Objective: To discuss practical strategies to consider for morbidity and mortality conferences (M & M). Materials and Methods: This article reflects on (i) insights that can be drawn from the M... Show moreObjective: To discuss practical strategies to consider for morbidity and mortality conferences (M & M). Materials and Methods: This article reflects on (i) insights that can be drawn from the M & M literature, (ii) practical aspects to consider when organizing M & M, and (iii) possible future directions for development for this long-standing practice for routine reflection. Results: M & M offers the opportunity to learn from past cases in order to improve the care delivered to future patients, thereby serving both educational and quality improvement purposes. For departments seeking to implement or improve local M & M practice, it is difficult that a golden standard or best practice for M & M is nonexistent. This is partly because comparative research on different formats is hampered by the lack of objective outcome measures to evaluate the effectiveness of M & M. Common practical suggestions include the use of (i) a skillful and active moderator; (ii) structured formats for case presentation and discussion; and (iii) a dedicated committee to guide improvement plans that ensue from the meeting. M & M practice is affected by various sociological factors, for which qualitative research methods seem most suitable, but in the M & M literature these are sparsely used. Moreover, aspects influencing an open and blame-free atmosphere underline how local teams should tailor the format to best fit the local context and culture. Conclusion: This article presents practice guidance on how to organize and carry out M & M This practice for routine reflection needs to be tailored to the local setting, with attention for various sociological factors that are at play. Show less
Vos, M.S. de; Hamming, J.F.; Marang-van de Mheen, P.J. 2021
ObjectiveIt remains unclear to what extent the morbidity and mortality conference (M&M) meets the objective of improving quality and safety of patient care. It has been suggested that M&M... Show moreObjectiveIt remains unclear to what extent the morbidity and mortality conference (M&M) meets the objective of improving quality and safety of patient care. It has been suggested that M&M may be too focused on individual performance, hampering system-level improvement. The aim of this study was to assess focus and sustainability of lessons for patient care that were derived from M&M. MethodsThis is an observational study of routinely collected data on evaluated complications and identified lessons at surgical M&M for 8 years, assessing type and recurrence of lessons and cases from which these were drawn. Semistructured interviews with clinicians were qualitatively analyzed to explore factors contributing to lesson focus and recurrence. ResultsThree hundred eighteen lessons were drawn from 10,883 evaluated complications, primarily for those that were more severe, related to surgical or other treatment, and occurring in nonemergent, lower risk cases (all P < 0.001). Most lessons targeted intraoperative (43%) rather than preoperative or postoperative care as well as specifically technical (87%) and individual-level issues (74%). There were 43 recurring lessons (14%), mostly about postoperative care (47%) and medication management (50%). Interviewed clinicians attributed the intraoperative, technical focus primarily to greater appeal and control but identified an array of factors contributing to lesson recurrence, such as typical staff turnover in teaching hospitals. ConclusionsThis study provided empirical evidence that learning at M&M has a tendency to focus on intraoperative, technical performance, with challenges to sustain lessons for more system-level issues. Morbidity and mortality conference formats need to anticipate these tendencies to ensure a wide focus for learning with lasting and wide impact. Show less
Vos, M.S. de; Marang-van de Mheen, P.J.; Smith, A.D.; Mou, D.; Whang, E.E.; Hamming, J.F. 2018
