Midwives’ and Nurses’ Views on the Shift from Hierarchical to Clan Culture in Nigerian Public Healthcare Facilities

Purpose Midwives/nurses play a pivotal role in maternity care delivery, yet their perspectives on organisational culture remain underexplored. This study aimed to characterise both the existing and preferred organisational culture profiles among midwives/nurses in public healthcare facilities of Osun State, Nigeria, and to identify strategic recommendations for optimising organisational performance. Methods A cross-sectional survey design employed the Organisational Culture Assessment Instrument, grounded in the Competing Values Framework. Data were collected online from 352 midwives/nurses representing tertiary, secondary, and primary healthcare tiers. Descriptive and inferential analyses were conducted to compare current and preferred culture dimensions. Results Participants reported a predominance of Hierarchy culture (mean = 39.5, SD = 11.4; p < 0.001) characterized by centralized decision-making, rigid protocols, and limited autonomy. In contrast, the Clan culture emerged as the preferred model (mean = 36.1, SD = 9.1; p < 0.001), emphasizing teamwork, open communication, and shared leadership. These findings reveal a discord between entrenched bureaucratic practices and staff aspirations for participatory, innovation-oriented work environments. Conclusion To reconcile this gap, a dual-track change strategy is recommended: retain hierarchical safeguards for accountability while embedding clan-oriented dynamics to foster empowerment, collaboration, and innovative problem-solving. Key interventions include teamwork training, governance reforms with frontline inclusion, performance systems recognising both compliance and innovation, routine multidisciplinary rituals, and real-time feedback mechanisms. This original study is the first to map organisational culture across all three tiers of public maternity services in Osun State. By elucidating midwives/nurses’ cultural perceptions and preferences, it provides an empirical foundation for targeted interventions that can enhance team cohesion, accelerate evidence-based practice, and ultimately improve maternal and neonatal outcomes.