My wife is a pediatric nurse and nurse educator and my entire career has been in professional services, so to learn from each other we often have discussions about delivering the highest-quality care and other issues in our respective fields. This month, I’d like to write about what is referred to in the health care industry as M & M Conferences (MMC). In the hospital setting, M & M means morbidity and mortality. The MMC is a tradition where physicians and nurses from within their specialty (such as pediatrics) will meet – confidentially and very respectfully – to discuss cases in which the patients had a very serious or sometimes fatal outcome.
The primary motive of the MMC is to review if the standard of care was met and if there was anything, in hindsight, that could have been done differently to prevent the negative outcome. It is an open and safe forum for teaching, learning, and discussion of the most difficult cases. These conferences used to be exclusively for physicians and residents/interns. Nowadays, it is not uncommon to see other departments attending these MMCs, including pharmacy, respiratory therapy, hospital administration, etc.
Just like a post-mortem project meeting, the goal of these M & M conferences is quality improvement with peer review. Everyone’s contribution to the discussion is valuable; we all have a unique perspective and our experience comes with that. Hospitals are adopting a “just culture” approach, in which individuals are held accountable for their actions, but without penalizing them for their mistakes (as long as the behavior was not reckless). Additionally, it is imperative that there is an examination of systems issues. “Change the people without changing the system and the problems will continue,” said Don Norman, noted author of The Design of Everyday Things.
The conferences have a lot to offer, including teaching and self-reflection, as well as the opportunity for debriefing, collegiality, and mutual support. As the format for MMCs is evolving, many hospitals/specialties now have a rubric or score that they assign and report on each case. There are measurements if the standard of care was met and there is documentation to support the score.
At Cloud for Good, we have our own version of an M & M conference – we call ours post-project evaluations. We like to think of it as a postpartum discussion (meaning the “baby” – your project – has been delivered). After a project has been completed, we meet as a team to discuss the outcomes. Everyone associated with the project, which includes the Account Executive, Consultant(s), Project Manager, and management, attends the meeting. We actively consider and discuss the following:
- Did we complete the project on time?
- How did we implement the best practice?
- How did the team/customer view the communication?
- Were we over/under budget?
- What went well and what could have gone better?
Having these discussions has increased our awareness of the process of delivering each project in a way that satisfies our clients. As we continue to build our best practice, we learn more about the role of each team member. Sometimes changes result from these conferences. In other times, it gives us a chance to (briefly) celebrate the success of completing another quality project.
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