Evaluation of practice of morbidity and mortality meetings and associated factors among healthcare workers at tertiary teaching hospitals in Tanzania

Abstract

ABSTRACT Background: Morbidity and Mortality (M&M) meetings are among the most powerful teaching tools and cornerstones for surgical and medical training and learning. They provide a platform for healthcare organizations and trainees to discuss adverse incidents and management failures in patient care that may have led to complications or death. Studies have shown that the majority of M&M meetings are focused on maternal and perinatal care, as opposed to other medical disciplines. In Africa, healthcare practices are still inadequate, compromising the quality of care. M&M meetings, are crucial for assessing the quality of care, but there is little information regarding their existence, performance, and the practical barriers to their implementation across all medical disciplines. This study evaluated the practice of M&M meetings and the factors associated with them among healthcare workers (HCWs) at tertiary teaching hospitals in Tanzania. Aim: To evaluate the practice of morbidity and mortality meetings and its associated factors among HCWs at a tertiary teaching hospital in Tanzania. Methodology: This was a cross-sectional study conducted at Muhimbili National Hospital (MNH), Muhimbili Orthopedic Institute (MOI), and Kilimanjaro Christian Medical Centre (KCMC). Using consecutive sampling, 300 HCWs were enrolled in the study from June to November 2023. A total of 14 M&M meetings were observed among the three institutes using a structured observation checklist to evaluate the institutional practice. A standard questionnaire assessed HCWs’ awareness, knowledge, attitude, and perception of M&M meetings. Data collection and analysis using SPSS version 26 included bivariate and multivariate analyses with independent factors identified using logistic regression models at p-values <0.05. Results: Only eight meetings in eight of the enrolled departments from KCMC, five meetings in seven of the enrolled departments from MNH, and one meeting from MOI were observed in a period of five months. The practice of conducting M&M meetings was found to be adequate only in five of the 14 observed meetings. Most participants (96.7%) reported having heard about M&M meetings, 80.7% of participants perceived the practice of M&M meetings as effective, and 92.8% had a positive attitude toward the practice. However, the overall knowledge was low and only 21.0% had adequate knowledge. In bivariate analyses, sex, age, cadre, years of experience, knowledge, and perception were strongly associated with the regular participation of HCWs in M&M meetings. Doctors and specialists showed a higher proportion of regular participation compared to nurses (95% CI: 1.33-5.32, p = 0.01), and (95% CI: 5.45-30.55, p= 0.00) respectively. Participants with positive perceptions had a higher likelihood of regular participation (95% CI;2.05-22.41, p=0.00). Logistic regression analysis revealed that only adequate knowledge was independently associated with regular participation (AOR= 265.58, 95% CI; 59.71-1181.13, p=0.00). Conclusion: The study revealed a significant gap in adherence to guidelines and inadequate practice of M&M meetings. Healthcare workers who have adequate knowledge about these meetings were more likely to participate regularly. Aligning local practices with international guidelines from the World Health Organization (WHO), national or evidence based guidelines can help standardize M&M processes, promote consistency in quality improvement efforts, and ultimately contribute to enhanced patient safety and outcomes within Tanzanian healthcare settings. Furthermore, the study has highlighted the importance of educational interventions among HCWs to promote regular participation and enhance the effectiveness of M&M meetings. Keywords: morbidity and mortality (M&M) meetings, healthcare workers (HCWs).