Reimagining Morbidity and Mortality Conferences
Reimagining the Morbidity and Mortality Conference for the 21st Century
The Mortality and Morbidity Conference (MMC) is a 100-year tradition started as a forum to provide education and accountability in medical practice. Through our projects in stroke and emergency medicine, the MMC emerged as a rare example of a space reserved for and dedicated to what the social scientist Harold Bridger described as the “double task” of acting and reflecting.
As systems practitioners, reflection is core to improving the process of decision-making. It requires an engagement with the what, why, and how of the situations in which we find ourselves. A reflective practice helps us determine the negative spaces of where and how we look: what is worth attending to, what is most important, what’s left out, overlooked, or missing. For acting and reflecting to happen in tandem, we need to foster learning environments that support comprehensive reflection as a core practice to learning and developing.
Rooted in a patriarchal history, designed by white men of privilege, MMCs excluded black and female physicians from the start. Built on a colonialist mindset, fostering a culture of blame and control, a focus on error and mistake, the MMC is met with fear in some practices, indifference in others.
From institution to institution, MMCs are highly variable with no shared definition of what constitutes error, no agreement on what’s in need of review, no questioning whether searching for error and blame is conducive to learning. Sometimes MMCs lead to improvements in practice, and sometimes that’s not a consideration. They are often designed around the review of one-off unusual cases which have questionable benefit to improved learning and outcomes.
The MMC remains a fixture in practice, across specialties, and yet medical error is reported to be the third leading cause of death in the US. Some put the numbers between 200 and 400 thousand preventable deaths per year. Faced with this shocking data, what is the educational value of the MMC? Where is the accountability? Is the MMC fit for purpose in the 21st century?
In our months of study and investigation, research, internal studio, and conversations with healthcare professionals we were at first dismayed to learn that the MMC is often practiced, not as a space to “learn and develop”, but as a space to blame and shame. We worked to gain insight into how and why these attitudes and influences took hold. We employed our creative practices to consider underlying epistemological errors and how forgotten histories retain hidden influence in contemporary systems.
We studied the scholarship of a number of authors, including Charles L. Bosk’s seminal work, Forgive and Remember.
We found spaces of innovation that inspired us not to abandon the MMC, not to criticize what has been, but to reimagine its potential. Our current thinking is that the potential remains – MMCs can be a unique and important tool in a practice of acting and reflecting, learning and developing – and also a powerful tool for advancing health equity and reducing adverse health outcomes.
Please return to this space periodically to follow the journey. We will be uploading content and artifacts of the process we have undertaken to act and reflect on the potential for the MMC to be redesigned and made fit for purpose in the 21st Century. As always, we welcome your feedback.