Organisational culture in maternity care: a scoping review

Lucy Frith, Marlene Sinclair, Katri Vehviläinen-Julkunen, Katrien Beeckman, Christine Lotyved, Ans Luybens

Research output: Contribution to journalArticlepeer-review

103 Downloads (Pure)


Aim. To present the results of a scoping review of the research literature addressing the influence of organisational culture on the quality of maternity care.Background. Organisational culture is increasingly seen as key in both healthcare system operations and quality of care.Design. A scoping review using a modified version of Askey and O’Malley’s (2005) framework to identify: key concepts, gaps in the research and types and sources of evidence to inform practice, policy making and research. Research databases used were:PubMed, Med Medic, MEDPILOT, Medline, CINAHL, PsycINFO, Cochrane, Social Sciences Abstracts, Web of Knowledge and Scopus.Method. Development of a protocol specifying search terms and inclusion and exclusion criteria.Results. A total of 3521 papers were identified in the search. Following application of the inclusion criteria, 16 papers were eligible for full review. There was a focus on the organisational and cultural barriers to the practice of good maternity care.Most of the studies included consideration of how organisational culture could be influenced or changed and four of the studies evaluated some form of change of practice to find ways of enabling a ‘midwifery culture of practice’.Conclusion. This scoping review shows midwives and maternity nurses perceived organisational factors to be important determinants affecting practice. It highlights time pressures, procedural imperatives and professional conflicts to be the main organisational barriers to the practice of good maternity care.
Original languageEnglish
Pages (from-to)16-22
JournalEvidence Based Midwifery
Issue number1
Publication statusPublished - Mar 2014

