Belonging in Hospital Medicine: Insights From Mapping Hospitalists' Priorities for Inclusive Workplace Strategies

Introduction We aimed to identify priority areas among strategies to foster an inclusive and engaging work environment and to examine how these strategies relate to one another through a needs assessment in a large hospital medicine group. Methods We conducted a secondary analysis of an anonymous survey administered in February 2023 at the University of Kentucky, a university hospital in the southern United States. A total of 85 respondents at the Division of Hospital Medicine ranked nine key strategies by urgency, including recruitment, retention, educational opportunities, belonging, psychological safety, inclusive workplace, inclusive policies, equity in care, and opportunities for collaboration. We used unfolding multidimensional scaling (UMDS) to visualize the relationships among respondents and strategies. Results Of the 85 complete responses, the respondents were primarily physicians (60 (70%)), White (51 (60%)), and women (43 (51%)). Retention (3.6±2.6) and belongingness (4.1±2.6) had the lowest (i.e., highest priority) mean ranks. The UMDS plot suggested one dimension spanning from diversity to inclusivity and the other from organizational to interpersonal continuum. Belonging and psychological safety clustered in the interpersonal-inclusivity domain, while recruitment, retention, and collaboration clustered in the interpersonal-diversity domain. Inclusive workplace, inclusive policies, and equity in care were aligned within the organizational-inclusivity domain. Education was an outlier, suggesting varied interpretations of its importance. Conclusion Belonging emerged as a high-priority strategy closely linked with psychological safety, suggesting its role in workforce inclusivity and engagement. Fostering belonging may support retention and promote a more inclusive culture in academic hospital medicine. Clarifying the definition and measurement of belonging can enhance its integration into institutional strategies.