The Room Where We Get Better

Not every case becomes a success story, and not every ending is the kind you want to talk about over coffee. Some cases spiral in the ER at 2 a.m. before the team has even caught its breath. Some start in cardiology and seem entirely manageable until a lab value, a rhythm, or a tiny detail shifts the ground underneath you. Some are so routine that no one even thinks to be worried until suddenly everyone is.

Then, days or weeks later, someone stands up in front of a room full of peers and walks through the whole thing, from the first history taken to the last decision made. They do not simply narrate what happened. They unwrap how they thought. They retrace their reasoning, show their diagnostic logic, expose their judgment calls, and then they do the hardest part.

They explain where things went wrong.

These sessions have a name that sounds like it belongs more in a gothic novel than a teaching hospital: Morbidity and Mortality Rounds. The title alone can make people brace themselves. But the real weight of the room does not come from the terminology. It comes from what the room asks of you.

You are not just presenting facts. You are inviting your colleagues into your decision-making process at the very moments when patients were fragile, time was short, and certainty was in short supply. You are allowing others to see the gap between what you knew then and what you know now, and you are doing it in public.

That is not simply a test of medical knowledge. It is a test of courage.

The Courage to Stand There Anyway

Every time I sit in one of these sessions, I am struck by the weight carried by the person at the front of the room. For at least a few minutes, everyone in that space is following their thought process frame by frame.

You can almost hear the unspoken translation of the presentation: “Here is the best call I could make with the information I had and the pressure I was under. Here is what I considered, what I ruled out, what I chose, and where the outcome suggests I may have been wrong.”

That is a level of vulnerability most professions never come close to requiring.

It would be much easier to let those cases fade into the background. You could attribute them to luck, timing, a strange presentation, or “one of those things,” which is a phrase medicine has quietly used for generations when the universe decides to throw a wrench through the window. You could protect your ego, preserve your confidence, and avoid re-entering the moment when things started to go sideways.

Yet in well-run hospitals, we do not bury those cases. We bring them back to the surface on purpose. We examine them not because we enjoy reliving hard outcomes, but because we recognize what honest reflection can unlock.

The act of standing there, case in hand, is not self-punishment. It is a public commitment to learning.

What Actually Happens in That Room

Despite the ominous name, M&M Rounds are not supposed to be a ritual of blame. They began in human medicine as a structured way to review adverse outcomes and complications so teams could learn from them without turning every discussion into a professional indictment. Veterinary medicine adopted the practice for the same reason: it works.

But it only works when the focus stays on the process, not the verdict.

Picture a case where a clinician misses a subtle finding on a radiograph. Maybe the opacity is faint and tucked into an area that is easy to overlook. The patient is unstable, alarms are chiming, and the clinician is juggling ten decisions at once. Six hours later, the patient codes.

It would be a cheap form of hindsight to freeze the film on the missed finding and ask, “How could you not see that?” That kind of question may feel sharp, but it does not make anyone better. It only teaches people to hide the next miss more carefully.

In a healthy M&M Round, the conversation sounds different. Another clinician might mention a similar case where they nearly made the same mistake. Someone may wonder whether the imaging protocol for that presentation should include a second set of eyes. Someone else may suggest a checklist that flags patterns where subtle findings are more likely to be missed.

The shift is subtle but profound.

The questions are not designed as gotchas. They are framed as genuine inquiry. The suggestions come from shared experience rather than superiority. The underlying message is not, “How could you have done this?” It is, “We are all capable of this miss. How do we make it less likely for any of us?”

No one walks out of a session like that thinking, “What a relaxing way to spend an afternoon.” But relaxation is not the point. The point is whether the room is strong enough to hold the truth without turning it into a weapon.

Safety Is Not the Same as Ease

To an outside observer, the vulnerability on display in M&M Rounds might look like a personality trait, as if only the especially brave or especially thick-skinned can tolerate it. In reality, it is usually a function of culture.

Researchers often call this psychological safety, which is a useful term even though it has been dragged through enough corporate slide decks to deserve a small vacation. At its core, it means people believe they can speak up, admit uncertainty, ask questions, and acknowledge mistakes without being punished, humiliated, or quietly pushed to the margins.

