A QI method also relevant to patient safety is morbidity and mortality conferences (M&M). Ideally, M&Ms should encourage system-level improvement and create space for staff discussion of safety improvement. M&Ms were implemented in a remote district hospital in Nepal that previously had no systematic method for quality improvement.1 M&Ms occurred weekly during staff meetings to ensure wide participation, and discussion focused on: clinical operations, supply chains, equipment, personnel, outreach, societal, and structural. Following the M&Ms, the hospital administrator and executive director were responsible for the implementation of proposed interventions. Some examples of interventions pursued as a result of M&Ms reviewing complicated deliveries included a task shifting workshop on emergency, point-of-care investigations to improve efficiency during high patient flow and a training in partograph use during labor. Despite these successful interventions, there were a few challenges that surfaced from the evaluation. These included difficulties implementing M&Ms on the planned weekly basis and lack of contribution from junior staff. Even considering these barriers, M&Ms may be an effective QI method in limited resource settings and can identify intervention points to improve patient safety.

References:

  1. Schwarz D, Schwarz R, Gauchan B, Andrews J, Sharma R, Karelas G, et al. Implementing a systems-oriented morbidity and mortality conference in remote rural Nepal for quality improvement. BMJ Qual Saf. 2011;20(12):1082–8.