New cutting-edge technologies, the unique needs of patients, a constantly growing volume of care, and the need for versatility among healthcare professionals require our healthcare system to develop a flexible and multimodal organizational network.
While waiting for such a network to be developed, the growing complexity of healthcare activities, combined with strains on human resources, increases the risk of adverse events.
Identifying and understanding these events through systemic analysis in order to learn from them (and prevent them from happening again) is essential.
Morbidity and Mortality Meetings (MMM) or Experience Feedback Committees (CREX) are dedicated forums for sharing experiences and analyzing events that may include accidents, incidents, or near misses, sometimes referred to as "close misses" in English. The analysis also provides an opportunity to revisit key solutions such as teamwork. CREX (Critical Feedback and Experience) reports result from a multidisciplinary approach to analyzing a specific event, leading to improvement measures. These committees, which generally meet monthly, are intended to complement the Morbidity and Mortality Reviews (MMRs) by addressing identified precursors upstream of the incident.
Use these meeting times to foster a culture of best practices
According to the French National Authority for Health (HAS), a Morbidity and Mortality Review is a“collective, retrospective, and systematic analysis of cases involving a death, a complication, or an event that could have caused harm to the patient, with the aim of implementing and monitoring measures to improve patient care and patient safety.”*
In concrete terms, it is a comprehensive analysis that provides an assessment of a team’s performance and enables the implementation of a program to improve practices. It allows us to move beyond an analysis focused solely on one or more individuals.
The French National Authority for Health (HAS) emphasizes the importance of "seeking the causes, not who is at fault." This approach involves understanding what happened during the adverse event without blaming healthcare professionals. Therefore, the facilitator must remain strictly neutral regarding the opinions expressed and avoid acting as a judge. Analyzing adverse events helps improve the quality and safety of care and is not about blaming healthcare professionals or finding someone to blame. Following this analysis, lessons can be learned about existing strengths and vulnerabilities to inform actions aimed at improving the quality and safety of care. For a successful Morbidity and Mortality Review (MMR), it is essential to adopt an approach based on objective analysis and grounded in a fair and positive culture. An ethical commitment from the facilitator and other participants is necessary. Respect for the confidentiality of participants’ statements and the cases studied is paramount. The criteria for good conduct for a successful morbidity and mortality meeting are: listening to other participants, respecting professional secrecy, respecting the confidentiality of participants’ statements, respecting the confidentiality of the cases studied, no blaming, no judgments. src="https://cdn.prod.website-files.com/61f1c5bbc327ec3679e7457c/62778d24ee72c11d0e8c1e3f_Capture%20d%E2%80%99e%CC%81cran%202022-05-08%20a%CC%80%2011.22.30.png" width="auto" height="auto" loading="lazy">
Key Stages in CREX - RMM
Traditionally, these exchange sessions follow several key stages:
- Reconstructing the Chronology of Events:
The care process is divided into successive chronological stages.
When did it happen? Who were the people involved (anonymously)? What actions (or omissions) did these people take? How were the actions carried out (what methods were used)?
- Investigation into the causes of the incident:
There are many factors that can explain why adverse events occur: the number of people involved in the patient’s care, their interactions, interruptions in their work, and how they manage stress or fatigue…
Therefore, before the error occurs, it is necessary to understand the malfunctions and identify all the causes—both immediate and underlying—that contributed to the event. These causes only become apparent during a thorough analysis of the root causes.
- Analysis of safety barriers:
Safety barriers refer to all human, technical, or organizational measures that make it possible to prevent the occurrence of an adverse event, to recover from it when it occurs, or to mitigate the severity of its consequences.
- Action plan and follow-up:
Following this in-depth analysis of the adverse event, corrective actions and the methods for implementing them must be selected.
During the analysis process, our experts believe it is also very valuable to share success stories or the factors that made it possible to recover from a situation that got off to a bad start. Sharing success stories also has the advantage of focusing on what works rather than what doesn’t. The next step is to identify and preserve the key elements of success: briefings, checklists, clear assignment of roles…
Simple things can help you analyze your experiences: focus on questions that begin with “how” rather than those that begin with “why.” The risk with questions that begin with “why” is that they lead to a fruitless search for causes, hindering efforts to improve care, whereas questions that begin with “how” allow healthcare facilities to identify organizational issues.
SafeTeam and the organization of a morbidity and mortality meeting
The analysis of a medical incident cannot be improvised.
To improve patient safety at your facility and adopt a modern risk management approach, it is essential to transform your meetings into multidisciplinary and informative sessions. With this in mind, the SafeTeam Academy has designed a training program on organizing and conducting a Morbidity and Mortality Review (MMR) meeting. In this program, participants will lead or participate in an MMR following a medication error. They will be assessed on their skills in safety culture and will systematically analyze their performance. At the end of the module, they will attend a presentation explaining the key steps of these patient safety meetings. If you too would like to contribute to improving the reliability of care within your facilities, SafeTeam Academy training courses are for you! For more information, write to the following address: contact@safeteam.academy.