In medicine, where the stakes are high and the margin for error can be thin, that kind of safety is not decorative. It is the foundation that allows honest reflection to happen.

Without it, people do not stop making mistakes. They stop talking about them. Problems stay hidden until they grow large enough that no one can ignore them. Documentation becomes less about accurately capturing reality and more about building a legal moat around oneself. In that environment, learning slows to a crawl because no one wants to show their work.

In strong M&M cultures, you can feel the difference almost as soon as you walk into the room. A clinician can say, “Here is what I wish I had done differently,” and instead of being met with raised eyebrows or thinly disguised judgment, they get earnest engagement. Senior clinicians do not just model expertise. They model how to be learners in public.

They ask questions that invite participation rather than shut it down. They are willing to say, “I am not sure. What do you all think?” That single sentence may do more for the culture of a team than any laminated values statement in the lobby.

Learning to Think Differently About Mistakes

One of the hardest lessons in any high-stakes profession is learning to separate what happened from who you are.

That sounds simple until your decision is attached to a patient, a client, a student, a colleague, or an outcome you wish you could change. In those moments, the mind can become a very poor courtroom. It wants a verdict. It wants someone guilty. Too often, the person on trial is yourself.

M&M Rounds push against that instinct.

They remind us that a mistake is not an identity. A missed finding does not make someone careless. A delayed diagnosis does not automatically mean someone lacked judgment. A poor outcome does not, by itself, prove that the decisions were poor.

You can make every reasonable decision and still lose a patient. You can also make a weak decision and get lucky. Outcomes matter deeply, but outcomes alone do not tell the whole truth. If we only celebrate what worked and bury what did not, we end up learning the wrong lessons from both success and failure.

The real work is examining the thinking.

What did we know? What did we assume? What signals did we overweight? What did we explain away? What information was missing? What pressure was the team under? What could we build into the system so the next person has a better chance of seeing what this person could not?

That is where growth lives.

It Is Rarely Just One Person

One of the things I respect most about well-run M&M Rounds is their resistance to the simplest narrative: that one person, in one moment, is the entire story.

Yes, every case involves individual decisions. Judgment matters. Accountability matters too. But decisions are made inside systems, and systems have fingerprints all over outcomes.

Consider the clinician who misses a subtle radiographic finding at the end of a long shift, after back-to-back emergencies, with no realistic chance to reset their brain. Or the lab value that never gets flagged because the notification system buried it three clicks deep. Or the handoff between services that technically occurred but effectively failed because critical details were assumed rather than stated. Or the protocol that exists on paper but is ambiguous enough that each person interprets it differently.

When an adverse outcome emerges from that context, it is misleading to pretend that only one decision, from one clinician, is responsible.

Good M&M Rounds widen the aperture. They ask better questions. What in our system made this outcome more likely? What assumptions were embedded in our processes? Where did communication falter? How do we change the environment so the next clinician faced with this pattern has a clearer path?

That is systems thinking, and it is the difference between leaders who chase culprits and leaders who build learning organizations.

The blame-and-shame approach may produce impressive documentation and very eloquent explanations of why, technically, the failure was not anyone’s fault. But it does little to prevent the next version of the same event. A just culture recognizes that while individuals are responsible for their choices, those choices are shaped by the systems in which they operate.

That is not excuse-making. It is leadership.

Every Organization Needs a Version of This

It is tempting to treat M&M Rounds as a uniquely medical practice, a necessary ritual for people who live in a world of vital signs, ventilators, lab values, and very expensive machines that beep with opinions.

But the underlying logic applies far beyond hospitals.

Every organization has its own version of adverse outcomes. Projects that miss the mark. Strategies that looked brilliant until reality walked in carrying a folding chair. Hiring decisions that did not play out as expected. Communication plans that collapsed under real-world complexity. Policies that made perfect sense in a meeting and then failed the moment they encountered actual humans.

Most of those experiences get quietly shelved. They show up as bullet points in a perfunctory “lessons learned” slide, if they are acknowledged at all. Leadership teams move on, often with a nagging sense that something never got fully resolved. Then, months later, the same pattern returns wearing a different hat, and everyone acts surprised.

Imagine if we did something different.

