Facilitators and barriers to successful M&M practice, grouped in themes and structured across levels of a framework for achieving change in healthcare
| Theme | Factor | Facilitator (+) | Barrier (−) |
| Case level | |||
| Type of case (1) | Attractive topic | + | |
| Clinical relevance | + | ||
| Value for education/ improvement | + | ||
| Information (2) | Includes local data | + | |
| Literature | + | ||
| Skills education | + | ||
| Information from those involved | + | − | |
| Addressing system factors | + | ||
| Addressing ‘soft skills’ | + | ||
| Presentation (3) | Qualified presenter | + | |
| Proper preparation | + | ||
| Proper supervision | + | ||
| Fixed format | + | ||
| Action level | |||
| Type of plan (4) | Attractive topic | + | |
| Clinically significant topic | + | ||
| More disciplines involved | − | ||
| Higher complexity | − | ||
| Planning (5) | Explicitly formulated | + | |
| Responsibility assigned | + | − | |
| Time frame determined | + | ||
| Included in protocols | + | ||
| Individual level | |||
| Motivation (6) | Intrinsic motivation | + | |
| Interest in specific topic | + | ||
| Values/beliefs | + | − | |
| Other priorities/incentives | − | ||
| Participation (7) | Personality | + | − |
| Realisation (8) | Empowerment, control | + | |
| Forgetfulness | − | ||
| Social level | |||
| Culture (9) | Safe environment | + | |
| Team spirit | + | − | |
| Super specialisation | − | ||
| Leadership (10) | Reinforcing attendance | + | |
| Reinforcing actions | + | ||
| Hierarchy | + | − | |
| Exemplary behaviour | + | ||
| Participants (11) | Participation of experts | + | |
| Interactivity | + | ||
| Audience composition/size | + | − | |
| Multidisciplinary participation | + | − | |
| Moderation (12) | Qualified moderator | + | |
| Organisational level | |||
| M&M format (13) | Strong focus on improvement | + | |
| M&M in specialist setting | + | ||
| Communications (before/after) | + | ||
| Too many cases per meeting | − | ||
| No tracking of actions | − | ||
| No check/feedback on effect | − | ||
| Reporting (14) | System for data collection | + | |
| Difficult access to data | − | ||
| Lack of feedback from data | − | ||
| Staff (15) | Dedicated staff/committee | + | |
| Super specialisation | − | ||
| Staff turnover | − | ||
| Other/conflicting expectations | − | ||
| Time (16) | Overall lack of time | − | |
| Receiving dedicated time | + | ||
| External level | |||
| Healthcare (17) | Inevitability (‘nature’) | − | |
| Benchmarking | + | ||
M&M, morbidity and mortality conference.