The evolution of morbidity and mortality conferences.

Morbidity and mortality conferences (MMCs) have become a vital element of patient care, sitting at the intersection of medical education, quality improvement and risk management. MMCs may have increased in importance as a staple of safety education since the Accreditation Council for Graduate Medical Education has identified that the discussion and analysis of adverse events in a structured fashion promotes the learning of key quality and safety concepts. Groups across specialties and disciplines have implemented innovative models of MMCs as a vehicle to engage clinicians in discussions to learn from adverse events and to identify opportunities to improve care. In studying these new models, it has become clear that deliberate attention to the structure, processes and content of the conference yields the greatest opportunity for improving the quality of patient care beyond just learning the concepts of quality and safety. 5 We now face the next iteration of the MMC and are tasked with describing the facets that will best allow MMCs to drive learning and improved outcomes. In this issue, Kwok and colleagues highlight the impact of implementing a structured MMC, the Ottawa M&M Model (‘OM3 model’), at their acute care tertiary centre across multiple specialties. The model consists of five key elements, including appropriate case selection, structured case analysis, the creation of and dissemination of bottomline summaries, the development of effective pathways for action items and interprofessional and multidisciplinary participation. The authors conducted a yearlong study of 16 clinical groups implementing the OM3 model. The investigators provided an OM3 toolkit that included relevant educational materials, dedicated coaching to the teams, encouraged the groups to establish a quality committee for subsequent action items and identified a specific champion for the MMC. The authors primarily sought to assess the improvement in the quality of MMCs as measured by the overall OM3 index, a scoring system they created based on the key elements of the OM3 model. They applied the index to the MMCs of the participating groups prior to and after the intervention. Their secondary outcomes included awareness of the principles by attendees, changes in clinical policy and procedures as a direct result of the MMCs, perception of effectiveness of MMCs on quality of care, perception of the impact of the OM3 structure on the group environment, culture, existing processes and finally identification of success factors and barriers to implementation. Their study demonstrated a significant improvement in the OM3 scoring index for participating teams. The median index increased from 12/24 to 20/24 for teams, with a greater degree of improvement for the surgical versus non-surgical teams. All elements of the score improved, except for the frequency of MMCs. Both online and in-person survey results showed participants generally felt that the elements of the OM3 restructure were implemented and were well received. Importantly, attendees felt that having the structure provided the opportunity to have improved discussions. Barriers identified through the surveys included lack of time, like a formal training in patient safety, and persistent cultural resistance to the change. The work presented by these authors highlights both the progress and the opportunities in the evolution of the MMC. While demonstrating that a structured model for MMCs can be successfully deployed across specialties, the work also exposes some of the areas that still need to be developed. First, it is difficult to measure the quality of MMCs. The authors recruited