A Different Type of Morbidity & Mortality (M&M) Conference: Advancing Racial and Health Equity via a Focused M&M Series

Background: Many hospitals have made aspirational commitments to anti-racism and eliminating disparities in healthcare, but struggle with practical ways to integrate these commitments into clinical care. One way to actualize these commitments in the clinical realm is to build on existing infrastructure. Morbidity & Mortality (M&M) conferences are department-wide or hospital-wide, case-based reviews of adverse events that are traditionally focused on clinical errors. We designed a new type of M&M conference series focused on advancing racial and health equity in patient care.

Methods: We created a quarterly M&M conference that focused on the racial and health equity barriers of recent, complex cases in inpatient pediatrics (pediatric ward and intensive care units). Conferences were designed with an approach informed by psychological safety and cultural humility. All staff on our pediatric inpatient units were invited to attend, including physicians, nurses, social workers, child life specialists, and others. After our second conference, we administered an anonymous, online 10-item survey instrument to attendees. The survey included questions from the AHRQ Surveys on Patient Safety Culture (SOPS) Hospital Survey 2.0 and the Attitudes Toward Implicit Bias Instrument (Gonzalez CM et al 2021).

Results: The survey response rate was 77% (20/26), of which 35% were attendings (7/20) and 35% were nurses (7/20). 75% of respondents felt empowered to identify bias in a patient encounter (15/20). Of those who reported feeling empowered, 46% had attended only one of the M&M conferences (7/15). 65% (13/20) of respondents felt they had skills to address their own implicit biases that came up in the course of delivering patient care. 72% (8/11) of those who had attended more than one conference reported they had these skills compared with 44% who attended a single conference (4/9).

Conclusion: Our interdisciplinary racial and health equity focused M&M format allowed for meaningful discussions that helped participants feel empowered to identify and disrupt bias in patient encounters. Highlighting racial and health disparities in recent patient cases from our unit was effective in promoting individual practice changes and encouraging our staff to make system-level changes.