• Marit S de Vos, Jaap F Hamming, and Perla J Marang-van de Mheen.
• Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
• BMJ Open. 2017 Nov 12; 7 (11): e018833.

ObjectivesTo explore barriers and facilitators to successful morbidity and mortality conferences (M&M), driving learning and improvement.DesignThis is a qualitative study with semistructured interviews. Inductive, thematic content analysis was used to identify barriers and facilitators, which were structured across a pre-existing framework for change in healthcare.SettingDutch academic surgical department with a long tradition of M&M.ParticipantsAn interview sample of surgeons, residents and physician assistants (n=12).ResultsA total of 57 barriers and facilitators to successful M&M, covering 18 themes, varying from 'case type' to 'leadership', were perceived by surgical staff. While some factors related to M&M organisation, others concerned individual or social aspects. Eight factors, of which four were at the social level, had simultaneous positive and negative effects (eg, 'hierarchy' and 'team spirit'). Mediating pathways for M&M success were found to relate to available information, staff motivation and realisation processes.ConclusionsThis study provides leads for improvement of M&M practice, as well as for further research on key elements of successful M&M. Various factors were perceived to affect M&M success, of which many were individual and social rather than organisational factors, affecting information and realisation processes but also staff motivation. Based on these findings, practical recommendations were formulated to guide efforts towards best practices for M&M.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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