title: Introducing the Hospitalist Morale Index: A new tool that may be relevant for improving provider retention.
abstract: To develop a valid instrument to assess morale and explore the relationship between morale and intent to leave employment due to unhappiness.
  
  
  
  An expert panel identified 46 drivers of hospitalist morale. In May 2009, responders of our single-site pilot survey rated each driver in terms of current contentment and importance to their morale. With exploratory factor analysis, a 28-item/7-factor instrument emerged. In May 2011, the refined scale was distributed to 108 hospitalists from 2 academic and 3 community hospitals. Confirmatory factor analysis (CFA) was used for internal validation and refinement of the Hospitalist Morale Index. Importance ratings and contentment assessments were used to generate item scores, which were then combined to generate factor scores and personal morale scores. Results were used to validate the instrument and evaluate the relationship between hospitalist morale and intent to leave due to unhappiness.
  
  
  
  The 2011 response rate was 86%. The final CFA resulted in a 5-factor and 5-stand-alone-item model. Personal morale scores were normally distributed (mean = 2.79, standard deviation = 0.58). For every categorical increase on a global question that assessed overall morale, personal morale scores rose 0.23 points (P < 0.001). Each 1-point increase in personal morale score was associated with an 85% decrease (odds ratio: 0.15, 95% confidence interval: 0.05-0.41, P < 0.001) in the odds of intending to leave because of unhappiness.
  
  
  
  The Hospitalist Morale Index is a validated instrument that evaluates hospitalist morale across multiple dimensions of morale. The Hospitalist Morale Index may help program leaders monitor morale and develop customized and effective retention strategies. Journal of Hospital Medicine 2016;11:425-431. © 2016 Society of Hospital Medicine.
authors.affiliation: Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Shalini
authors.initials: S
authors.lastname: Chandra
authors.affiliation: Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Wright
authors.affiliation: Johns Hopkins University School of Nursing, Department of Community and Public Health, Baltimore, Maryland.
authors.forename: Sharon
authors.initials: S
authors.lastname: Ghazarian
authors.affiliation: Virtua Health Hospitalists, Voorhees, New Jersey.
authors.forename: George M
authors.initials: GM
authors.lastname: Kargul
authors.affiliation: Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Howell
mesh_terms: D000046:Academic Medical Centers; D005260:Female; D020445:Hospitalists / Q000523:psychology*; D006764:Hospitals, Community; D006801:Humans; D007588:Job Satisfaction; D007857:Leadership; D008297:Male; D009013:Morale; D010563:Personnel Turnover; D011795:Surveys and Questionnaires