Imagine if leaders regularly stood in front of their teams and said, “Here is what we thought we understood. Here is the decision we made. Here is what actually happened. Here is where our assumptions were wrong. Here is what we would do differently now. What can we learn from this together?”

That would change a room. More importantly, it would change what people believe is safe to say in that room.

People pay close attention to what leaders do with failure. If leaders hide it, everyone else learns to hide it too. If leaders weaponize it, people become experts in self-protection. But if leaders examine it openly, thoughtfully, and without theatrical blame, people begin to believe that truth is safe enough to bring forward.

That is how organizations get smarter.

What This Teaches Me About Leadership

I do not think I could quantify exactly how much M&M Rounds have improved my clinical skills, but I have no doubt they have sharpened my leadership.

They remind me that the real goal in complex work is not flawless execution. It is honest reflection. Perfection is an illusion that invites denial. Reflection is a discipline that invites growth. Leadership in that room does not look like someone who never makes a mistake. It looks like someone who is willing to examine hard outcomes openly, in front of others, and treat them as shared curriculum rather than private shame.

The idea of psychological safety can sound like corporate jargon when it is printed on a slide, but in M&M Rounds, it becomes tangible. When people feel safe saying, “I do not know,” or “I was wrong,” or “I need help,” the collective intelligence of the team rises. They spot patterns sooner. They intervene earlier. They learn faster.

Transparency stops being a buzzword and becomes a behavior. Leaders say, “Here is where I misjudged this,” and by doing so, they give everyone else permission to be honest about their own missteps.

Over time, these experiences reinforce a belief I hold deeply: the scenic route, the one with detours, wrong turns, and occasional dead ends, is not an inefficient path to leadership. It is the path. The shortcuts, polished narratives, and carefully edited biographies may look cleaner, but they do not teach as much.

The messy, honest, humbling moments are where the real education lives.

What I Carry Out of That Room

Every time I walk out of an M&M Round, I carry a few convictions a little more firmly than before.

The first is that failure is information, not identity. When leaders can separate what happened from who they are, they model a kind of emotional intelligence that ripples through their teams. People stop equating “I made a mistake” with “I am a mistake,” and that subtle shift makes them braver in their learning.

The second is that safety is non-negotiable. Without psychological safety, the best you can hope for is compliance. People may follow rules as written and avoid drawing attention to themselves, but they will not surface emerging problems or share half-formed concerns. With safety, teams move from compliance to commitment. They flag issues early, offer ideas, and participate in continuous improvement because they trust that doing so will not be used against them.

The third is that systems and individuals are inseparable. Outcomes, good and bad, rarely hinge on one person’s decision in isolation. They emerge from the intersection of individual judgment, team dynamics, processes, communication pathways, resource availability, and institutional norms. The best leaders are the ones who ask, “What can we change in the system so good people can consistently do good work?” rather than, “Which person do we need to fix?”

And finally, I am reminded that leadership requires humility in active form. The leaders I admire most are not the ones who appear unflappable or infallible. They are the ones who can say, “Here is where I got this wrong,” and then stay in the conversation long enough to help everyone, including themselves, understand why.

That kind of humility is not weakness. It is the engine of trust.

The Room Where We Get Better

In the end, every M&M Round is about more than the single case under discussion. It is about what kind of organization we want to be.

Do we want to be a place where people silently carry their regrets and pretend they never falter? Or do we want to be the kind of place where someone can say, “This did not go as planned. Let’s walk through it together,” and know they will be met with curiosity instead of condemnation?

Each time I watch someone stand at the front of that room and dissect a tough case, I am reminded that real leadership is not about having all the answers ready on demand. It is about having the willingness to examine your questions in public. It is about choosing transparency over self-protection, reflection over revisionism, and learning over ego.

That is how growth happens. That is how trust takes root. And that is why, for all its weight, that room remains one of the most important spaces we have.

Somewhere in your own work, whether in a hospital, a classroom, a business, a nonprofit, a farm, a clinic, or a boardroom, there is or could be an equivalent room. A space where people bring forward what did not go as planned and turn it into shared learning.

The real question is not whether your organization has failures. It does. Every meaningful organization does.

The better question is whether you have a place where those failures can be safely, honestly, and collectively examined.

And if you do not, what would it take to create one?