Cultural Interpretations of Patients and Employees in an Organization Certified Through the Baby-Friendly Hospital Initiative: A Focused Ethnographic Study
Abstract
BACKGROUND: The Baby-Friendly Hospital Initiative (BFHI) is a program that was developed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to enhance global support for breastfeeding. Since 1991, organizations have been able to become BFHI-certified through the implementation of policies, including the Ten Steps to Successful Breastfeeding (TSSB). However, research over the past three decades has revealed contradictory results related to the BFHI’s association with breastfeeding exclusivity and longevity. A critical gap within the literature is how organizational culture affects the individuals within BFHI-certified organizations, including patients and employees.
AIM: The purpose of this study was to explore the organizational cultural aspects of a BFHI-certified organization from the perspectives of patients and employees. The research question was, “What are the cultural interpretations of individuals within a BFHI-certified organization?”
METHODS: A focused ethnographic methodology was implemented, which included exploring a sub-culture within a healthcare context. Purposive sampling was performed to recruit two participant groups from one BFHI-certified hospital network in Ontario, Canada, including ten patients and eight employees. Data collection methods involved conducting one-to-one, semi-structured interviews between 2023-2024. Data analysis procedures followed Roper and Shapira’s framework for analyzing ethnographic data.
RESULTS: Five core themes emerged from the data, including: (1) knowledge is power, (2) community of support, (3) contextual considerations, (4) environment for breastfeeding, and (5) patient factors. Through narrative descriptions, these interrelated themes exhibit how patients and employees have experienced or provided care that is consistent with breastfeeding-supportive policies and additional gaps that may not be addressed through policy research.
CONCLUSION: The research findings demonstrate organizational cultural implications and key considerations for additional breastfeeding support within BFHI-certified organizations. Implementation research has provided vast evidence for organizations who strive for BFHI designation; however, more work needs to be done to understand organizational culture within designated facilities, and how to meet individualized breastfeeding goals. This knowledge will be disseminated to healthcare providers, researchers, and policymakers, with a goal of using this information to guide policy development and enhance breastfeeding experiences for individuals in the future.