Improving outcomes for women, babies, and families has never been just about clinical expertise. While technical skill saves lives, it is culture, the everyday behaviours, conversations, and values within teams, that determines whether care truly feels safe, compassionate, and equitable. 

Across maternity and neonatal services, staff work under immense pressure, making complex decisions in emotionally charged situations. In these moments, culture matters. It shapes whether someone speaks up, whether a concern is heard, and whether a team pulls together or works in silos. 

In this blog, Head of Programme Delivery (Patient Safety and Improvement), Kay Khan discusses the national Perinatal Culture and Leadership Programme (PCLP), which was created with this understanding at its heart.  

It set out to connect leadership, culture, and safety improvement across the East Midlands, not as separate priorities, but as one shared ambition: To create environments where staff can thrive, and where women and families receive the safest, most compassionate care possible. 

You can also listen to Kay discussing the programme with Alma Gallagher, Deputy Head of Improvement Team, in our recent podcast. 

Why culture matters 

Culture is often described as “the way we do things around here,” but in healthcare, it is much more than that. It is the invisible force that influences how teams communicate, how decisions are made, and how people respond when things go wrong. 

In perinatal care, where outcomes can change rapidly, culture is not an abstract concept, it is a safety-critical factor. 

The PCLP recognised that psychological safety, inclusive leadership, and collaboration are not optional “soft” elements of care; they are foundational to patient safety. When staff feel safe to speak up, to challenge, and to reflect openly, risks are identified earlier, learning is shared more freely, and care improves. 

By bringing focus to these elements, the programme helped shift culture from something intangible into something that can be seen, discussed, and actively improved. 

What we did 

The programme combined structured support with the flexibility for local ownership, recognising that no two organisations or teams are the same. 

At a regional level, we worked closely with the QUAD leadership teams (the four members of staff who make up the perinatal leadership team in each trust), building alignment and shared commitment. Locally, teams were supported to explore their own culture through diagnostics such as the Maturity Matrix, creating honest insights into where they were starting from. 

We invested in people through the development of Culture Coaches, individuals equipped with the skills to facilitate difficult conversations, challenge constructively, and support teams on their improvement journeys. 

Alongside this, we introduced the MOMENTS safety culture framework, providing a practical way to embed safer behaviours into everyday practice. Networks meetings and an MS Teams space was created for teams to connect, share learning, and learn from one another across organisational boundaries. 

“We found the training extremely useful. We are applying the principles to some of our work and we are championing the MOMENTS Tool at all opportunities.” 

This was not a top-down programme. It was a collaborative effort, built on trust, curiosity, and a shared willingness to learn. 

What changed 

The impact of the PCLP is reflected not only in numbers, but in the shift in how people think, feel, and work together. From April 2024 until March 2026, we saw: 

• 21 Culture Coaches trained, creating a sustainable workforce to support change. 

• 179 staff trained in MOMENTS, embedding shared language and behaviours. 

• Increased leadership confidence, particularly in navigating cultural challenges. 

• More open and honest conversations, even when the topics were difficult. 

• Locally owned improvement plans, designed by those closest to the work. 

But beyond the metrics, something more meaningful began to emerge. 

Teams started to talk differently. 
Leaders began to listen more deeply. 
Staff felt more able to speak up, to question, and to reflect. 

Culture became part of everyday practice, woven into safety conversations, team huddles, and decision-making. 

“I believe I have always been quite self aware, but undertaking the skills sessions has enabled me to truly consider how I communicate and where I can strengthen some areas.”  

What we learned 

Through this journey, several important lessons became clear: 

1. Relationships drive change 
   Sustainable improvement is built on trust. Taking the time to build relationships created the psychological safety needed for honest conversations and meaningful reflection. 
2. Psychological safety is foundational 
   Without it, improvement efforts stall. When people feel safe, they engage, contribute, and take collective responsibility for change. 
3. Soft” skills are critical 
   Empathy, active listening, and skilled facilitation are not optional extras, they are essential leadership capabilities that directly impact safety and quality. 
4. Context cannot be ignored 
   Maternity and neonatal teams operate in demanding, high-pressure environments. Flexibility, compassion, and understanding of these realities are key to any successful intervention. 
5. Culture change takes time 
   There are no quick fixes. Real change requires consistency, persistence, and a long-term commitment, even when progress feels slow. 

A lasting legacy 

One of the greatest strengths of the PCLP is the foundation it leaves behind. 

• A growing network of skilled Culture Coaches. 

• Accessible toolkits and resources to support ongoing work. 

• Stronger collaboration across organisations and systems. 

• Wider adoption of frameworks like MOMENTS, embedding shared approaches. 

This legacy ensures that culture change does not end with the programme. Instead, it continues to evolve, led by the people who live and breathe it every day. 

What next? 

The journey is not over. The learning from the PCLP will be actively integrated across other programmes, helping us to better understand the cultures and behaviours that enable or hinder improvement and innovation. 

This creates a powerful opportunity: to move beyond individual projects and initiatives and instead build a shared, system-wide understanding of how culture influences outcomes, experiences, and change. 

There is also a clear need to further embed culture into escalation processes, safety systems, and wider system priorities. By doing this, culture shifts from being seen as an additional consideration to becoming a core part of how improvement is designed, delivered, and sustained. 

Ensuring that culture remains central, not peripheral, will be key to maintaining momentum and achieving lasting impact across the system. 

The true impact 

The PCLP has shown that culture change is not only possible, it is powerful. 

When change is locally owned, when people feel psychologically safe, and when culture is embedded into everyday practice, transformation happens. 

Because ultimately, this work is not just about organisations or systems. 

It is about people. 

It is about the midwife who feels confident to speak up. 
The neonatal nurse who knows their voice will be heard. 
The team that comes together in moments of pressure. 
And the families who experience care that is not only safe, but compassionate, respectful, and human. 

That is the true impact of culture.