Rethinking Morbidity and Mortality Meetings in Surgery

Area of Science:

• Healthcare Quality Improvement
• Surgical Outcomes Research
• Clinical Governance

Background:

• Morbidity and mortality meetings (MMMs) are crucial for surgical outcome improvement via reflective practice.
• Global institutionalization of MMMs contrasts with fragmented practices in Portugal, lacking published standards.
• Current Portuguese MMMs are unstandardized and weakly integrated into clinical governance.

Purpose of the Study:

• To critically appraise the current model of morbidity and mortality meetings in Portuguese surgical departments.
• To propose evidence-based reforms for Portuguese MMMs, drawing on successful international frameworks.
• To identify gaps and recommend improvements for patient safety and continuous learning.

Main Methods:

• Narrative review synthesizing historical developments, national regulations, and international models.
• Analysis of international frameworks like UK's National Confidential Enquiry and US's National Surgical Quality Improvement Program.
• Comparative assessment of Portuguese practices against global benchmarks.

Main Results:

• Portuguese regulations reference morbidity and mortality but lack unified guidance on case selection, governance, and corrective actions.
• Cultural barriers (blame avoidance, hierarchy) impede psychological safety and learning in Portuguese MMMs.
• International programs demonstrate structured, data-driven approaches fostering accountability and transparency.

Conclusions:

• Portugal requires national guidelines, risk-adjusted benchmarking, and multidisciplinary involvement for MMM reform.
• Enhancing MMMs necessitates addressing cultural barriers, ensuring protected time, and establishing formal follow-up systems.
• Evolving MMMs from symbolic to impactful tools demands regulatory leadership, cultural change, and alignment with international standards for patient safety and learning.