Overcoming Professional Silos and Threats to Psychological Safety: A Conceptual Framework for Successful Team-Based Morbidity and Mortality Conferences

Background

Adverse events in health care are frequently discussed in morbidity and mortality conferences. However, while health care has evolved to be delivered by interprofessional teams, morbidity and mortality conferences have been slow to include all team members. One particularly potent barrier to conducting an interprofessional team–based morbidity and mortality conference is a lack of psychological safety among team members. Clinicians from various professions bring differences in perspectives, culture, perceived hierarchy, and assumptions about other professions. These perspectives may bring value to the interprofessional team–based morbidity and mortality conferences, but they may also degrade psychological safety.

Methods

This report explores the link between professional silos and psychological safety among the health care team in the context of an interprofessional team–based morbidity and mortality conference using the perioperative space as an example. The authors draw on the concept of team fault lines—a potential division along a team members' characteristics that can divide a group or team into subgroups. The roots of perioperative professional silos, which define these fault lines, are then traced to the historical context of the health care professions, the individual development of professional identities, and the role of organizations in maintaining these silos. From these observations, a framework for describing these foundations is proposed, which the authors use to evaluate the broader teamwork-in-health-care literature to generate specific recommendations to promote psychological safety in team-based morbidity and mortality conferences.

Conclusion

This framework can be used to postulate strategies for improving the ability for teams to learn from morbidity and mortality conferences. However, future work remains in implementing and studying these recommendations.