Health Equity Prototypes for Reimagining the Morbidity & Mortality Conference (MMC)
During our Framing Studio, CfC developed six prototype interventions for reimagining and improving the purpose, equity, and efficacy of the MMC. These prototypes function as an ecosystem, operating at different scales of impact (from acute to systemic) and points of entry into the structures, cultures, operating principles, and very boundaries of the MMC itself (from preparation to delivery to post-processing). We developed these interventions with the goal of helping the MMC achieve its highest potential as a tool for medical education, the advancement of health equity, and the reduction of what is somewhat euphemistically titled adverse outcomes — unnecessary and potentially avoidable harm and death. Applied together, the interventions have the potential to:
reveal the hidden biases, systems dynamics, and epistemological errors that perpetuate inequity and lead to adverse outcomes
shift the mindsets, cultural conditions, and modes of operating within healthcare systems at different scales that perpetuate inequities
reimagine the principles and practices of the healthcare system to realize a more humane ethos and achieve healthcare equity
Our studio brief was informed by desk research — including comparative analysis of existing scholarship published on the history, design, and management of the MMC, insight from applying creative practice to inquiry, and over two years of collaboration and conversation with emergency room professionals, in particular our work with Jay Baruch MD and Michael Barthman MD of Brown University/Lifespan. At the outset of our framing studio, our intent was to not only understand if the MMC was fit for purpose, but to imagine interventions to achieve the most productive and useful role for the MMC. We had the opportunity to advance our prototypes and interest in health equity through our involvement with the Health Equity Collective, facilitated by IDEO.org and funded by the Robert Wood Johnson Foundation. Virtual gatherings with the Collective provided valuable opportunities to share prototypes, ideas, and insights with healthcare and social justice practitioners working in seven teams across the country. CfC was the only team not situated within a medical institution.
At CfC, we began our work on the MMC with a balance of admiration and skepticism. Admiration for a 100 year old tradition designed to be self-reflective and self-improving — a rare practice. Skepticism because how could adverse outcomes be the third leading cause of death in a highly respected profession applying a long-lived teaching tool intended to improve practice?
This led us to questions about the theatrical nature of the MMC, the excellent investigation and critique done by Charles L. Bosk in FORGIVE AND REMEMBER, and to an assessment of whether or not the MMC had become ineffective; a vestigial organ of the past, too irrelevant or neglected to be useful. We found that its history is white and privileged, and we questioned whether a system built by the privileged, white, male medical society of the time might continue to reflect the views and needs of that privileged foundation. In exploring its role and purpose, we realized we must continue to examine how issues of bias and privilege could be compromising the potential value of the MMC. How might old mindsets, processes, constructs, and procedures shape what is considered error, who is most likely to make an error, what kinds of cases should be reviewed, how should people be held accountable? We take inspiration from Adrienne Marie Brown’s writing: “I often feel I am trapped inside someone else’s capability. I often feel I am trapped inside someone else’s imagination, and I must engage my own imagination in order to break free.” We began to imagine ways in which the MMC can break free from the constraints and constructs of its founding and 100+ year history in order to achieve its full potential for ongoing clinician education and equitable and improved health outcomes for patients.
To invite feedback on our prototypes, we created a video presentation aggregating our interventions. Both an experiment in communications and synthesis, the video presentation was shared with 90+ healthcare and equity practitioners, inviting input on the strengths and blindspots of our proposals. We sent anonymous Google Surveys for each of the 6 prototypes to ensure that respondents felt comfortable sharing honest feedback.
Systems Map of Medical Error That Reveals Inequity
Curricula to Reveal Hidden Biases
Condition Setting for Equity to Start MMCs
CfC welcomes additional feedback and potential future collaboration on this project. Please email us at complexity@risd.edu. Along with the video presentation, below is a link to a higher resolution slide deck of the presentation. Physicians may also be interested in our initial survey soliciting feedback from professionals who have participated in MMCs.
Reimagining MMCs + Health Equity Prototypes_02.17.21.pdf
References:
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The American Medical Association and Race – Robert B. Baker
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Women’s Struggles to Practice Medicine in Antebellum America – Myra C. Glenn
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African American Physicians and Organized Medicine, 1846-1968 timeline – American Medical Association
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The Forgotten Third: Liability Insurance And The Medical Malpractice Crisis – William M. Sage