Here are a selected sample of consulting work undertaken recently.
Context - NHS Trust required independent review of internal SI review after post-operative patient death. 
Brief- To review internal SI report and determine it’s adequacy in addressing care delivery problems identified.
Delivery- Independent single reviewer
* Agreed TOR with Executive MD
* Interviewed relevant parties including bereaved spouse and medical practitioner
* Read relevant clinical documentation including surgical records and hand over notes
* Deployed national level guidance on SI investigations to benchmark internal review.
* Submitted draft report
* Made required amendments and submitted final report
Outcome - Trust was able to gain assurance that their internal review had been robust and benchmarked favourably against national guidance
Key Learning- NHS Trusts need to better understand the system level factors that militate against patient safety and to have pro-active mitigation strategies to address them.