Every month at the Lloyd Veterinary Medical Center, someone stands up in front of a room full of colleagues to present a case.
Not a success story. Not a textbook outcome. A case that didn’t go as planned.
Could be emergency and critical care. Could be cardiology. Could be a routine case that looked straightforward until it wasn’t. The veterinarian walks everyone through the history, the physical exam, the diagnostics, the decision points. They show their reasoning.
And then they explain what went wrong.
These sessions are called Morbidity and Mortality Rounds—which sounds morbid as hell. And honestly? Standing up there to dissect your clinical judgment in front of your peers takes guts. You’re inviting scrutiny of decisions you made under pressure, with incomplete information, with a patient’s life in your hands.
But what actually unfolds is one of the most powerful acts of leadership development you can witness.
The Courage It Takes
I’ve sat through several of these sessions now, and every time, I’m struck by the same thing: the courage it takes to stand at that podium.
You’re essentially saying, “Here’s where I made the best call I could with the information I had. Here’s where the outcome suggests I might have been wrong.” You’re inviting scrutiny of your clinical judgment, your diagnostic reasoning, your decisions made under pressure with incomplete data and a patient’s life in your hands.
It would be so much easier to bury these cases. To chalk them up to bad luck. To quietly move on.
But we don’t. And there’s a reason why.
What Actually Happens in That Room
M&M Rounds began in the early 1900s in human medicine as a structured way to review adverse outcomes without blame. The tradition carried over into veterinary medicine because it works.
But here’s the key: we’re not dissecting the outcome. We’re analyzing the process.
Picture this: A veterinarian presents a case where they missed a subtle finding on a radiograph. Could have happened to anyone—the opacity was faint, the patient was crashing, they were making ten decisions a minute. But they missed it, and the patient coded six hours later.
Here’s what doesn’t happen in a good M&M Round: no one says “How did you miss that?” No one questions competence. No shame spirals. No finger-pointing.
Here’s what does happen: Someone pulls up similar cases where they made the same miss. Another clinician asks if the imaging protocol should be adjusted for that breed. Someone suggests adding a checklist trigger for the specific presentation.
The questions aren’t gotchas—they’re genuine curiosity. The suggestions come from shared experience, not superiority. The entire tone is: we’re in this together, and we’re going to figure this out together.
That room isn’t comfortable. But it’s safe.
And that’s why it works.
Why Safety Matters More Than Comfort
For this to work, the room has to feel safe. Not comfortable—nothing’s comfortable about admitting you missed something critical. But safe.
Researchers call it “psychological safety”—the ability to speak up, admit uncertainty, and take risks without fear of punishment or humiliation. Study after study shows it’s the foundation of high-performing teams in medicine, business, and beyond.
Without it, people hide problems until they become crises.
With it, people learn.
In the best M&M sessions, that safety is palpable. A clinician can say “Here’s what I wish I’d done differently,” and instead of judgment, they get engaged curiosity. The attending physicians modeling this behavior aren’t just teaching medicine—they’re teaching leadership. They’re showing what it looks like to create a culture where learning trumps ego.
That’s not easy. It requires leaders who can set aside their need to be the smartest person in the room. Who pause to invite input. Who frame questions with curiosity instead of judgment. Who are willing to say, “I’m not sure—what do you all think?”
But when it works, you get a room full of people who trust each other enough to get better together.
Learning to Think Differently About Mistakes
Carol Dweck coined the term “growth mindset”—the belief that abilities develop through effort and learning. Sounds obvious until you try to practice it when your ego and a patient’s life are both on the line.
M&M Rounds force that practice.
Here’s what the research shows, and what I see every month: people who view mistakes as information rather than identity ask better questions. They develop more nuanced judgment. They bounce back faster. They build resilience.
The alternative—treating mistakes as proof you’re not good enough—leads to defensive medicine, burnout, and repeated errors that could have been prevented.
Everyone in that M&M room knows perfection isn’t possible. Medicine is practiced by imperfect humans making decisions with incomplete information under time pressure. Sometimes those decisions lead to good outcomes. Sometimes they don’t.
