Progress in patient safety has been exceedingly slow, hampered by lack of both clarity regarding the definition and standard methodology to assess iatrogenic patient harm in obstetrics and gynecology. Understanding the causes of medical error and strategies to reduce harm is simple compared with the complexity of clinical practice. On the other hand, patient safety interventions will not be successful without a receptive culture of safety. This culture can only occur with engaged organizational and individual leaders who understand the importance of patient safety. Transforming groups of individual experts into expert teams is central to this cultural transformation. Strategic pathways to accelerate future improvement in patient safety include fundamental changes in health care education, patient engagement, transparency, care coordination, and improving health care providers' morale.