Table 3

Recommendations for successful M&M practice based on identified facilitators and barriers, and mediating pathways for M&M-based learning and improvement*

RecommendationFurther details (related themes in table 1)
1. Urgency
Select topics relevant to the audience and demonstrate a sense of urgency.
Ensure topics are applicable to one’s own practice, clinically significant and accompanied by a sense of urgency, for example, by supporting presentations with (local) data on incidences and harm (1, 4, 13).
2. Information
Maximise informativeness and attractiveness of presentations.
Use well-prepared presenters, engagement of those involved in cases, and fixed presentation formats including case details, literature, local/benchmark data, as well as system-level and soft/human factors (2, 3, 6).
3. Planning
Be explicit in terms of action items and follow-up.
Determine who will do what, when and how, with a plan for follow-up and re-evaluation (5, 10, 13).
4. Motivation
Motivate participants through interactivity and feedback.
Ensure that participants are motivated, for example, by using moderators to promote interactivity and ‘close the loop’ on prior actions through evaluation and feedback (6, 10–14).
5. Anticipation
Consider feasibility of actions, and anticipate and counter problems.
Anticipate and plan how to counter problems with realisation and sustaining of actions, for example, due to complexity, lack of empowerment or engagement of all staff involved, or staff turnover (4, 7, 10).
6. Input
Draw on collective expertise of participants.
Ensure presence and input from all involved in care processes, for example, by actively inviting comments from experts, juniors or other disciplines (7, 9–11).
7. Receptivity
Cultivate an open mindset, receptive to all input and opportunities.
Emphasise that input of all involved in care is essential and valued as such, and underline the need to be sensitive to ‘weak signals’ that may signal opportunities for improvement (7, 9–13).
8. Setting
Consider M&M meetings in specialist settings.
In meetings on the subspecialty or multidisciplinary level (‘integrated care’), participants may be more informed and in control as topics are more closely related to their daily practice (8, 9, 13, 15).
9. Resources
Dedicate time and staff to M&M practice and ensuing plans for improvement.
Consider blocking time for attendance but also preparation and realisation of actions, and consider use of a dedicated committee or staff to implement plans that ensue from M&M (6, 10, 15).
10. Data
Dedicate time and staff to M&M practice and ensuing actions for improvement.
Ensure that data collection and monitoring systems are accessible to allow assessment of local performance, benchmarking against others and re-evaluation of prior plans for improvement (14, 17).
  • *There is no hierarchical order in this list. Numbers, how recommendations relate to earlier published frameworks for improvement in healthcare and to mediating pathways, are depicted in online supplementary appendix 3.

  • M&M, morbidity and mortality conference.