But the outcome alone doesn’t tell you whether the decision was sound. You can make every right call and still lose a patient. You can get lucky despite poor reasoning and celebrate a win you didn’t earn.
M&M Rounds force us to look past the outcome and examine the thinking. That’s where growth happens.
It’s Never Just One Person
Here’s what I love most about well-run M&M Rounds: they resist the urge to pin everything on one individual.
Yes, a specific person made a specific decision. But that decision happened within a system—a hospital, a team, protocols, communication structures, workload, culture.
Maybe the clinician missed something on the radiograph because they were at the end of a long shift with back-to-back emergencies. Maybe critical lab values didn’t get flagged because the notification system failed. Maybe there was a breakdown in the handoff between services. Maybe the protocols themselves were unclear.
Good M&M Rounds ask: What in our system set someone up to fail? How do we fix the system so it doesn’t happen again?
That’s systems thinking, and it’s what separates leaders who build learning organizations from leaders who just manage blame.
The alternative—the blame-and-shame approach—just teaches people to cover their asses. You get great documentation of why the failure wasn’t technically your fault. You don’t get actual improvement.
What If Everyone Did This?
Here’s where this gets interesting for anyone outside a hospital: What if every organization held its own version of M&M Rounds?
Not about medicine. About leadership decisions. Projects that failed. Strategic initiatives that flopped. Communication breakdowns. Missed opportunities. Assumptions that proved wrong.
What if, instead of quietly shelving those experiences, leaders stood up and said: “Here’s what we were thinking. Here’s what we did. Here’s what happened. Here’s what we’d do differently. What can we learn together?”
Organizational researchers call this a “just culture”—where learning takes precedence over punishment and accountability is shared rather than imposed. It’s the opposite of the zero-defect, cover-your-ass culture that crushes innovation and burns people out.
In a just culture, failure is information. Mistakes get surfaced quickly, examined openly, and converted into improvements. People don’t hide problems—they bring them forward because that’s how the organization gets better.
Sound idealistic? NASA implemented formal debriefing processes after catastrophic failures. Aviation got dramatically safer when pilots could report errors without losing their jobs. The highest-performing surgical teams use structured debriefs to reduce complications.
The common thread: psychological safety, systems thinking, and the humility to know we’re all works in progress.
What This Teaches Me About Leadership
I don’t know if M&M Rounds make me a better veterinarian—though I’m certain they do. But I know they make me a better leader.
They teach me the goal isn’t perfection. It’s honest reflection, continuous learning, and the humility to recognize we’re all figuring this out as we go.
They remind me that psychological safety isn’t a buzzword—it’s the foundation of high-functioning teams. When people feel safe saying “I don’t know” or “I was wrong” or “I need help,” that’s when real growth happens.
They show me that transparency builds trust. When leaders model vulnerability—when they admit their own mistakes and invite scrutiny—they give permission for everyone else to do the same.
They reinforce what I believe deeply: the scenic route with its detours and wrong turns isn’t actually a detour. It’s the only route that teaches you anything worth knowing.
What I Take From That Room
So here’s what I take from each M&M Round:
Failure is information, not identity. Leaders who can separate what happened from who they are model the emotional intelligence that builds resilient teams.
Safety is non-negotiable. Without it, you get compliance at best and cover-ups at worst. With it, you get teams that surface problems early and improve continuously.
Systems and individuals both matter. Success and failure rarely come down to one person’s decision—they emerge from the intersection of judgment, processes, communication, and environment. The best leaders ask: what do we fix in the system so good people can do good work?
Leadership requires humility. The leaders I respect most aren’t the ones who never fail. They’re the ones who fail, reflect openly, learn publicly, and invite others to do the same.
The Room Where We Get Better
Each time I watch someone stand at the front of that room and dissect a tough case, I see what real leadership looks like.
It’s not the person who has all the answers. It’s the person willing to examine their questions.
That’s how growth happens. That’s how trust is built. That’s the room where we get better.
Shape
What spaces exist in your work for honest reflection on what didn’t go as planned? And if those spaces don’t exist—what would it take to create them?