Table 1

Facilitators and barriers to successful M&M practice, grouped in themes and structured across levels of a framework for achieving change in healthcare

Case level
Type of case (1)Attractive topic+
Clinical relevance+
Value for education/
Information (2)Includes local data+
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+
Other priorities/incentives
Participation (7)Personality+
Realisation (8)Empowerment, control+
Social level
Culture (9)Safe environment+
Team spirit+
Super specialisation
Leadership (10)Reinforcing attendance+
Reinforcing actions+
Exemplary behaviour+
Participants (11)Participation of experts+
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’)
  • M&M, morbidity and mortality conference.