A call for safety: Anticipating and mitigating risk across an obstetrics and gynecology service line.

Delivery of healthcare is a complex interaction of patients, healthcare providers, nurses, ambulatory practices, and hospitals. As the model of health care transitioned, free standing physician practices and hospitals have coalesced to form networks of ambulatory practices and hospitals. This change in the model of healthcare delivery presented challenges to provide safe, quality, cost-effective care for patients, with potentially increased risk to an organization. The development and imbedding of comprehensive safety strategies are imperative to the foundation of this model. Northwell Health, a large health system in the northeastern United States developed a strategy for their Obstetrics and Gynecology Service Line which includes weekly interaction by departmental leadership from each hospital to discuss operations, share concerns and identify potential opportunities to prevent recurrent suboptimal outcomes and improve patient safety. The weekly Safety Call, described in this article is a component of the safety and quality program that has contributed to a 19% decrease in the Weighted Adverse Outcomes Index for the 10 maternity hospitals delivering over 30,000 babies annually within the system since inception. There was also a significant reduction in insurance premiums based on actuarial projections of risk reduction because of the implementation of an Obstetrical Safety Program.