Mortality and morbidity (M&M) meetings have been taking place in various forms since the beginning of modern medical practice. Initially these meetings were used to help inform surgical training, by taking time to discuss adverse outcomes.

In today’s healthcare settings, these meetings are no longer just an opportunity to educate trainees. Consultant surgeons, surgical units and hospitals make use of these meetings to learn lessons from clinical outcomes and drive improvements in service delivery.

Mortality and morbidity review meetings provide a systematic approach to reviewing patient deaths and complications in care, as part of professional learning. They offer a unique opportunity for learning and action close to the patient care episode. The meetings give ownership to clinical care teams and offer a direct opportunity to improve care delivery in a timely manner.

The Scottish Mortality and Morbidity Programme (SMMP) has been established to provide structure, support and offer standardised approaches to mortality and morbidity review meetings and related processes. This programme will be able to help NHS Boards improve such process, identify opportunities for improving patient care and share learning.

There are examples of good practice across NHSScotland, yet there exists significant variation in the governance, structure, practice and presentation of outputs. This presents a loss of opportunity for shared learning and improvement. The SMMP has strived to support a systematic approach to the mortality and morbidity process by developing national practice guidance.  The guidance, inclusive of toolkit, offers the flexibility to allow for adaptations to fit with current clinical practice in order to identify learning which can be shared locally and nationally.


" The work of the SMMP will help us to better understand and address the wider issues surrounding deaths, complications, near-misses and overall patient outcomes. The programme allows us to design, test and implement reliable peer review processes in hospitals across Scotland, through the provision of a structured and where appropriate consistent approach to mortality and morbidity reviews. "

Manoj Kumar   |   National Clinical Lead SMMP, Healthcare Improvement Scotland and Consultant General Surgeon, NHS Grampian

Project Aims and Objectives

The Scottish M&M Programme’s aim is to enhance learning opportunities and improvement from M&M meetings to advance the quality of care across health and social care in Scotland.

The objectives are to improve the mortality and morbidity review process through:

  • Learning and training: To provide skills and support to run an effective mortality and morbidity meeting
  • Sharing learning: Working across NHS Boards to share learning from M&M to promote a positive safety culture
  • Technology: advise and facilitate discussions on technology and IT systems to support mortality and morbidity reviews


This information is intended for all clinical teams and the practice guidance can be adapted by individual departments or services where necessary.

" The benefits of the work of the SMMP is far reaching; helping to improve local learning from deaths, supporting local action to reduce HSMR; and providing thematic national data for improvement and improved governance at local and national level in relation to mortality reviews. "

Brian Robson   |   Executive Clinical Director, Healthcare Improvement Scotland