We would like to congratulate the Journal for their Patient Safety series. This series has among other things raised awareness of this critical frontier of medicine. It has also vindicated our persistent approach and our methodology.

At more than 12,000 participants, the MORE ^OB Program is the world’s largest and longest-running supported Comprehensive Unit based patient safety program (CUSP) in obstetrics. Rolled out to its first pilot sites in 2002, MORE ^OB was created by the American College of Obstetricians and Gynecologists’s (ACOG) sister society, the Society of Obstetricians and Gynaecologists of Canada.

As Dr Pronovost called for in the first of your series, the MORE ^OB Program has for years been fully endorsed by ACOG because of our robust methodology and outcome results. The program nets the user up to 50 ACOG credits per year (American Academy of Family Physicians prescribed credits are also obtainable).

We were pleased to see the results from New York’s experience. Significant positive findings were also noted in our first New York site in 2005. The results of Grunebaum et al mirror our data, which show a crushing 75% reduction in cost per claim (39 hospitals, P < .001) (available from DATA on File at the offices of HIROC, a reciprocal Hospital Insurer). Independent research on our effect indicates statistically significant maternal and neonatal outcome improvements ( P < .05). Supporting Dr Pronovost’s observation that “unit-level approaches create local ownership for the improvements of patient safety,” we add that this creates sustainability of initiatives on which units focus.

The observations of Pettker et al on culture are also supported in the larger scale. Our Culture Survey was implemented 2 years after the Pilots as an evolution of the program; the findings mirror the observations made by Dr Pettker. In our sample size (9000), we found statistically significant improvements through each year of involvement in the intervention.

We thank you for placing such a focus on patient safety. It is clear to us in patient safety that the next great saving in lives (human life of those we serve and the professional lives of our colleagues) will not come from a new instrument or a new pill but from a well-executed, proven, effective, and reproducible patient safety approach that seeks to place safety into the DNA of our health care teams.