Guiding Principles of Morbidity and Mortality (M&M) meetings in action podcast series

To support implementation of the CEC M&M guidelines, the Guiding Principles of Morbidity and Mortality (M&M) meetings in action podcast series was developed to explore the guiding principles of effective M&Ms in action. In implementing the guiding principles, there are often significant challenges in relation to culture and leadership and the podcasts emphasis ways in which teams can work together to enhance their M&Ms as a safe space for learning and improvement.

Each podcast captures an engaging narrative with clinical leaders around their practical experiences and insights from leading M&M meetings. Conversations highlight the significance of psychological safety and explore the importance of effective leadership and facilitation to enable open discussions that engage the diversity of perspectives within a team.

Series one - Creating safety in M&M discussions

This first series of CEC's M&M podcasts provides insight into the power of effective facilitation to enable psychological safety in M&M meetings.

David Sweeney as the Director for Leadership at HETI reflects on the HETI standards of facilitation and highlights the powerful link between the targeted use of facilitation and the exercise of leadership and Dr Andrea Christoff as a medical Co-director and leader of M&Ms gives practical insights into her experiences of facilitating M&Ms to enhance the diversity of perspectives and enable learning from past experiences of clinicians.

The three-part series explores key themes around facilitation standards, psychological safety and lessons learnt from experience of supporting the leadership in M&Ms.

Listen to season one - introduction

David Sweeney explores the HETI Facilitation Standards with Dr Andrea Christoff who shares her experiences of how effective facilitation can really support and enhance M&M discussions. Andrea explores her early experiences of M&Ms and the challenges of using a systematic approach to review cases.

The discussion includes the significance of facilitation skills in enabling a diversity of perspectives to understand the complexities of the system in which patient care is delivered. Andrea highlights the importance of establishing functional relationships and a culture of openness and transparency which is nurtured outside the M&M meetings.

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David and Andrea explore how facilitation enables psychological safety in M&M meetings. This includes highlighting the importance of relationships and trust and fostering a culture of speaking up for safety within teams. The structure of an M&M is also explored in terms of developing transparency and openness of what will be discussed and ensuring clinicians know what to expect before coming to a meeting.

This includes the engagement of clinicians' feedback and not only ensuring that the right people are in the room but that they are engaged in advance in relation to the meeting agenda and cases to be discussed.

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David and Andrea explore key lessons learnt around managing difficult conversations including using reframing and inquiry techniques and to ensure everyone has a voice in the room even if some of the voices are controversial. Key strategies are discussed around managing difficult conversations and emotions that may surface.

This includes the importance of reframing any blaming and establishing shared agreements about how the meeting's going to run, what is acceptable behaviour, and what constitutes being respectful.

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Season two - Right material and right people: M&M leadership and case selection

This season of the Guiding Principles of Morbidity and Mortality (M&M) meetings in action podcast series provides insight into the importance of effective leadership to enable psychological safety in M&M meetings.

Dr Clare Skinner and Dr Dane Chalkley talk about their experiences of M&Ms as emergency physicians and reflect on the power of choosing the right cases and the importance of the M&M leadership in establishing a safe space for discussion and learning.

The four-part series goes through the key themes around choosing the right cases, the importance of the leadership in M&Ms, safety sciences and human factors and the importance of multidisciplinary participation and modelling vulnerability by the M&M leadership.

Listen to season two - introduction

Clare and Dane talk about the importance of choosing the right cases and ensuring you have the right people engaged in the meeting.

Clare describes the importance of empathy and her determination that no one would ever have a surprise in the M&M by ensuring that clinicians are clear on what cases are being discussed.

Dane emphasises that making the meeting psychologically safe is about choosing the 'right case for the right person' and thinking carefully of the timing of case selection as this will impact on the capacity to learn.

Clare and Dane talk about their experiences with the safety sciences and human factors to enable safe discussions from a systems perspective. This includes identifying cases that include positive learning experiences.

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Clare and Dane emphasise the importance of the M&M chair as a senior leadership responsibility. They describe M&M leadership as an opportunity for setting the culture within a department and role modelling safety and quality principles.

Dane and Clare discuss the evolution of medical education, and their experiences of moving away from traditional styles of learning to an exposure of contemporary principles and a greater understanding that people learn more when they are psychologically safe.

This discussion includes practical examples of the importance of M&M leadership and the role of facilitation in building and protecting teams and ensuring everyone's voice is valued and heard. Clare and Dane also emphasise the importance of tailoring the M&M Guidelines to the needs of each group.

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Clare and Dane discuss the importance of the M&M Chair having a good understanding of safety sciences, Human Factors and cognitive bias. They both give examples of what a good M&M meeting looks like with a strong focus on learning from when things go well (Safety II) and exploring in a safe way the learning from when things go wrong (Safety I).

The discussion includes recommendations around an introduction into safety sciences and human factors. Whilst historically M&Ms have focused on Safety I, Clare and Dane emphasise the importance of learning from when things go well and ensuring teams know they are valued, important and appreciated.

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Clare and Dane discuss the importance of normalising human error and reframing it as a learning opportunity rather than alienating clinicians who made the error. This is a growth moment and supporting clinicians enables that growth and learning.

This discussion emphasises the importance of the M&M leadership to model vulnerability and share and demonstrate their own learning experiences from errors. Dane and Clare also talk about Civility and Tribalism and the importance of multidisciplinary engagement in M&M discussions.

Practical examples are shared around understanding the context of incivility and bad behaviours and ways to address this to enhance connections and empathy across teams and disciplines.

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