Upon reading your journal editorial, titled “Quality patient care in labor and delivery: a call to action,” I was reminded of the successes our unit in Syracuse (NY) has had implementing the MORE ^OB program, an international safety program designed to place patient safety first, as the priority, at all times, for everyone involved in patient care.

This 3-year program began in 2005 in Syracuse. It is a multidisciplinary program involving unit nurses and providers. The program was completed in 2008 and recently restarted for an update, referred to as MORE ^OB Plus . The patient safety approach has grown to involve other units such as the neonatal intensive care unit, postpartum, and emergency. And the reason it has been successful is because the program is so much more than just a program of drills. It is everything you talk about in your call to action editorial. And I must add that here in Syracuse it is THE program, not just another program along the way.

The most important tool of this program is communication. It is clearly dynamic and involves every member of the health care team in addition to the patient and her family . Sometimes this is obvious to the participant and many times it is embedded. The elements of crew resource management are embedded in virtually every activity. Attention to not only the specific language used but also nonverbal cues, body language, professionalism, attitude, and preset conditions that sway one’s understanding are all part of this program. We discuss fatigue, sleep deprivation, and the ability to respond in crisis. We review the support staff’s ability to speak up and assist when patient safety is at risk.

A list of strategies was placed in your call to action, and this program does each and every one of these items and more. High reliability functions are the founding principles of this program. Patient safety comes first. It is a journey of culture change and we learn how to sustain it. We have been given the tools and ability to accomplish such tasks and are very excited to report success.

You have placed forth a challenge to our communities in obstetrics as a call to action. I would suggest that we have such action here in Syracuse. The goals of learning together, working together, and changing the culture, applying the HRO principles, using teamwork skills, placing communication at the forefront, and doing this in a multidisciplinary approach to all activities. MORE ^OB is THE program and it is supported by the American College of Obstetrics and Gynecology. We have all the items you describe and the statistics to now support the success of this program.