Evaluation of the implementation of a quality improvement program through morbidity and mortality reviews in a developing country

Lahnaoui, Oumayma; Souadka, Amine; Ahmadi, Brahim El; Ghannam, Abdelilah; Belkhadir, Zakaria; Amrani, L.; Benkabbou, Amine; Mohsine, Raouf; Majbar, Mohammed Anass

doi:10.1016/j.amsu.2022.103987

Cited by 7 publications

(20 citation statements)

References 38 publications

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“…13,28,29 Some institutions have a well-structured M&M conference where they used validated tools to analyze and classify opportunities for quality improvement initiatives that prevent future errors. 5,7,30 Conversely, many institutions do not have a clearly defined structure for M&M conferences. 28 Lack of an objective structure allows bias to infiltrate into any inquiry such that people of lower hierarchical positions and minoritized identities become targets.…”

Section: Discussionmentioning

confidence: 99%

“…15,21,27 A standardized structure for M&M conference has been found to improve patient care by directly spurring more quality improvement initiatives. 30 Examples of structured M&M conferences include a description of teaching points for each case; the use of the Situation, Background, Assessment and Recommendation (SBAR) format; the use of the fishbone template for root cause analysis; the use of a moderator to facilitate the discussions. Other examples of standardization around the M&M process include the use of electronic databases to identify cases for presentation and distribution report cards that detail factors that contribute to morbidity with actionable recommendations.…”

Section: Discussionmentioning

confidence: 99%

“…10 Interventions improving the quality of M&M conferences have been implemented and demonstrated to improve the quality of education, decrease the culture of blame, 12 and increase of quality improvement projects resulting from M&M conferences. 3,13,30 Furthermore, structured M&M conferences can contribute to building a Just Culture, whose goal is create a safe environment for open and honest error reporting, with the aim of identifying human factors and system factors that need improvement. 31 We suggest that a structured M&M may help in improving psychological safety.…”

Section: Discussionmentioning

confidence: 99%

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Mixed Methods Assessment of Incivility During Surgical Mortality and Morbidity Conference

Abahuje,

Yang,

et al. 2023

Annals of Surgery

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Objective: This study assessed incivility during Mortality and Morbidity (M&M) Conference. Background: A psychologically safe environment at M&M Conference enables generative discussions to improve care. Incivility and exclusion demonstrated by “shame and blame” undermine generative discussion. Methods: We used a convergent mixed-methods design to collect qualitative data through non-participant observations of M&M conference and quantitative data through standardized survey instruments of M&M participants. The M&M conference was attended by attending surgeons (all academic ranks), fellows, residents, medical students on surgery rotation, advanced practice providers, and administrators from the department of surgery. A standardized observation guide was developed, piloted and adapted based on expert non-participant feedback. The Positive and Negative Affect Schedule Short-Form (PANAS) and the Uncivil Behavior in Clinical Nursing Education (UBCNE) survey instruments were distributed to the Department of Surgery clinical faculty and categorical general surgery residents in an academic medical center. Results: We observed 11 M&M discussions of 30 cases, over six months with four different moderators. Case presentations (virtual format) included clinical scenario, decision-making, operative management, complications, and management of the complications. Discussion was free form, without a standard structure. The central theme that limited discussion participation from attending surgeon of record, as well as absence of a systems-approach discussion led to blame and blame then set the stage for incivility. Among 147 eligible to participate in the survey, 54 (36.7%) responded. Assistant professors had a 2.60 higher Negative Affect score (p-value=0.02), a 4.13 higher Exclusion Behavior score (p-value=0.03), and a 7.6 higher UBCNE score (p-value=0.04) compared to associate and full professors. Females had a 2.7 higher Negative Affect Score compared to males (p-value=0.04). Conclusion: Free-form M&M discussions led to incivility. Structuring discussion to focus upon improving care may create inclusion and more generative discussions to improve care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mixed Methods Assessment of Incivility During Surgical Mortality and Morbidity Conference

Abahuje,

Yang,

et al. 2023

Annals of Surgery

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“…Amine Souadka 1,2,3 Saber Boutayeb 2,3,4 Basma El Khannoussi 2,5 Hanane El Kacimi 6 Oumayma Lahnaoui 1 Amine Benkabbou 1,3 Mohammed Anass Majbar 1,3 Abdelilah Ghannam 7 Zakaria Houssain Belkhadir 7 Raouf Mohsine 1 Brahim El Ahmadi…”

Section: Not Applicableunclassified

Elevating standards: A comprehensive model for peritoneal surface malignancy management in developing healthcare systems

Souadka,

Boutayeb,

El Khannoussi

et al. 2023

Journal of Surgical Oncology

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income countries (LMICs) in implementing comprehensive peritoneal malignancy programs. They rightly emphasized factors influencing the adoption of cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy, including access to a multidisciplinary team proficient in peritoneal malignancy, the learning curve of surgeons and staff, perioperative support, funding mechanisms, awareness, education about the benefits of CRS, and social barriers.

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“…We have established in our department a weekly procedure of MMR to examine all cases of severe complications occurring within 90 postoperative day [9] . A root cause analysis [10] is performed based on the ALARM framework from the French High Authority of Health (HAS) [11] , to analyze contributing factors and suggest measures of improvement in order to prevent or detect this lethal situation.…”

Section: Introductionmentioning

confidence: 99%

Beware of lethal Wernicke's encephalopathy after cytoreductive surgery with HIPEC for peritoneal pseudomyxoma: Case report of morbidity and mortality review

Evaluation of the implementation of a quality improvement program through morbidity and mortality reviews in a developing country

Cited by 7 publications

References 38 publications

Mixed Methods Assessment of Incivility During Surgical Mortality and Morbidity Conference

Mixed Methods Assessment of Incivility During Surgical Mortality and Morbidity Conference

Elevating standards: A comprehensive model for peritoneal surface malignancy management in developing healthcare systems

Beware of lethal Wernicke's encephalopathy after cytoreductive surgery with HIPEC for peritoneal pseudomyxoma: Case report of morbidity and mortality review

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