Researchers: Muszkat Mordechai ¹, Chinitz David¹, Cohen Joel Matan²

Background: Morbidity mortality conferences (MMC) are considered an important process for quality improvement. However, the practices of MMC in internal medicine departments in Israel have not been previously described.

Objectives: The aim of the study was to describe MMC practices and the perceptions of clinicians regarding MMCs.

Method: 33 in-depth interviews were held at 9 Medical Departments within 6 Hospitals, including large, medium and small size hospitals in peripheral and central locations in Israel. Interviews were held with medical managers, senior physicians, residents, head nurses and hospital quality improvement managers. Intreviews were recorded and transcribed, and analyzed using qualitative research methodologies. Triangulation was provided by anonymous questionnaire distributed at departmental staff meetings.

Findings: include four major themes: (1) Regulatory bodies offer no guidance for MMCs in Internal Medical Departments. (2) The models of MMC observed are: Designated MMCs in Departmental or in Divisional setting, and adhoc staff-based discussions not labeled as MMCs. (3) MMC characteristics that affect discussions include: format, setting, timing, atmosphere, content, conclusion and follow up. (4) Individuals' motivations to present at MMCs include system improvement and the personal experience of adverse events.

Conclusions: MMCs are self-initiated at the departmental level. There is a considerable variability in MMC characteristics among medical departments in Israel. Challenges faced by MMCs include: creating non-judgmental yet critical discussion, recognizing and responding to clinicians' traumatic experience of adverse event, inadequate participation of multi professional staff.

Recommendations: This study suggests the need for guidelines for MMCs in Internal Medicine in Israel, and suggests MMC moderators should create non-judgmental yet critical discussion, and address clinicians' traumatic experience of the adverse event.

Research end date: 10/2020