Review of the Department of Health and Human Services management of a critical issue at Djerriwarrh Health Services

This review, undertaken by the Australian Commission on Safety and Quality in Health Care, has taken a comprehensive approach to the analysis of the Victorian Government Department of Health and Human Services’ actions in detecting, responding to and managing a cluster of potentially avoidable perinatal deaths referred to the department by the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) occurring in 2013 and 2014 at Djerriwarrh Health Services.