Collaborative safety: The impact of patient and caregiver engagement in perioperative care.

Objective: Patient involvement in perioperative safety is increasingly emphasized, yet opportunities for patients and caregivers to participate meaningfully are often constrained by clinical workflows and limited role clarity. We adapted the One Safe Act (OSA) approach, a resilience-based intervention originally designed for staff, to evaluate whether a simple reflective prompt could foster patient and caregiver engagement. Methods: We conducted an exploratory quality-improvement study in the Perioperative Care Unit between February and August 2024. After routine surgical and anesthesia review, patients and caregivers were invited to identify one action they used or planned to use to promote safety and to complete brief survey items (awareness of safety, perceived role, comfort asking questions, and trust in facility efforts). Free-text responses underwent inductive thematic analysis. Associations between attitudes and behaviors were examined using Fisher's exact test with false-discovery-rate adjustment. Proactive engagement was also assessed at the respondent level. Results: We collected 122 OSA responses (98 patients, 24 caregivers). Most respondents reported awareness of patient safety (71%), endorsed a personal role (90%), felt comfortable asking questions (94%), and trusted the facility's safety efforts (84%). A composite high-engagement profile ("Proactivity Trust") was met by 28%. Eight behavioral themes emerged, most commonly dietary adjustments (33%), strategic planning (32%), and medication adherence (28%); 3% of responses described no specific action. When classified by engagement type, 58% of coded behaviors were routine and 41.8% were proactive. At the respondent level, 40.8% of patients and 45.8% of caregivers reported at least one proactive behavior ( Conclusions: Although most patients recognized a role in safety, fewer reported proactive engagement. The OSA prompt elicited patient- and caregiver-generated safety behaviors and identified opportunities to strengthen engagement. Practice implications: Embedding OSA in preoperative counseling may provide a scalable approach to normalize patient- and caregiver-initiated safety behaviors and strengthen communication at a vulnerable point in care.