Bibliographical note

This paper is part of the EU COST Action IS0907: ‘Childbirth cultures, concerns, and consequences: creating a dynamic EU framework for optimal maternity care’
and was supported by the European Commission.
Reference text: Allen S, Chiarella M, Homer C. (2010) Lessons learned from measuring safety culture: an Australian case study. Midwifery 26(5): 497-503.
Anderson S, Allen P, Peckham S, Goodwin N. (2008) Asking the right
questions: scoping studies in the commissioning of research on the
organisation and delivery of health services. Health Research Policy and Systems 6: 7.
Arksey H, O’Malley L. (2005) Scoping studies: towards a methodological
framework. International Journal of Social Research Methodology 8(1):
Braithwaite J, Hyde P, Pope C. (2010) Culture and climate in healthcare
organisations. Palgrave Macmillian: Basingstoke.
Braithwaite J, Westbrook MT, Iedema R, Mallock NA, Forsyth R, Zhang
K. (2005) A tale of two hospitals: assessing cultural landscapes and
compositions. Social Science & Medicine 60(5): 1149-62.
Brien S, Lorenzetti DL, Lewis S, Kennedy J, Ghali WA. (2010) Overview of
a formal scoping review on health system report cards. Implementation
Science 5: 2.
Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C,
Stewart M. (2012) Perinatal and maternal outcomes by planned place
of birth for healthy women with low-risk pregnancies: the Birthplace in
England national prospective cohort study. BMJ 343(7840): d7400.
Callen JL, Braithwaite J, Westbrook JI. (2007) Cultures in hospitals and
their influence on attitudes to, and satisfaction with, the use of clinical
information systems. Social Science & Medicine 65(3): 635-9.
Carolan M, Hodnett E. (2007) ‘With woman’ philosophy: examining the
evidence, asking question. Nursing Inquiry 14(2): 140-52.
Collin J, Blais R, White D, Demers A, Desbiens F. (2000) Integration of
midwives into the Quebec healthcare system. Canadian Journal of Public
Health 91(1): I16-20.
Collin JA, Fauser BC. (2005) Balancing the strengths of systematic and
22 © 2014 The Royal College of Midwives. Evidence Based Midwifery 12(1): 16-22
Frith L, Sinclair M, Vehviläinen-Julkunen K, Beeckman K, Loytved C, Luyben A. (2014)
Organisational culture in maternity care: a scoping review. Evidence Based Midwifery 12(1): 16-22
narrative reviews. Human Reproduction Update 11(2): 103-4.
Cragin L, Kennedy HP. (2006) Linking obstetric and midwifery practice
with optimal outcomes. Journal of Obstetric, Gynecologic, & Neonatal
Nursing 5(6): 779-85.
Currie G, Dingwall R, Kitchener M, Waring J. (2012) Let’s dance:
organisation studies, medical sociology and health policy. Social Science
and Medicine 74(3): 273-80.
Daudt HML, van Mossel C, Scott SJ. (2013) Enhancing the scoping
study methodology: a large, inter-professional team’s experiences
with Arksey and O’Malley’s framework. BMC Medical Research
Methodology 13: 48.
Davis K, Drey N, Gould D. (2009) What are scoping studies? A review of
the nursing literature. International Journal of Nursing Studies 46(10):
Davis S. (1984) Managing corporate culture. Ballinger: Cambridge.
Davies H, Mannion R, Jacob R, Powell A, Marshall M. (2007) Exploring
the relationship between senior management team culture and hospital
performance. Medical Care Research and Review 64(1): 46-65.
Davies H, Nutley S, Mannion R. (2000) Organisational culture and quality
of health care. Quality in Health Care 9(2): 111-9.
Debono D, Greenfield D, Travaglia JF, Long JC, Black D, Johnson J,
Braithwaite J. (2013) Nurses’ workarounds in an acute healthcare
setting: a scoping review. BMC Health Services Research 13: 175.
Deery R, Hughes D. (2004) Supporting midwife-led care through action
research: a tale of mess, muddle and birth balls. Evidence Based
Midwifery 2(2): 52-8.
de Vries R, Benoit C, van Teijlingen ER, Wrede S. (Eds.). (2001) Birth by
design: pregnancy, maternity care and midwifery in North America and
Europe. Routledge: New York.
Downe S. (Ed.). (2008) Normal childbirth: evidence and debate (second
edition). Churchill Livingstone: Oxford.
Dykes F. (2005) A critical ethnographic study of encounters between
midwives and breastfeeding women in postnatal wards in England.
Midwifery 21(3): 241-52.
Francis R. (2013) Report of the Mid Staffordshire NHS Foundation Trust
public inquiry. HMSO: London.
Gifford BD, Zammuto RF, Goodman EA. (2002) The relationship between
hospital unit culture and nurses’ quality of work life. Journal of
Healthcare Management 47(1): 13-25.
Halliday SV. (2002) Barriers to customer-orientation: a case applied and
explained. European Journal of Marketing 36(1-2): 136-58.
Hastie C, Fahy K. (2011) Inter-professional collaboration in delivery suite: a
qualitative study. Women & Birth: Journal of the Australian College of
Midwives 24(2): 72-9.
Hatch MJ. (2006) Organisational theory (second edition). Oxford University
Press: Oxford.
Hatem M, Sandall J, Devane D, Soltani H, Gates S. (2008) Midwifery-led
versus other models of care for childbearing women. Cochrane Database
Syst Rev 4: CD004667.
Hrešanová E. (2008) Kultury dvou porodnic: etnografická studie. [The
cultures of two maternity hospitals: an ethnographic study.] Západoceská
univerzita: Plzen: 216s.
Hughes D, Deery R, Lovatt A. (2002) A critical ethnographic approach to
facilitating cultural shift in midwifery. Midwifery 18(1): 43-52.
Jacobs R, Mannion R, Davies HTO, Harrison S, Konteh F, Walshe K. (2013)
The relationship between organisational culture and performance in
acute hospitals. Social Science & Medicine 76(1): 115-25.
Kennedy HP, Lyndon A. (2008) Tensions and teamwork in nursing and
midwifery relationships. Journal of Obstetric, Gynecologic, & Neonatal
Nursing 37(4): 426-35.
Khokher P, Bourgeault I, Sainsaullieu I. (2009) Work culture within the
hospital context in Canada: professional versus unit influences. Journal
of Health Organisation and Management 23(3): 332-45.
Kirkhan M. (1999) The culture of midwifery in the NHS in England. Journal
of Advanced Nursing 30(3): 732-9.
Lavender T, Chapple J. (2004) An exploration of midwives’ views of the
current system of maternity care in England. Midwifery 20(4): 324-34.
Leap N. (2009) Woman-centred or women-centred care: does it matter?
British Journal of Midwifery 17(1): 12-6.
Levac D, Colquhoun H, O’Brien KK. (2010) Scoping studies: advancing the
methodology. Implementation Science 5: 69.
Lindberg I, Christensson K, Ohrling K. (2005) Midwives’ experience of
organisational and professional change. Midwifery 21(4): 355-64.
Martin J. (2002) Organisational culture: mapping the terrain. Sage:
Thousand Oaks.
McKellar L, Pincombe J, Henderson A. (2009) Encountering the culture of
midwifery practice on the postnatal ward during action research: An
impediment to change. Women and Birth: Journal of the Australian
College of Midwives 22(4): 112-8.
Meyerson J. (1991) ‘Normal ambiguity’: a glimpse of occupational culture:
In: Frost PJ, Moore LF, Louis MR, Lundberg CC, Martin J. (Eds.).
Reframing organisational culture. Sage: London.
Purewel S, van der Akker OBA. (2009) Systematic review of oocyte
donation: investigating attitudes, motivations and experiences. Human
Reproduction Update 15(5): 419-515.
Scott-Findlay S, Estabrooks C. (2006) Mapping the organisational culture
research in nursing: a literature review. Journal of Advanced Nursing
56(5): 498-513.
Sheridan V. (2010) Organisational culture and routine midwifery practice
on labour ward: implications for mother-baby contact. Evidence Based
Midwifery 8(3): 76-84.
Sleutel M, Schultz S, Wyble K. (2007) Nurses’ views of factors that help
and hinder their intrapartum care. Journal of Obstetric, Gynecologic &
Neonatal Nursing 36(3): 203-11.
Smircich L. (1983) Concepts of culture and organisational analysis.
Administrative Science Quarterly 28(3): 339-58.
Tew M. (1998) Safer childbirth? A critical history of maternity care. Free
Association Books: London/New York.
Walker SB, Moore HD, Eaton A. (2004) North Queensland midwives’
experience with a team model of midwifery care. Australian Journal
of Midwifery: Journal of the Australian College of Midwives 17(1):
Walsh D. (2006) Subverting the assembly-line: childbirth in a free-standing
birth centre. Social Science & Medicine 62(6): 1330-40.
Walsh D. (2007) A birth centre’s encounters with discourses of childbirth:
how resistance led to innovation. Sociology of Health and Illness 29(2):
Wilson SM. (2000) An ethnography of midwifery work patterns during
organisational redesign. Australian Health Review: A Publication of the
Australian Hospital Association 23(1): 22-33.


  • Organisational culture
  • organisational behaviour
  • maternity care
  • scoping review
  • evidence-based midwifery


Dive into the research topics of 'Organisational culture in maternity care: a scoping review'. Together they form a unique fingerprint.

Cite this