Paper
Saturday, July 16, 2005
Leadership, Span of Control, Turnover, Staff & Patient Satisfaction
Amy McCutcheon, RN, PhD, Corporate Office, Vancouver Coastal Health Authority, Vancouver, BC, Canada and Ruth Anne Campbell, RN, Inpatient Mobility Program, St. Michael's Hospital, Toronto, ON, Canada.
| Learning Objective #1: Identify the leadership style that promotes optimum staff performance and patient outcomes |
| Learning Objective #2: Determine the optimum span of control |
The study examined the relationships between leadership style, span of control and outcomes as measured by nurses' job satisfaction, turnover, and patient satisfaction. The study used a conceptual model that linked concepts from three theories: Span of Control theory, Transformational Leadership theory and Contingency Leadership theory. Span of control is defined as the total number of staff reporting directly to the manager. Data were collected using a survey method conducted over a period of six months. Measures used included: Multifactor Leadership Questionnaire Form 5X, Patient Judgments of Hospital Quality Questionnaire, and McCloskey-Mueller Satisfaction Scale. The sample consisted of nurses (717), nurse managers (41) and patient care units (51) and seven hospitals. Hierarchical linear modelling and multiple regressions were used to test the study hypotheses. Transformational leadership style was found to be the strongest predictor of nurses' job satisfaction. Nurses who rated their manager as having a transformational leadership style had higher job satisfaction. Transactional leadership style was found to increase patient satisfaction. Span of control was the strongest predictor of staff turnover. Units with managers who had a wide span of control had higher levels of staff turnover. As well, span of control decreased the positive effects of transformational and transactional leadership styles on job satisfaction and patient satisfaction, and increased the negative effects of management-by-exception and laissez-faire leadership styles on job satisfaction and patient satisfaction. The major contribution of this study is its findings that no leadership style can overcome a wide span of control. Recommendations for practice include: organizations should implement management training programs to develop transformational and transactional leadership styles; and a policy needs to be developed regarding the optimum managerial span of control for managers.