How can the traditional Morbidity and Mortality (M&M) conference—sometimes experienced as a blame-and-shame game by healthcare professionals—transition into a more collaborative forum?
Today’s John H. Gibbon Jr. Lecturer will offer her experiences with a new process being used in Halifax, Canada.
“In many institutions, there was a culture of fear associated with the M&M conference,” explained Gail E. Darling, MD, FACS, FRCSC, the Dr. D. Alex Gillis Professor and Head of the Department of Surgery at Dalhousie University and chief of surgery at Nova Scotia Health Central Zone. “For those present, it could be a deeply uncomfortable experience, the only relief being that they were not the one being attacked.”
In addition to being fear-inducing, Dr. Darling will describe other negatives associated with the traditional M&M conference, including a lack of statistical rigor. She also will outline a new approach for these meetings adopted from the airline industry that looks at each adverse event in a systematic manner, examining all contributing factors rather than assigning blame to one or more individuals.
“The goal of M&M is for us to learn from our ‘mistakes,’ which is to say that the purpose is education. So how could we learn from these events? The airline industry takes an approach that provides psychological safety for anyone to speak up about events or processes that lead to adverse events, including those where something could have happened but didn’t, in other words, near misses,” said Dr. Darling, who is also president of the Canadian Association of Thoracic Surgeons.
At her institution, the M&M conference is now known as Quality Improvement (QI) Rounds.
“The goal is to provide a safe environment to discuss adverse events and focus on system issues rather than pointing a finger at individuals,” explained Dr. Darling. “There is also a legal benefit; we no longer talk about ‘errors’ or ‘mistakes,’ and by hosting these discussions in a QI framework, they are not available outside of the institution, so we are protected from litigation.”
In addition to describing the benefits of the new M&M conference model, she will discuss a key element that is missing in the new format.
“While the new M&M has a lot of positive attributes, it has removed the component of the surgeon telling their story, their narrative,” explained Dr. Darling. “Telling their story provides the surgeon with not only the opportunity to ‘confess,’ but also to honor the human element in the patient-surgeon relationship. The patient is not just a data point in a graph or a number in the Excel chart. By acknowledging their role in the patient’s adverse event, the surgeon demonstrates professional accountability and humility.”
The John H. Gibbon Jr. Lecture, “Trust, Resilience, and the Role of M&M Conferences,” is sponsored by the Advisory Council for Cardiothoracic Surgery.
For those who are unable to attend the lecture at 9:45 am in Hall F, it also will be livestreamed and made available for on-demand viewing within an hour after the live presentation for both virtual and in-person registrants.