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Span of Control in Health Care Organizations


The number of employees you are responsible for is a central condition for a leader. During the last 20 years, there has been fewer leaders and an in- creasing number of employees in health care or- ganizations. Today, many leaders are therefore re- sponsible for many employees and very complex leadership tasks.

Through the years, both international and Danish research has studied how span of control affects: performance, goal attainment, leadership behav- iour, the employees and the leaders.

Across the Danish health care sector, there are sig- nificant variations in the way which organizational set ups are modified, to address possible, negative consequences of large spans of control.

Hospitals often choose to have more side-by-side leaders at each section, who solves leadership tasks in collaboration. Furthermore, distributed leadership has become popular, since it may re- lieve some of the pressure on the formal leader. Distributed leadership means that employees per- form leadership tasks on behalf of a leader, while possessing authority towards colleagues. Finally, some hospitals deploy different support functions. This may be in the form of a deputy manager, a set of specialists attending to specific technical or or- ganizational responsibilities, or it may be more ad- ministrative support functions.

The purpose and methodology of the study

We address the need for additional studies on how span of control affects leaders and their employ- ees. Specifically, we know very little on whether the consequences of a given span of control will be different across different organizational set ups.

The goal of the study is

  • To provide knowledge on how span of con- trol affects leadership behaviour and the possibility for the employees to provide the best service towards the citizens.
  • To evaluate the degree to which side-by- side leaders, distributed leadership and the use of support functions leads to the in- crease in performed leadership behaviour.

Methodologically, two surveys are send to staff at Danish hospitals. First, a survey is send to nursing managers. Afterwards, a survey is send to 10 staff nurses of each nursing manager.
More information on the project
Professor Christian Bøtcher Jacobsen and senior advisor Lars Dahl Pedersen lead the project. We complete the project in collaboration with DNO (the Danish Nursing Organization), and we use an advisory group consisting of Dorthe Danbjørg, Irene Hesselbjerg; Jonna Søegaard and Thomas Garlov from DNO.