Cultivating compassion in the midwifery workplace culture to strengthen workforce resilience: An ecological futures approach and qualitative Scottish study

BACKGROUND: A deficit of compassion in midwifery workplaces has contributed to toxic cultures, low morale, burnout and persistent attrition. Addressing organisational compassion is essential for cultivating positive workplace cultures. OBJECTIVE: To explore compassion within the maternity services ecosystem and co-create future-orientated solutions with practising midwives. METHODS: Using a futures ecology approach, two participatory workshops were conducted with 21 practising midwives in a Scottish maternity unit. Data were generated through four sequential steps: Future Webs, Desired Futures, Future Stories, and Back Casting. Data were analysed using the Predisposing, Reinforcing, Enabling Constructs in Educational/Environmental Diagnosis and Evaluation logic model. Back casting outputs were synthesised using the Autonomy-Belonging-Contribution framework, to structure actionable visions, measures, and actions. RESULTS: Midwives identified compassion-eroding pressures, including the emotional toll of services reviews, expanding role demands, and strained interpersonal relationships. Their desired futures highlight meso‑level workplace conditions. Strengthening compassion was seen to require system-level action to enhance team cohesion, embedded compassionate leadership, and improve organisational climate. Midwives want working environments where staff are respected, valued, included in decision-making and supported to provide high-quality, safe, and person-centred care. Where they can self-manage time, with workplace logistics and professional development in place. Belonging emerged as the strongest influencing determinant of a compassionate workplace culture. CONCLUSIONS: Compassion in midwifery is primarily undermined by meso-level organisational pressures. Policy responses should prioritise healthcare organisations' social design through climate-focused monitoring, management accountability, staff-voice mechanisms and relational leadership. Transparent, participatory culture-change processes offer a pathway to a compassionate midwifery workforce.