Systems of Care

The Framing Studio on Morbidity and Mortality Conferences

In January of 2021, after 6 months of research, planning, and design, CfC conducted its own internal Framing Studio to interrogate and reimagine the Morbidity and Mortality Conference (MMC). MMCs are a 100-year tradition across institutions and specialties started as a forum to provide education and accountability in medical practice. The Framing Studio began with a Studio Brief, developed and facilitated by two leads on the team. The Brief and support materials were then provided to all five team members by email and hard copies delivered by the USPS across four states – a process necessitated by pandemic remote working conditions. During our internal studio, we dedicated 25 scheduled studio hours to co-learning, reflecting, and testing ideas and prototypes, in addition to debriefing and adapting each day to the next.

The 5-day intensive studio, spread out over two weeks, was organized around interrogating and reimagining the highest potential for the MMC. Could it be a vehicle for long-term systems change in healthcare? Is the MMC fit for purpose in the 21st Century? The team applied creative practice to imagine possible paths including a successful redesign, and/or design of a replacement. We trusted that the process scaffolded in the Brief would prevent us from embracing any preconceived notions about outcomes. Through deepening our inquiry, we developed the insight necessary to guide us toward a range of interventions fit for purpose. 

In the Brief, the On-ramp, Overall Architecture, and Threads provided three different vantage points from which to approach the MMC — different scales from which to examine the issues and arrive at insight and applied interventions. Rather than create a rigid plan to follow, we allowed space to recognize our blind spots in the process. What are we missing or misunderstanding? What do we still need to learn? Where should we look that we haven’t? What have we overlooked or grazed past? We mapped a process with permeable boundaries, leaving room for finding dragons along the way. We found ourselves in the “Fat Belly” where we created a plan and recalibrated the plan as we went. The “Fat Belly” is the meandering path of exploration that seems to delay progress along the x-y axis. Efficiency experts love 45-degree slopes, but creative consideration often benefits from a more patient approach: divergent paths for emergent insight

In our creative design process, although deadlines may loom, we see efficiency as an epistemological error. Every minute of work does not need to be the source of immediate insight. We do not traffic in certainty. We repeatedly look to make the familiar strange, to question our own assumptions, to ask better questions, to make room for things that emerge. 

A creative design process doesn’t operate on a linear relationship between time and progress. What may appear to be inefficient is not presumed to be wasteful. Operating in what we call the Fat Belly can be frustrating and uncomfortable. But, it is a process that provides the time to identify and define the actual problem, time for reflection, for the emergence of greater specificity, the exploration of possibility and a multiplicity of potential solutions. 

As a team, we have a deeper appreciation, not only for the practices of healthcare and the complex societal pressures in which it operates, but also for the discomfort that comes with letting go of expertise and facing the fear of failure; the challenges of embracing the willingness to become students again, to admit ignorance in pursuit of new insights. Inspired by the physicist James Clerk Maxwell, we believe that “thoroughly conscious ignorance” is the “prelude”, not just to advances in science, but to all important endeavors. It is the path toward epistemic humility.