Morbidity and mortality meetings to improve patient safety: a survey of 109 consultant surgeons in London, United Kingdom

Abstract

Background Morbidity & Mortality (M&M) meetings are a critical component of clinical governance. They have the potential to improve patient outcomes, quality of care, attitudes towards patient safety and they contribute to the education of clinical staff. This study aimed to evaluate individual surgeons’ experience of these meetings, and to explore their perceived usefulness and barriers to open discussion of adverse outcomes. Methods Consultant general surgeons in London, United Kingdom, were invited to anonymously complete an online survey consisting of 18 key items. Results Invitations were sent to 323 consultant surgeons from 19 NHS Trusts. Responses were received from 109 (33.7%), of which 99 (90.8%) answered all key items. Seventy-two of 104 (69.2%) attend almost all or all M&M meetings. These were rated as being more conducive for learning than for service improvement ( p = 0.001). On a scale of 1 to 10 (10 = fearless), 41 of 105 (39.0%) rated as ≤5 the fearfulness of legal or other negative repercussions resulting from open discussion of complications/mortalities. Ninety-eight respondents gave a median rating of 10 (IQR: 8–10) for willingness to talk openly about their complications/mortalities (10 = willing/able). Conclusions Many surgeons in London do not routinely attend M&M meetings, despite these occurring within ‘protected time’. There may be a willingness to talk openly about complications, though there exists a fear of litigation. The nature, content and learning potential of such open M&M discussions should be explored in future research.

CIRSE Standards of Practice on Conducting Meetings on Morbidity and Mortality

“…Increasing evidence suggests that a structured and transparent approach to M&M meeting results in measurable gains in user satisfaction and participation as well as educational benefit, overall patient safety and quality of care [12,20,33]. Tools that have been used to guide focussed and goal-directed discussion include the SBAR (Situation, Background, Assessment, Recommendations) model and Vincent, Taylor-Adams and Stanhope's framework for analysing medical error [10,11,32,34].…”

“…All recommendations should be SMART (Specific, Measurable, Achievable, Realistic, Timely) and assigned to a responsible party with an agreed timeframe for completion [7,10,11,19]. The implementation of an action plan may lead to a quality improvement project and a subsequent audit showing progress would close the loop of the patient safety feedback cycle [10][11][12]33].…”

“…The M&M conference can be a forum for identifying such issues to provide a basis to implement change and improve patient safety. Contemporary M&M meetings form an important part of the organisation's governance framework that supports individual learning and encourages examination of current systems and processes [6,7,[9][10][11][12][13].…”

“…Indeed, attendance at M&M meetings is mandatory for surgeons in the United States [18,19], and all surgeons in the United Kingdom are also expected to attend according to best practice guidelines [7]. Despite the growing evidence and the general consensus that M&M meetings are useful and a necessary part of good clinical practice, there is wide variation in the format and level of participation [9,12,20]. There is also limited guidance on how they should be conducted in order to maximise benefit [1,10,12,13].…”

“…There are known barriers to effective M&M meetings. These include unsupportive organisational and professional culture, lack of education regarding the process, anxiety in exposing individual fault, fear of legal ramifications and lack of time [6,12,21]. Historically, some M&M conferences had a 'blame and shame' culture, which is not conducive to openness and transparency [22].…”