The Australian Midwifery Workplace Culture Christine Catling RN RM MSc PhD Senior Lecturer @ChristineCatli1 uts.edu.au

The Australian Midwifery Workplace culture study uts.edu.au

Why Hospitals and organisations bring in: Innovations, policies, protocols etc Improve cost, efficiency, streamlining of health services BUT do they improve safety and quality?? uts.edu.au

Workplace cultures are important Manley (2008) – essential for a culture of safety were Shared governance Role clarification Transformational leadership Open communication Teamwork Person-centeredness Support and challenge Lifelong learning Involvement and participation of stakeholders in the workplace. uts.edu.au

Other literature Stromgren et al (2016) – ‘social capital’ – features include: recognition vertical trust (managers to employee) horizontal trust (employee to employee) Kelly et al (2011) – Magnet hospitals in the US organised around a nursing/midwifery model have higher staff and patient satisfaction rates positive outcomes lower mortality rates uts.edu.au

Social and historical Environment Rules Beliefs Attitudes Values Behaviours Family Community Economic Political Social and historical Environment uts.edu.au

Ongoing reports uts.edu.au

Phases of the AMWoC study 1. Interviews of midwives from rural and metropolitan areas 2. Creation of survey 3. Validation of survey 4. Pilot test of the survey 5. Further validation of the survey from midwifery managers uts.edu.au

Phase 3 – creation/validation of survey Item creation based on phase 1 of AMWoC study and the Culture of Care Barometer (Rafferty et al 2015) . uts.edu.au

Phase 3 continued Validation using Likert scale asking for Clarity Relevance Importance Experts in midwifery: 30 Midwifery Educators 8 Midwifery Academics   STATEMENT Relevance 1= not relevant 2= somewhat relevant 3= relevant 4= highly relevant Importance 1= not important 2= somewhat important 3= important 4= very important Clarity 1= not clear 2= somewhat clear 3= clear 4= very clear Suggestions (eg. rewording, restructuring or suggest omission of statement) uts.edu.au

Domains within the amwoc survey 32 Items were grouped into Domains: Role Team Engagement Resources Management and Leadership Empowerment Values A 6-point likert scale was used Survey was emailed to ACM members twice in May/June 2016 A number of items were related to each domain. uts.edu.au

Participants After data cleaning, there were 319 participants. Registered midwives Most aged 50-59 Most from NSW and ACT 24% BMid, 27% Grad Dip, 27% had Masters degree Worked part-time mostly on Ante/postnatal wards/birth suite 90% in public hospital, 13% in private midwifery model/institution,14% caseload model 12% were able to provide homebirth care uts.edu.au

Phase 4 – pilot test results Statement Total agree or strongly agree I know who my senior midwifery manager is 88.1% I know exactly what is expected of me in my job 79.0% The people I work with are friendly 76.8% I feel respected by my co-workers 67.8% I would like to have more access to resources, training or leadership 63.8% There are positive role models where I work 63.0% When things get difficult, I can rely on my colleagues 61.3% My manager treats me with respect 57.4% uts.edu.au

Total agree or strongly agree More results Statement Total agree or strongly agree My philosophy of care is shared by the midwives in my workplace 50.3% I feel good about working in this maternity unit 49.3% I would recommend this maternity unit as a good place to work 46.7% I get the training and development I need 46.2% I do not feel supported by my manager * 45.8% I have sufficient resources that I need to care for women and their families well (eg space, adequate rooms, equipment, supplies) 41.5% The maternity unit values the service I provide I am supported to make my own decisions about caring for women and babies 41.3% uts.edu.au

Total agree or strongly agree More results Statement Total agree or strongly agree My manager gives me constructive feedback 37.2% My managers understand how things really are 32.6% I do not feel supported to develop my potential * 32.4% Unacceptable behaviour is addressed appropriately 32.1% We are a well-managed team 31.8% I cannot change my working hours/shifts easily * 30.9% I feel I work in a place with a positive culture (eg collaborative peers, innovative, high morale, supportive management) 27.9% I have sufficient time to care for women and their partners 27.7% Our workplace celebrates when midwives achieve success (eg completes a course, uses innovation to improve practice) 24.0% uts.edu.au

Total agree or strongly agree Last results Statement Total agree or strongly agree I do not feel well informed about what is going on in our maternity unit * 23.3% I am able to influence the way things are done in my workplace 20.9% The maternity unit acts on midwives’ concerns 20.0% When we are short staffed, we are given adequate support 14.6% uts.edu.au

Some points Large proportion of midwives are dissatisfied with their workplace culture (only a quarter of midwives felt they had a positive culture at work) 68% midwives felt respected by their colleagues 50% midwives felt they had the same midwifery philosophy as their colleagues Nearly half felt unsupported by their managers Only 41% felt their work was valued by the maternity service Only a third of midwives felt inappropriate behaviour was addressed well Only 20% midwives felt their concerns were acted upon Only 15% midwives felt that when short staffed, they were given enough support Remember this is a small pilot study of midwives who were members of the ACM uts.edu.au

What next Larger quantitative study involving many local health districts Interstate App uts.edu.au

References Catling, C, Reid, F. & Hunter, B. 2017. Australian midwives’ experiences of their workplace culture, Women and Birth, 2017; 30 (2): 137-145. Kelly L, McHugh M, Aiken L. Nurse outcomes in Magnet® and non-magnet hospitals. Journal of Nursing Administration 2011; 41(10): 428-33. Manley K. The way things are done around here; Developing a culture of effectiveness: A pre-requisite to individual and team effectiveness in critical care. Australian Critical Care 2008; 21(2): 83-5. McKellar L, Pincombe J, Henderson A. Encountering the culture of midwifery practice on the postnatal ward during Action Research: An impediment to change. Women & Birth 2009; 22(4): 112-8. Rafferty, A-M. Philippou, J. Fitzpatrick, J.M. & Ball, J. 2015, ‘Culture of Care’ Barometer, Kings College, London. Retrieved from: https://www.england.nhs.uk/wp-content/uploads/2015/03/culture-care-barometer.pdf Strömgren M, Eriksson A, Bergman D, Dellve L. Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements. International Journal of Nursing Studies 2016; 53: 116-25. uts.edu.au