An application of the One Safe Act framework: Proactive safety behaviors in obstetric care

To perform a qualitative analysis of staff-reported proactive safety behaviors performed on the obstetric service.

This qualitative thematic analysis included a convenience sample of obstetric staff at a single tertiary care center who completed the One Safe Act survey, first introduced at Mount Sinai's Quality and Safety Summit (January 2024) and later distributed to all obstetric staff. All obstetric staff were eligible for inclusion. Participants were asked to reflect on their One Safe Act (proactive safety behavior) and record their experience as free text in an online survey tool. We used a combined deductive and inductive analytic approach to identify key themes and categorize self-reported staff safety behaviors within the obstetric environment.

A total of 141 obstetric staff members participated in the survey. Participants included attendings, fellows, residents, physician assistants, midwives, nurses, and anesthesiologists. A total of seven behavioral themes were identified, ordered from most to least common: (1) Patient communication, education, and engagement (26.2%); (2) Staff communication and team routines (22.0%); (3) Protocol adherence (13.1%); (4) Personal or team readiness (13.1%); (5) Prepared environment, equipment, and resources (8.9%); (6) Positive team culture (8.9%); and (7) Routine-based clinical care and documentation (7.7%).

The One Safe Act survey captured proactive safety behaviors performed by obstetric staff, from which seven themes were identified. This set of themes may serve as a foundation for individual practices and institutional initiatives that promote patient safety.