (King's PSSQ) is part of the National Institute for Health Research (NIHR) and is funded by the Department of Health.

  • Disclaimer This report presents independent research commissioned by the NIHR. The views expressed in this report are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval NHS Ethical Approval Granted (REC ref 09/H0807/74).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request from the corresponding author.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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