Morbidity and Mortality (M&M) rounds contribute to improved patient care through bringing together physicians and multidisciplinary teams to learn and identify improvement ideas.
While there is value in the traditional review model (known as Safety-I) there is increasing recognition that learning and improvement can be derived from understanding adaptation and the role of healthcare providers expertise in responding to emergent problems (Safety-II). The Ottawa M&M Model (OM3), which has been adopted by Island Health, also encourages holding “What Works” or “What Went Well” rounds in addition to the traditional M&M rounds approach.
Safety-I and Safety-II: An Overview
Safety I: “Traditional views define safety as a state in which as few things as possible go wrong and focus on minimizing adverse outcomes. This perspective, also termed Safety-I, uses tools such as root-cause analysis to identify the causes and factors that contribute to an adverse outcome” and is usually “triggered after an adverse event or mishap. The goal is to understand the causes of errors to prevent the future occurrence of a similar event. The typical outcome of this analysis is to standardize and adjust a linear process to remove variability, including the variation caused by human behavior.”
Safety II: “Safety-II recognizes that healthcare delivery systems are complex and adaptive, and views human behavior as an important source of creativity to manage that complexity as opposed to being a dangerous source of variation that requires control. In complex work environments, healthcare professionals adapt standard processes and create informal processes that allow flexibility to accomplish desired outcomes. Providers adjust their interventions when standard processes are not appropriate or when required resources such as equipment, medications, staff, protocols, and so on are not available for the patient who needs care at that moment.”
Reference: Resilient Healthcare and the Safety-I and Safety-II Frameworks. Patient Safety Network, Agency for Healthcare Research and Quality. December 14, 2022. https://psnet.ahrq.gov/perspective/resilient-healthcare-and-safety-i-and-safety-ii-frameworks (Accessed May 31, 2024)
What are “What Works” or “What Went Well” Rounds?
“What Works” (WW) or “What Went Well” rounds are an opportunity to celebrate and share good practices and discuss the contributing factors, whether they were individual factors, teamwork factors, or environmental/system factors. As with the OM3 model, the aim is to summarize clinical cases into tangible lessons or tips that can be broadly shared to improve quality of care.
WW rounds don’t have to be limited to cases with good clinical outcomes, there are opportunities to identify what went well or good things that happened during delivery of care that provide an opportunity to share good practice even in cases where the patient may not have done well clinically (e.g. expected course of the disease).
It’s important to take time to acknowledge and celebrate positive moments as a contributor to quality improvement.
A note for facilitators on sharing lessons learned: Coming soon we will be launching a tool for “What Works Rounds at Island Health” where findings from the WW rounds can be shared to encourage the spread of good ideas and celebrate quality care.
A Guide to Presenting “What Works” Rounds
WW rounds follow a similar format to presenting M&M Rounds. You can review our M&M Rounds page for Presenters here for details around the OM3 model and tips on preparing for your presentation.
Where WW rounds differ is in case selection and areas of focus for your case analysis.
Choosing an Appropriate Case: Select a case that you were involved in that highlights good practice and where you will be able to identify and articulate factors that contributed to “what worked well”. For suggestions on how to identify a potential WW rounds case please refer to the Guide to Holding ‘What Works’ Rounds. The focus in WW rounds is on celebrating and sharing good practices that can be spread to improve quality of care.
Perform a Case Analysis: When performing your case analysis it is important to focus on and articulate specific objective factors that helped contribute to “what worked well”. Consider your case from the following perspectives:
- Individual factors that contributed – Do you have novel approaches or tips to share you’re your team? Are there cognitive aids that you utilize for specific clinical situations?
- Teamwork factors that contributed – Ask yourself “who else contributed to this case that went well?” Consider the interactions between team members including communication techniques or handover tools, or other examples that highlight good teamwork. Invite multidisciplinary team members to the rounds or ask them to co-present with you to share their perspective on what worked.
- Environmental/system factors that contributed – Are there things within the environment that enabled optimal care, including technologies or processes?
We encourage you to connect with other providers who were involved in the case to gain further insights or perhaps even co-present.
Develop Bottom Line Slide: As with the OM3 format you will need to develop a bottom line slide to summarize the factors identified during your case analysis. When drawing lessons from your WW rounds case, consider tangible lessons or tips that could be shared as action items that can be adopted more broadly. You can include both individual and system level recommendations.
Prepare for your presentation: The majority of your time should be dedicated to sharing the findings of your case analysis. The recommendation is to split your session evenly into thirds:
- 10 minutes for review of the case
- 10 minutes for case analysis, focusing on individual, teamwork, and/or system factors that contributed to what worked well
- 10 minutes for discussion, review of bottom lines and providing opportunity for others to share their own tips and suggestions as part of the discussion.
Using this model, every WW case presentation should have a few mandatory slides. Click here for a template to get you started.
Please remember these rounds are confidential and we need to endeavour to protect the privacy of patients. No patient initials, dates, times, or names of staff involved should appear in your presentation. Rounds should be structured under Section 51 of the BC Evidence Act to promote a safe, open and blame-free environment for learning.
Presenting at WW Rounds: We recommend connecting with your Facilitator a week before to review your presentation.
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Resources for Presenters: Island Health Guide to “What Works” Rounds Island Health M&M Rounds Toolkit for presenters |
Looking for additional information about M&M Rounds at Island Health? Navigate to one of our sub-pages to learn more.
