Did you know that despite their century-long history, morbidity and mortality (M&M) meetings in medicine frequently fall short of their potential to improve patient care? LetS delve into the complexities and crucial improvements needed in this vital medical practice with dr. Evelyn Reed, a leading expert in healthcare quality and patient safety.

Morbidity and mortality (M&M) meetings,a century-old practice in medicine,aim to dissect patient harms and improve healthcare. These meetings, where doctors discuss cases and analyze outcomes, are intended as educational opportunities and tools for quality betterment. Though, a critical perspective reveals that these gatherings frequently enough fall short, notably in capturing the full patient experience and driving meaningful systemic change. The absence of patient voices and the potential for groupthink raise concerns about the effectiveness of M&Ms in truly addressing medical errors and improving patient care.

The author recounts a personal experience, illustrating the emotional toll these meetings can take. When my friend suggests dinner, I beg off. ‘Finishing M&M, not in the mood,’ I explain with a sad emoji. ‘One of those,’ she sympathises. This anecdote highlights the somber atmosphere associated with these reviews.

The history of M&M meetings dates back to the 1930s, when surgeons, physicians, and anesthetists convened to discuss cases and determine if deaths were preventable. The author notes, In the 1930s, a group of surgeons, physicians and anaesthetists would meet to discuss cases and conclude with a vote if the death was preventable. Imagine the contest of ideas (and egos) in that gathering.

While the format has evolved, the core aim remains surprisingly unclear. Even though deaths must be recorded, attendance at the meetings is not compulsory. The author points out that the meetings are variously regarded as an educational chance, a tool for quality improvement, and a forum for identifying outliers. It may also serve to restrain hubris, interrogate standards and force system changes, the last especially relevant in shifting from the traditional ‘blame and shame’ approach to a collaborative one.

The author emphasizes the delicate nature of these discussions, noting that No clinician enjoys being in the crosshairs of an M&M. It is indeed a delicate matter to raise problems without judgment, acknowledge the benefit of hindsight and focus on the future rather of litigating the past. However, conducted from a place of psychological safety, curiosity and empathy, the process can be useful for setting standards.

One of the primary concerns raised is the definition of morbidity itself. While mortality is straightforward, morbidity is open to interpretation, and doctors often underestimate the patient experience. The author states, Mortality means only one thing, but morbidity is open to interpretation – and it is well recognised that doctors frequently underestimate the patient experience.

An illustrative example involves a chemotherapy patient with severe diarrhea and weakness who received delayed assistance,ultimately becoming bedbound. Despite the patient’s distress and hallucinations induced by morphine, the medical notes described his condition as stable because he wasn’t getting worse. This highlights how non-fatal events can be downplayed, preventing systematic exploration and potential recurrence. The author explains, This is how non-fatal events can be downplayed instead of receiving systematic exploration to ensure they are not repeated.

The absence of the patient or family voice is a meaningful deficiency. While the meetings aim to untangle medical errors in a safe space, excluding the patient experience, even when filtered through doctors, disserves patients. The author argues that The most powerful way of reflecting on our omissions and commissions is to hear how they affected the patient. ‘It was the worst experience of my life, and I really thought Dad was going to die’ lands differently than ‘the patient’s daughter was a bit upset’.

The author further illustrates this point with another example: ‘I kept calling, got passed around, and have never felt more alone’ is more damning than ‘sadly, the patient couldn’t reach us’. Without patient accountability, the magnitude of their troubles can go unheeded. M&Ms need a better way of incorporating the patient voice, even if the patient is not in the room.

These meetings are intended to help doctors reflect on what could have been done better and advocate for a healthcare system that is an ally. However, the author notes that it’s hard not to carry a heavy conscience when the pattern of errors is familiar. A lack of dialog between providers, a failure to listen to the patient, a surfeit of confidence, a dearth of humility.

the author concludes by emphasizing that The M&M meeting is an opportunity to get things right the next time. But without skilful and impartial moderation, the process can turn into a mere checkbox exercise, which may well leave patients wondering how this could ever achieve systemic change in a healthcare system that is always distracted by some or the other crisis.

The author dreams of an outcome that says to affected people: We reflected on your case. Here is how it made us feel and this is what we learned.In the future, this is what we will do differently.

Despite the challenges and frustrations, the author acknowledges the importance of continuing to attend M&M meetings. Mostly, I love my job but ther are days when I dread the thought of attending another M&M. But I know it’s vital to go back because we owe it to our patients, past and future.

Expert Insights: Dr. Evelyn Reed on Improving M&M Meetings

We spoke with Dr. Evelyn Reed, a leading expert in healthcare quality and patient safety, to gain further insights into the challenges and potential improvements for morbidity and mortality meetings.

