Part 2: Applying the cultural web – Changing the labour ward culture

Abstract

This is the second of two articles looking at cultural change in maternity services using Johnson's cultural web model (1992). Part one explored and explained the model in terms of the dominant cultural paradigm, and its analysis and potential for change ( Freemantle, 2013 ). This article demonstrates the application of the cultural web model to maternity services and its potential impact on women-centred care—specifically labour ward culture. A cultural web is developed and summarised before using the model to consider change and identify a desired culture that aligns with the Chief Nursing Officer's (CNO) ‘6 Cs’ vision for nursing and midwifery care ( Department of Health (DH), 2012 ), the Safer Childbirth report ( Royal College of Obstetricians and Gynaecologists (RCOG) et al, 2007 ) and Maternity Matters ( DH, 2007 ). For demonstration purposes, the change focus or problems are continued use of outdated, entrenched labour ward practices around the second stage of labour, which conflict with National Institute for Health and Care Excellence (NICE) (2007 ) best practice guidance and may well diminish or deny the opportunity for normal birth ( Williams, 2007 ). It recognises the fundamental part midwives and midwifery leadership plays in shaping and changing the culture of care, with particular reference to Supervisors of Midwives (SoM). Consequently, this model has the potential for widespread application throughout maternity services by improving efficiency, effectiveness and the environment of care.