Presented by: Kwok ES, Calder LA, Barlow-Krelina E, Seely AJ, Cwinn A, Worthington J, MacKie C, Frank JR

1. Enhancing the Quality of Morbidity &
Mortality rounds Hospital-wide: the
Ottawa M&M Model (OM3)
Kwok ES, Calder LA, Barlow-Krelina E, Seely AJ, Cwinn A,
Worthington J, MacKie C, Frank JR
Canada’s Forum on Patient Safety & Quality Improvement
Edmonton AB October 2014
Dr. Edmund Kwok: ekwok@toh.on.ca

2. PROBLEM /OPPORTUNITY
Morbidity & Mortality Rounds (M&MR) traditionally used as
potential opportunity for healthcare professionals to review
errors and identify issues to be addressed
Recent current state analysis of our institution revealed:
not all Dept/Div held M&MR regularly
for those who did, variable effectiveness in the quality of
M&MR discussions and any resulting actions impacting quality
of care
We recently published a novel structured approach to M&MR1,
but it has not been validated across specialties
1Calder LA, Kwok ES, Cwinn AA, Worthington J, Yelle JD, Waggott, Frank JR.
Enhancing the quality of morbidity and mortality rounds: the Ottawa M&M
model. Acad Emerg Med. 2014;21(3):314-21

3. AIM
To implement and evaluate a structured M&MR model across
multiple specialties in a tertiary care teaching hospital
INTERVENTION
Identified M&MR Champions within each
participating group
Educational/coaching workshops at beginning and
throughout 12-month study period
Implementation of OM3 components:
appropriate case selection
dissemination of lessons learned
development of institutional mechanisms to
address identified issues (e.g. establishing Quality
Committees)
encourage inter-professional & multidisciplinary
involvement

4. MEASUREMENT
1. Needs assessment
Interviews & Exit
Interviews with M&MR
Champions
2. Before/After Web Surveys
of M&MR participants
3. In-person participant
Paper Surveys during
M&MRs
4. Policy audit of Quality
Committees and/or other
relevant institutional
mechanism for action
items arising from M&MRs
Overall “OM3 Score” (Total=24)

5. RESULTS: HOSPITAL-WIDE
Significant
improvement in:
Improvement
needs addressed
Impact-cognitive
Impact-system
Overall OM3 Score
improved from 11
to 21
Significant
increase in policy
action items to
address issues
arising out of
M&MRs
Figure 1: Before/After Web Survey Results on 5-Point Likert Scale
Figure 2: Before/After Participant Rating Figure 3: Before/After Overall OM3 Score
on M&MRs Effectively Addressing
Cognitive/System Issues

6. RESULTS: SURGICAL vs
NON-SURGICAL
There were significant cultural differences between these 2 groups on how M&MRs functioned
e.g. Trainees/Residents uniformly presented M&MR cases in Surgical groups, whereas a more
even mix of Residents/Staff Physicians presented for Non-Surgical Groups
Regardless, significant improvement in M&MRs for both groups
Figure 4: Before/After OM3 Scores for
Surgical Groups (N=5)
(Statistically significant improvements in Case
Selection, Case Analysis and Outcomes)
Figure 5: Before/After Scores for
Non-Surgical Groups (N=12)
(Statistically significant improvement in all domains
except for Frequency of Rounds)

7. CONTRIBUTION TO PATIENT
SAFETY AND QUALITY OF CARE
We demonstrated a successful implementation of a
structured M&MR model across various specialties
The OM3 intervention led to a hospital-wide
improvement in the quality of M&MR discussions and
the number of quality improvement actions in response
to issues arising out of these rounds
Our experience shows that this practical model can be
easily adopted at any hospital/institution
This has implications for patient safety culture and the
reduction of adverse events across different medical and
surgical specialties

8. LESSONS &
SUSTAINABILITY
Alignment with corporate strategy and recruitment of Champions are
critical for success of hospital-wide quality improvement initiatives
Continuous refinement of interventions to cater to the specific needs
of individual groups is essential
• We are in the process of developing a Surgical-Specific OM3 model
to address fundamental differences in their approach to M&MRs
Regular feedback to participants on progress can act as powerful
reinforcements for sustained improvements
• We are currently providing summary Report Cards for each
participating Dept/Div to showcase their progress in relation to the
rest of the hospital