Organisational culture in maternity care: a scoping review

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.