Background

Span of control (SOC) has been used as a description of the number of individual employees that a manager is responsible for and is often used for assessing first-line managers' (FLMs') scope of responsibilities. However, there are arguments that SOC should include more factors than number of direct reports to illustrate the diversity and complexity of FLMs' responsibilities in hospital settings. Mentions of being an objective instrument including such factors have been made of 'The Ottawa Hospital Clinical Managers Decision-Making Tool' (TOH-SOC) which includes three decision-making categories: unit-, staff- and program-focused. The unit-focused category includes two indicators: unit complexity and material management. The staff-focused category includes four indicators: volumes of staff directly reporting to the FLM, autonomy of the team, staffing stability, and diversity of staff. The program-focused category includes two indicators: diversity and budgetary responsibilities. The TOH-SOC tool is referred to in both international reviews and Swedish reports as an instrument for assessing FLMs' scope of responsibilities, but published results from using it are limited. Hence, there is a need to further test the instrument's validity, reliability, and generalizability in different settings and countries. 

Aim

The aim of this study is to investigate how the TOH-SOC describes the span of control of hospital first-line managers at medical and surgical units in Sweden and what descriptions and reflections first-line managers have regarding the instument's content validity and clinical usefulness.

Methods

A mixed method design with an explanatory sequential approach is used and includes three stages; the first is quantitative data collection and analysis, the second is asking how the results from stage one can be used in stage three, which, last and ongoing, includes a quantitative and qualitative data collection and analysis. The participants in stage one was driven from a randomized sample of Swedish hospital FLMs at medical and surgical units, and in stage three, the participants consisted of a subsample of FLMs included in stage one. Descriptive statistics are used to describe respondents' demographics and their span of control. From the interviews, quantitative and qualitative viewpoints on the TOH-SOC is analyzed with the standard method for computing an item-level content validity index (I-CVI) .78 or higher and qualitative content analysis.

Results

Results from the first stage showed how the majority out of the total 33 FLMs scored as having an appropriate span of control, according to the scoring guidelines described in the TOH-SOC tool. Although the results from the first stage are in line with earlier research, questions for clarification regarding the instrument have been identified. These questions, along with initial results from the second and last stage, identifying how norms differ between the origin of the instrument and the Swedish context, imply a need to further test and develop the instrument to be relevant in hospital context and, in particular, Swedish hospital medical and surgical units. More detailed results will be presented later this year.