The Core Issues with M&M Conferences

Senior editor (SE): dr. Reed, thank you for joining us. The article “The Bitter reckoning” highlights the emotional toll and potential shortcomings of M&M conferences. Can you elaborate on why these meetings, designed to improve patient care, sometimes fail to achieve that goal?

Dr. Reed (DR): The core issue with many M&M conferences lies in their structure and approach. While the intention – to analyze adverse events, identify systemic issues, and prevent future harm – is laudable, the execution frequently enough falls flat. These meetings frequently become focused on individual “blame and shame,” rather than on a systemic, collaborative approach to identifying root causes and implementing effective solutions. The lack of psychological safety often prevents clinicians from openly discussing errors without fear of judgment or professional repercussions. This stifles honest reflection and prevents the identification of crucial systemic issues. The article correctly points out that the absence of the patient’s voice severely limits the meeting’s efficacy.

Incorporating the Patient Perspective

SE: The article emphasizes the crucial role of patient perspective. How can M&M meetings effectively incorporate the patient voice to ensure a more holistic and effective review process?

DR: Incorporating the patient’s voice is paramount.To achieve this, several strategies are vital.first, consider inviting patients or their families to attend portions of the M&M sessions, when appropriate and with their consent. Their firsthand accounts offer invaluable insights into the lived experience of illness and care, frequently revealing perspectives that clinicians might miss. Second, ensure that patient perspectives, even if not directly voiced in the meeting, are consistently documented and included in case reviews. Medical notes and reports should accurately reflect the patient’s experience of both the illness and its treatment; something the article aptly illustrates with examples of patient experiences differing from the medical evaluation.

Defining Morbidity Accurately

SE: The article mentions the challenges in defining “morbidity.” How can clinicians ensure a more extensive and accurate assessment of harm?

DR: Precisely defining morbidity is crucial. Mortality is unambiguous, as death is a clear, singular event. But morbidity is a broader, more subjective concept. It encompasses a wide spectrum of patient experiences,including physical symptoms,emotional distress (psychological morbidity),functional limitations,and overall impact on quality of life. Thus, a precise and inclusive definition of morbidity is essential to avoid underestimating the severity and lasting effects of adverse events. Improving methods of capturing patient-reported outcomes (PROs), like standardized surveys, can help. Medical professionals should also be trained to look beyond solely physiological indicators when assessing the full impact of adverse events, including considering all facets of the patient encounter and taking a holistic overview.

Moving Beyond Blame

SE: The article suggests that the traditional “blame and shame” approach is counterproductive. What are the most effective alternatives for fostering a culture of safety and enhancement within M&M meetings?

DR: Shifting away from blame requires a commitment to a collaborative, just culture. This means moving beyond an individual-focused approach and instead concentrating on understanding the underlying systemic and organizational factors that contribute to medical errors. This involves focusing on what went wrong, what could have been done better, and what changes can be implemented to prevent future occurrences. This culture change requires training, open dialogue, effective leadership, a clear framework for reporting, and a structured approach to inquiry that utilizes tools like root cause analysis and failure mode and effects analysis (FMEA). It also demands a strong commitment to safety from within the hierarchy of the clinical team.

Tangible Steps for Improvement

SE: What tangible steps can healthcare organizations take to improve the effectiveness of their morbidity and mortality meetings?

DR: Here are some key recommendations:

• establish clear goals and objectives for each meeting: define in advance what specific areas need to be investigated.
• Foster a culture of psychological safety: Ensure that clinicians feel cozy expressing concerns and opinions without fear of reprisal.
• Incorporate patient perspectives: Actively include the voices of patients and families, either through direct participation or the incorporation of their observations.
• Employ structured methods for incident analysis: This might include root cause analysis or other incident investigation mechanisms.
• Implement an effective system for tracking of incidents: Ensure actionable insights from M&M are reported and actions are documented, tracked, and followed through.
• Regularly review and update M&M protocols: Adapt methodology in line with ongoing training and evidence.

The Path Forward

SE: dr. Reed, could you sum up the essential improvements necessary for making M&M meetings more effective and patient-centric for a more supportive, safer, and inclusive healthcare system?

DR: Ultimately, M&M meetings should evolve from primarily medico-centric reviews toward truly patient-centered forums, driven by curiosity and empathy. By prioritizing the patient’s narrative, fostering psychological safety, employing effective analysis techniques, and adopting the principle of a “just culture,” we can transform M&M sessions from exercises in possibly unproductive self-reflection into powerful agents of system-wide improvement. It’s about learning from mistakes, not blaming individuals, to create a safer healthcare environment for everyone.

SE: Thank you, Dr. Reed, for sharing your insightful perspective. The improved effectiveness of M&M meetings is crucial for better patient care and overall improvements to our healthcare systems. Readers, what are your thoughts on this discussion? Share your comments and experiences below!