Part 1: The cultural web – A model for change in maternity services

Abstract

Organisational culture is a recognised problem in the NHS and can have significant impact, positively or negatively, on patient welfare and care. Although maternity services were not implicated, the recent Francis Report (2013) recognised the influence of a dysfunctional culture as a major factor in system-wide failings and their devastating consequences for patient care. The report's recommendations are set to impact all NHS institutions and influence policy for the foreseeable future. In a more recent and damning review of Furness Hospital's maternity service, cultural and professional failings have been brought to public attention. Morecambe Bay NHS Foundation Trust, along with the Care Quality Commission, has been indicted for a cover up of serious incidences within the maternity services, which included the deaths of 16 babies ( BBC, 2013 ). Sadly, these cases implicate midwives and also cast a shadow over the effectiveness of statutory supervision of midwives; the latter of which has been subject to Nursing and Midwifery Council (NMC) review (2011) . The profession cannot be complacent about the current provision and culture within UK maternity services. It is imperative for all providers, regulators and users of UK health services to explore how cultural change may be implemented to improve efficiency, effectiveness and the environment of care throughout the NHS. In this series of two articles, a model for cultural analysis, change and its challenges is identified. The first, focusing on woman-centred care, introduces Johnson's ‘cultural web’ model (1992) ; while in the second, the possibilities and potential of the model are demonstrated through a process of understanding and changing the culture of the labour ward.