Welcome to sickcare entrepreneurship M/M conference

Morbidity and mortality (M&M) conferences are a mandated activity at virtually all residency programs, with 94% routinely holding M&M conferences as part of their academic curricula. While these conferences vary immensely in structure, they share a common purpose: to track and discuss medical errors in an environment that facilitates learning, encourages accountability, and promotes leadership and academic development.

Most of these conferences have evolved from those trying to target the "bad apple" to those that take a more lifelong learning approach at the individual, organizational and multisystem level. Many are now interdisciplinary, since many times the adverse outcomes can be traced to multiple sources that further compound and lead to an adverse outcome. For example, a patient presenting to the ER is sent to the radiology department without proper handoff information and the films are misread leading to a subsequent diagnostic and treatment error. The inputs are multifactorial.

Black boxes on airplanes record detailed information about flights. Now, a technology that goes by the same name and captures just about everything that goes on in an operating room during a surgery is making its way into hospitals.

The OR Black Box, a system of sensors and software, is being used in operating rooms in 24 hospitals in the U.S., Canada and Western Europe. Video, audio, patient vital signs and data from surgical devices are among the information being captured.

The technology is being used primarily to analyze operating-room practices in hopes of reducing medical errors, improving patient safety and making operating rooms more efficient. It can also help hospitals figure out what happens if an operation goes wrong.

Given the morbidity and mortality of most biomedical and clinical innovation, entrepreneurship, and startup initiatives, it's time we learn from each other's mistakes in the same ways we learn from medical M/Ms so we can share the experiences and not have to include them on our own failure resumes.

An innovation M/M conference has the following components:

1. Presentation of the case
2. Explaining the complication or death or the company or cancellation of the new product development
3. A review of the literature relevant to the adverse outcome.
4. A personal, organizational, systemic or multisystemic root cause analysis
5. A remediation plan
6. Measuring the impact of the remediation plan moving forward

Perhaps we can start with these failed companies.

Some are even introducing patient or doctor experience M/Ms.

Here is another case for discussion.

Now, please welcome our presenter, Dr. Rishad Usmani

The US Army calls their version of analyzing what went wrong after action reviews and several companies have adopted the practice. The AAR was constructed in four parts, each centered on a different question: 1) What did we expect to happen? 2) What happened? 3) Why was there a difference between what we expected and what happened? 4) What can we change next time?

Roughly 25% of the time was allotted to Parts 1 and 2, with the remaining 75% allotted to Parts 3 and 4.

Much like clinical complications, entrepreneurial complications happen. If they don't, you are not doing it enough. To manage them, you need to:

1. Avoid them
2. Detect them early. AI might help using predictive analytics
3. Have early warning alerts
4. Intervene
5. Don't make matters worse making another bad management decision
6. Communicate to the stakeholders what's happened and what you did to manage it
7. Call for help if you need it
8. Call risk management if necessary
9. Learn from your experience
10. Move on and don't perseverate or ruminate on the case. Sh#T happens.

A sick care culture of safety requires transparency and a safe culture to discuss failure, whether it be at a surgery or emergency medicine M/M conference or a failed digital health newco postmortem. Depending on the economy, it might require weekly, not monthly, conferences.

Arlen Meyers, MD MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack