Deconstructing Morale: The Hospitalist Morale Assessmenta Multisite Analysis

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97665


Recruiting new hospitalists is expensive and turnover remains a challenge. Monitoring morale may help leaders improve retention. There are no published instruments that quantify hospitalist morale. Our study describes the Hospitalist Morale Assessment (HMA), a validated and reliable instrument that aims to identify program strengths and weaknesses by quantifying hospitalists’ contentment with their work.


By reviewing our prior qualitative work and the morale literature, we identified 54 potential contributors or “keys” to hospitalist morale. In 2009, 29 hospitalists rated the importance of and their contentment with each key on a five point Likert scale (“not at all important” to “tremendously important” and “extremely discontent” to “extremely content”). Scales were scored 0–100 and called the Importance Scores (IS) and Contentment Scores (CS). Factor analysis and internal reliability testing reduced the number of keys to 36. The keys, 10 global morale questions, and a series of demographic questions constitute the HMA. In 2011, we invited all 108 hospitalists from two academic and three community hospitals to complete the HMA. We used each hospitalist’s importance and contentment ratings to calculate her Individual Morale Index (IMI) to quantify her morale. The median IMI, the Hospitalist Morale Index (HMI), is thought to reflect the group morale. Indices range 0 to 100.


Of the 108 hospitalists, 93 responded. Response rates for each program ranged from 56% to 100%. IMI’s were normally distributed and ranged from 24 to 82. HMI’s ranged from 51 to 59. IS’s for the top 10 keys across all sites ranged from 76 to 84, while the respective CS’s ranged from 73 to 85. Each program had a unique set of top 10 keys. All groups ranked family time in the top 10; it was the most important key for three programs and for the aggregate group (IS 84, CS 73). Keys relating to leadership ranked highly in all groups and made up the majority of the top 10 in two groups. Pay and shifts per month ranked highly in only two groups, while relationship with nurses ranked highly in only one group. One program stood out by ranking four keys (number of night shifts, job security, efficiency of hospital, and autonomy) in the top ten that were ranked lower by the others.


The HMA is a reliable and validated tool that quantifies morale. Results suggest that individual programs’ needs are unique and that an instrument such as the HMA is necessary to solve the turnover problem in hospital medicine. Programs may be able to improve morale by affecting change in a targeted manner that may not necessarily be resource intensive (e.g. focusing on leadership). Our findings are being used to guide hospitalist leaders in making programmatic changes and serve as a benchmark for future studies.

Table 1Ten Most Important Keys to Hospitalist Morale

Ranking Key Importance Score Contentment Score
1 Family Time 84 73
2 Fairness of Program Leaders 80 81
3 Approachability of Program Leaders 79 85
4 Program Leaders’ Role as a Hospitalist Advocate 79 80
5 Feeling Valued within Program 78 75
6 Program Leaders Receptiveness 78 81
7 Patient Census 78 73
8 Relationships with Patients 76 79
9 Efficacy of the Program Leaders 76 82
10 Time for Scholarly Work 76 69

To cite this abstract:

Howell E, Kargul G, Wright S, Chandra S. Deconstructing Morale: The Hospitalist Morale Assessmenta Multisite Analysis. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97665. Journal of Hospital Medicine. 2012; 7 (suppl 2). Accessed March 28, 2020.

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