Background: The traditional Morbidity and Mortality Conference (MMC) is known for its punitive aspects. Some programs have met the ACGME Internal Medicine (IM) requirement for MMC or Quality Improvement (QI) conferences by focusing on general principles of patient safety. We describe the impact of a QI-based MMC on resident perceptions of psychological safety and the effect on patient safety event (PSE) reports at the University of Arizona College of Medicine-Phoenix Internal Medicine Residency Program.
Purpose: The aim of MMC is to focus on patient safety and create an open environment for discussion. An additional aim is to track perceptions of psychological safety in three dimensions: risk identification and just culture (confidence to freely speak up), team cohesion and engagement with patient safety, and error transparency and risk mitigation.
Description: MMC was introduced in the IM patient safety didactic session. An anonymous survey helped determine baseline engagement with patient safety culture. MMC was held during the existing noon conference to facilitate resident attendance in person and virtually. Voluntary presenters defined a PSE (morbidity or mortality) with the audience participating in root cause analysis. Both traditional face-to-face discussion and anonymous polling were used. After each MMC, anonymous surveys monitored engagement with patient safety culture and perceptions of psychological safety.Before MMC, 68% of surveyed residents (n = 22) reported lacking knowledge of PSE reporting options. 45% of respondents favored an MMC to discuss patient safety concerns within the program. Concerns for starting MMC included limited time in the curriculum, feelings of intimidation, absence of a psychologically safe environment, and skepticism about MMC’s value. Five MMC sessions were held for which six presenters submitted cases. Attendance at MMC increased from 7 participants at the first session, to 21 participants at the fifth session. Cumulative analysis revealed that 66% of respondents recognized risk identification of PSE within teams and a positive perception of just culture. 67% of respondents reported adequate transparency in error reporting and risk mitigation, a decrease of 1.75% from baseline. After 5 sessions, 75% of respondents expressed at least moderate willingness to share adverse PSE in settings like MMC. 62% of respondents reported team cohesion and positive engagement with PSE. 78% of respondents favored continuing MMC. 22% favored utilizing only polling technology for participating in MMC, 33% favored traditional techniques and 44% favored both approaches.
Conclusions: Incorporating PSE reporting education into MMC may increase resident confidence in submitting PSE reports. Confounding factors in cumulative data analysis include repeat survey respondents; MMC may be held more frequently in the next academic year to diversify respondent feedback. Traditional engagement techniques and polling technology will both be used to foster a safe space for discussion. A year-long comparison of PSE reporting to pre-MMC implementation will be useful in quantifying the MMC effect on the number of PSE reports submitted.