Table 2

Qualitative analysis of OM3 intervention data and exit interviews

Theme and data setQuotes and examples
Most frequently identified system issues:
  • (1) Communication (interdepartmental)

  • (2) Documentation

  • (3) Transition of care and/or handover

“Communication between systems”
“Miscommunication or absent communication between services”
“Access to and use of medical records to get full accurate history”
“Dual electronic and paper records”
“Lack of continuity of care during handover”
“Transitions of care & medication re-evaluation”
Most frequently identified cognitive issues:
  • (1) Anchoring

  • (2) Communication (interdepartmental)

  • (3) Bandwagon effect

“Fixation on diagnosis”
“Error of over-attachment to diagnosis”
“Misunderstanding consult”
“Communication between services”
“Inheriting the thinking of others”
“Habitual thinking”
Most frequently cited reasons intervention successes:
  • (1) Implementation of actual change

  • (2) Improved case selection and analysis

  • (3) Improved attendance

  • (4) Improved multidisciplinary involvement

  • “Has led to actions; improved attendance.”

    “Culture change; changes implemented”

  • “When rounds are structured and useful, acts as a positive feedback loop”

  • “Now have structured format; now have defined process to identify system issues and to forward these up the ladder; now presentations are multi-disciplinary”

Most frequently cited barriers to intervention success:
  • (1) Attendance and Scheduling

  • (2) Learning curve (time to learn intervention)

  • (3) Following up with action items

  • (4) Persistent culture of shame and blame

  • “Initially, trying to convince people to attend; engaging both campuses”

    “Takes time to learn terminology”

    “Finding the time and resources to effect change (i.e. address action items)”

    “People still resistant regarding shame and blame”

Most frequent recommendations made to future implementers:
  • (1) Get support and/or enlist aid

  • (2) Generate enthusiasm or buy-in early

  • (3) Attend a structured rounds or attend workshops

  • “Don't go it alone. Make sure that you have a team of people that are helping out. It comes to the point where you realise you can't do a great job otherwise”

    “It's important to get people on board with the philosophy very early. Getting people thinking about it and talking about it…”

    “Go to workshops; have committee meetings either before or after rounds—approve bottom lines right away”

No of action items hospital-wide reported to have arisen directly out of M&M rounds:
  • (1) Before OM3 intervention: 0

  • (2) After OM3 intervention: 45

  • “Improving central line insertion learning module”

    “Establishment of electronic communication portal with community geriatric specialties”

    “Development of standard operating procedures of prevention of nosocomial respiratory tract infections in BMT units”

    “Standardising of CADD pumps and related training throughout the hospital”

  • BMT, bone marrow transplant; CADD, computerised ambulatory drug delivery.