Podcast #21

Person about to step on banana peel.
'The only mistake in life is the lesson not learned.' -Albert Einstein.

Every vet will make mistakes in their careers. This isn’t a likelihood, this is a fact. We will all miss some clinical sign, follow a wrong diagnosis, intervene too early, intervene too late, etc. Usually these mistakes are minor and easily correctable, however sometimes these mistakes are catastrophic and we lose a patient.

What do we do when we make mistakes? How do we address these mistakes? How do we acknowledge these mistakes to our colleagues, to ourselves? Another aspect of this conversation is how we address these mistakes to the owners, but that is not the focus of today’s blog. This blog will address how important it is to address medical mistakes with our colleagues and our clinical team, to help us process, grow and learn, and prevent mistakes from occurring a second time. (See blogs on How to Recover Yourself After a Mistake, and How To Address Mistakes With Clients.)
Magnifying glass on old papers and ink blots.
M&M Rounds are a systematic, thorough and complete review of a case, to find ways to improve both cognition and systemic processes to prevent future mistakes.
“M&M Rounds” are important, needed and should be a part of any clinic. Once a month your clinic should be getting together to discuss a case that either went poorly, or could have gone better. By dissecting and addressing cases on a regular basis, you will all grow as a team. This helps your clinic progress medically, but also helps everyone on the team to prevent future mistakes, and most important CONSTRUCTIVELY recover when mistakes are made.

If you don't believe me, let this TED TALK by Brian Goldman convince you! I promise it will be worth your time!

One of the most important parts of M&M Rounds is that it is a safe, non-judgmental and constructive session and setting.

A big part of making these sessions not feel like an attack or punishment is by having these sessions regularly, and not just when a case has gone spectacularly badly.

Terminology is important! This is a medical dissection, and therefore it should be addressed as if you were discussing a case study. Third person terminology should be used, with no names/direct connection to any particular vet/nurse.

This removal of pronouns, removal of individuals involvement and just looking at each aspect of the case as a cold medical conversation, allows for everyone to discuss the case critically and at the same time removes any emotional component, or any component of blame.

It is also very important to recognize and acknowledge, outwardly and verbally, “This is a critical dissection of the case, with both the benefit of hindsight and the purpose of learning and growing and improving together as a team.”
Dragon railing on steps in Vietnam (Tam Coc)
Having a consistent, organized and regimented process for picking and presenting cases will help make your M&M Rounds more productive.
So, how do you start having M&M Rounds? How do you run one of these sessions?


As an owner/manager you can either select a case you feel is important to learn from, but a more ideal way to pick a case is to have staff nominate cases. 
Ideal cases are ones with ADVERSE OUTCOMES (or near misses), PREVENTABLE, and ones with LESSONS to be learned.


Ideally the nominator would present the case, however as a manager it is important to ensure you are involving all members of the team (everyone gets a chance), and to be sensitive people’s emotions. 

The presented will then perform a careful and thorough review and evaluation of the case including the following:
- Chronological, detailed (all diagnostics, all interventions, all vitals, etc.) and thorough review of the case. (Include client communications)
- List of areas where the case went well
- List of areas where the case could have gone better
- Where there any COGNITIVE ERRORS (errors in thinking) or SYSTEM ERRORS (errors with how the clinic runs) that could be improved?
- Suggestions for improvement (Specific suggestions to help prevent future mistakes/errors)
- Prepare a handout for all team members with the case review, findings and suggestions. Distribute this prior to the meeting for team-members to review and create own suggestions for improvement.
- 2min introduction by supervisor- reminder of rules, purpose and intention of the rounds.
- 10min case review by presenter.
- 5min discussion on what went well, what could have gone better by presenter.
- 5min discussion on any cognitive and systemic errors by presenter.
- 15min open discussion on the case.
- 5min summary where 2-3 concrete and specific solutions are agreed upon.
Having a timed and organized outline will help keep the rounds on track, prevent the meeting from spiralling into unhelpful territory, and will keep everyone on focusing on the aims and goals of the M&M rounds!

Avoiding goals such as “more training” or “try harder” are unhelpful! Try to get 2-3 specific, concrete and achievable goals.
Have one person designated in the meeting to taking notes, and have the case summarized, along with the solutions, and emailed to all members of the team.
If you clinic has never had M&M Rounds before, start by picking a case where you, as the senior vet/owner, have been the one to miss something/made a mistake. This will show your staff how the process should go, and also not feel like punishment to an employee. It will allow as the start of regular M&M Rounds. You can also consider starting with a case that didn’t die, but just didn’t go as smoothly as it could have, to ease everyone into the process.

When you are just starting up, have anonymous evaluation/assessments of the M&M Rounds afterwards to ensure you are facilitating a positive and productive experience.

You can also consider partnering with a few other clinics in your area with which you have a good relationship, or if you are part of a bigger company having group M&M Rounds. This will not only help improve medicine across multiple clinics, but will improve inter-clinic communication and relationships as well!
Do you feel that M&M Rounds could benefit your practice and don’t know how to get it started? Did you have a bad case and now feel you can’t go on? Do you need someone to talk to? OR, have you started M&M Rounds and want to share how it helped (or didn’t?). Contact Us or check out our KICK ASS Consulting to see if we can be of help!
Written by Dr. Ann Herbst BSc, DVM

Published December 9th, 2019

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