title: Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety?
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: Higginson
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Walters
authors.forename: Naomi
authors.initials: N
authors.lastname: Fulop
mesh_terms: D000288:Administrative Personnel / Q000941:ethics / Q000523:psychology / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D054976:Clinical Governance; D006126:Group Processes; D017052:Hospital Mortality / Q000639:trends; D006784:Hospitals, Teaching / Q000941:ethics; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000592:standards; D009313:National Health Programs; D061214:Patient Safety / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D014798:Vital Statistics