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Perspectives on Perioperative Team-Based Morbidity and Mortality Conferences: A Mixed Methods Study
Background:
Morbidity and mortality conferences (MMCs) are quality improvement mechanisms during which adverse events are reviewed, often by physicians within a single discipline. There is a growing desire to include nonphysicians and physicians from other disciplines in team-based morbidity and mortality conferences (TBMMs). This mixed methods study investigates perioperative perspectives on MMCs generally and TBMMs specifically.
Methods:
A national survey of perioperative health care professionals, including surgeons, anesthesiologists, and nurses, was used to explore opinions about MMCs and TBMMs. Semistructured qualitative interviews and focus groups were conducted with health care professionals and leaders at a single study site. Quantitative data were compared using a Kruskal-Wallis test. Interview transcripts were inductively analyzed. Data were analyzed using a concurrent mixed methods approach, triangulating both sources of data.
Results:
Survey respondents (N = 1,466) were generally positive about both MMCs and TBMMs, agreeing that conferences were respectful, affected practice, and were educational. Nurses, compared to surgeons and anesthesiologists, were more likely to find conferences educational (p = 0.004) and were less comfortable speaking up in conferences (p < 0.001). Attendees who had more experience with TBMMs rated conferences as having significantly higher utility in achieving educational and safety goals. Qualitative data from 14 participants identified barriers and facilitators at the micro, meso, and macro level. Barriers include negative personal interactions, unsupportive leadership, and legal and regulatory issues. Facilitators include interpersonal relationships between professionals, buy-in from leadership, and external motivators.
Conclusion:
Perceptions of TBMMs were overall positive, but significant barriers to implementation remain. Team members may be invited to the table, but more effort is needed to make the entire team feel included in the discussion and optimize the value of these conferences. Strategies for overcoming identified barriers remains an open area of research.
Insights
Team-based morbidity and mortality conferences (TBMMs) show promise for quality improvement. However, challenges like interprofessional communication barriers and leadership support must be addressed for effective implementation and to ensure all team members feel included.
Area of Science:
- Healthcare Quality Improvement
- Patient Safety
- Medical Education
Background:
- Morbidity and mortality conferences (MMCs) are traditional quality improvement tools, typically involving single disciplines.
- There is a growing trend towards interprofessional team-based morbidity and mortality conferences (TBMMs) to enhance adverse event reviews.
Purpose of the Study:
- To investigate perioperative healthcare professionals' perspectives on MMCs and TBMMs.
- To identify barriers and facilitators for implementing TBMMs in healthcare settings.
Main Methods:
- A mixed-methods approach combining a national survey (N=1,466) and qualitative interviews/focus groups (N=14).
- Survey data analyzed using Kruskal-Wallis test; qualitative data analyzed via inductive thematic analysis.
- Concurrent triangulation of quantitative and qualitative data to provide comprehensive insights.
Main Results:
- Survey respondents generally viewed MMCs and TBMMs positively, citing respect, practice impact, and educational value.
- Nurses found TBMMs more educational but reported less comfort speaking up compared to surgeons and anesthesiologists.
- Qualitative findings revealed micro, meso, and macro-level barriers (e.g., negative interactions, leadership issues) and facilitators (e.g., relationships, leadership buy-in).
Conclusions:
- While perceptions of TBMMs are positive, significant implementation barriers persist.
- Enhancing inclusivity and optimizing the value of TBMMs requires further effort beyond simply inviting team members.
- Developing strategies to overcome identified barriers is crucial for advancing TBMM effectiveness.
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