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Published on: January 8, 2020
[Morbidity/mortality review: usefulness and shortcomings]
M Gignon1, M-L Pibarot, M Sfez
1Département de Santé publique, CHU d'Amiens, place Victor-Pauchet - Amiens.
Insights
Physicians rarely use the Morbidity-Mortality Conference (MMC) methodology, citing lack of knowledge and time. Implementing MMC requires targeted education and support to enhance patient safety and care quality.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety Research
- Clinical Risk Management
Context:
- The Morbidity-Mortality Conference (MMC) is a HAS-validated process for analyzing deaths and complications to enhance care quality and safety.
- Despite its validation and potential use in physician recredentialing and hospital accreditation, data on MMC implementation in France is scarce.
- A regional project aimed to assess physicians' experiences and perceptions of the MMC methodology in clinical risk management.
Purpose:
- To investigate the current implementation and physician perceptions of the Morbidity-Mortality Conference (MMC) methodology in French hospitals.
- To identify barriers and facilitators to the adoption of the MMC for improving patient care and safety.
- To understand physician motivations for implementing the MMC, particularly concerning patient safety and surgical care management.
Summary:
- A survey of 150 hospitals in northern France revealed that only 11% formally use the MMC methodology, with most adverse event analysis occurring in informal meetings (76%) or mandatory reports (77%).
- Key barriers to MMC adoption include lack of knowledge (66%) and time (50%), while fear of litigation was minimal (1%).
- Physicians view adverse event analysis as crucial for improving patient care (90%) and education (61%), leading to protocol modifications (70%) and organizational changes (71%).
Impact:
- Findings highlight a significant gap between the recognized importance of structured adverse event analysis and its actual implementation via the MMC methodology.
- The study underscores the need for specific educational initiatives and support systems to facilitate MMC adoption.
- Physician motivation for MMC implementation is primarily driven by patient safety concerns, suggesting that emphasizing these benefits can promote wider acceptance and effective use.
Goal:
The Morbidity-Mortality Conference is a formalized exercise validated by the Haute Autorité de Santé (HAS) whose aim is to improve the quality and safety of care through periodic (weekly or monthly) analysis of deaths and complications. In France, no data is available concerning the implementation of the MMC methodology despite the interest of the National Institute of Healthcare Quality (HAS) in using the MMC as part of the physician recredentialling process and of hospital accreditation (mandatory in France since the laws of 2005 and 1997 respectively). We aimed to study the experience and perceptions of physicians with this specific methodology in the context of a large regional project aimed to improve clinical risk management.
Methods:
A one page questionnaire with eight confidential questions and a space for free commentary was sent to 150 hospitals in the north of France.
Results:
We received 83 responses from 29 hospitals (range: 1-14 responses per hospital). Analysis of unexpected adverse events is performed mainly in informal meetings (76%) and mandatory reports (77%); the MMC methodology is rarely used (11%). The analysis of adverse events is considered to be an important tool for the improvement of patient care and safety (90%) and continuing education (61%), and it results in modification of care protocols (70%) or organizational change (71%). Lack of knowledge of the MMC methodology (66%) and lack of available time (50%) are the main obstacles to the adoption of the MMC. Fear that the findings of the MMC could be available for use in litigation (1%) was not an obstacle. Physicians interested in implementing the MMC are motivated by a desire for improved patient safety (86%) and care management on the surgical service (54%). Self-responsibility is more important than the mandatory process for re-credentialing.
Conclusion:
The implementation of the MMC requires specific measures such as teaching and support.
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