1. The Australian Midwifery Workplace Culture
Christine Catling RN RM MSc PhD
Senior Lecturer
@ChristineCatli1
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2. The Australian Midwifery Workplace culture study
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3. Why Hospitals and organisations bring in:
Innovations, policies, protocols etc
Improve cost, efficiency, streamlining of
health services
BUT do they improve safety and quality??
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4. 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.
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5. 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
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6. Social and historical Environment
Rules
Beliefs
Attitudes
Values
Behaviours
Family Community
Economic
Political
Social and historical Environment
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7. Ongoing reports
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8. 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
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9. 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) .
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10. 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)
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11. 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 ed to ACM members twice in May/June 2016
A number of items were related to each domain.
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12. 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
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13. 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%
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14. 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%
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15. 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%
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16. 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%
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17. 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
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18. What next
Larger quantitative study involving many local health districts
Interstate
App
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19. References
Catling, C, Reid, F. & Hunter, B Australian midwives’ experiences of their workplace culture, Women and Birth, 2017; 30 (2):
Kelly L, McHugh M, Aiken L. Nurse outcomes in Magnet® and non-magnet hospitals. Journal of Nursing Administration 2011; 41(10):
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):
Rafferty, A-M. Philippou, J. Fitzpatrick, J.M. & Ball, J. 2015, ‘Culture of Care’ Barometer, Kings College, London. Retrieved from:
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:
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