Structured Judgement Review Programme


In A Nutshell:

Since 2014, we have been working with acute, community and mental health trusts on a systematic, evidence-based mortality review programme that can drive improvement in the quality and safety of patient care. The Improvement Academy is working to deliver training in this method directly to front-line staff across the UK.

What is Structured Judgment Review (SJR)?

The structured judgement case note review method was developed and validated by Professor Allen Hutchinson at the University of Sheffield. This methodology allows trained reviewers to identify and describe the quality of care received and in doing so, to create a score of that quality.

Regional Mortality Programme

The Improvement Academy has delivered more than 60 training sessions across 19 acute and mental health trusts within the Yorkshire and Humber region. Over 800 clinical staff have been trained across different specialties, departments and roles from consultants and registrars to specialist nurses and patient safety leads. Thematic analysis of the findings of case note reviews is undertaken by the organisations, enabling targeted improvement initiatives.

We recognise the need for a more systematic approach to thematic analysis, improvement work and shared learning across the region and are working with regional teams to develop this. The Regional Mortality Network enables region wide collaboration and learning (please see link to network page below). Some examples of local learning and improvement have been captured in case studies featured in the PDF download section below.

The National Programme

NHS England commissioned the National Mortality Case Record Review (NMCRR) Programme to support the standardisation of, and learning from, mortality case note reviews in NHS Acute Trusts. Between 2016 and 2019, the Improvement Academy worked in partnership with the Royal College of Physicians (RCP) to deliver the national programme across England and Scotland. In October 2018, the first NMCRR annual report was published (please see link below).

Structured judgement review is now practiced as standard in most NHS Acute Trusts across England. However, it is recognised that the learning and improvement from mortality reviews varies greatly between different organisations. The Improvement Academy remains passionate about learning from deaths and is working in partnership with NHS England and Improvement to progress this agenda.

The Mental Health Programme

For information regarding our mental health programme please see the related content section below and follow the link.

SJR in Ambulance Trusts

The Improvement Academy was selected by NHS England and NHS Improvement to support implementation of the learning from deaths guidance for ambulance trusts across England.

In July 2019, the National Quality Board published new guidance for ambulance trusts on learning from deaths. As part of this guidance ambulance trusts are required to undertake case record reviews on a proportion of deaths in their care using an adaptation of structured judgement review methodology as employed in the National Mortality Case Record Review Programme.

The Improvement Academy will provide training for Ambulance Trusts across England based on appropriate training materials that can be adapted to potential variations and transitions to digital records.


The programme had been shortlisted for over three awards:

who we are working with

Royal College of Physicians

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