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Dear Workforce How Does a Health Care Organization Determine Its Staff-to- manager Ratio

Dear Confounded:

Although yours is a great question, the answer is neither short nor definitive–and it depends on at least four factors.

1. Type of organization

Clearly, there are major differences in staffing models for a health maintenance organization versus a large laboratory, research facility, long-term care provider or group of hospitals.

A skilled nursing home operator like Genesis Healthcare might be able to operate comfortably with a 10-to-1 employee-to-manager ratio (otherwise known as “span of control”). A traditionally organized 650-bed full-service hospital may work well with something closer to a 25-to-1 mix. Higher spans of control today are often a result of the transfer of certain supervisory responsibilities from those with management titles to nurses, technicians and other clinical professionals.

2. Function and department

Ratios can vary widely within one company. As an example, East Alabama Medical Center in Opelika, Alabama,whose retention efforts we recently discussed, has one manager for 11 employees in admissions and a ratio of 93 employees to one manager in a general medical/surgical unit. Its typical department is staffed on the order of 40 employees per manager. Another full-service hospital whose administrators we talked to operates in the range of one manager for every 40 to 50 employees in clinical positions.

There are businesses that will analyze your organization chart (for a fee) and make recommendations on ways to optimize your management staffing. Be careful: This is an area where “one size fits one.”

3. Organization model/philosophy

Pay attention to your organizational structure. Some questions to ask:

  • Is your company organized with a traditional management hierarchy for each specialty and subspecialty, or is it organized in some other fashion?
  • Is authority highly centralized or decentralized?
  • Do you believe that people need to be supervised or do they need to be led?
  • Are you hiring from the top or the bottom of the barrel?

Your answers to these questions all matter a great deal as you contemplate management-staffing ratios.

4. Type of support

To a great degree, a manager’s job is influenced by the level of support available.

Do your managers have the services of a well-functioning recruiting team, for example, or must they fend for themselves? Do they have strong IT systems that keep them from having to fumble with paperwork all day? Are you diligent–in good times and bad–about providing proper, well-timed training for your managers?

Each of these items can cause as much as a 50 percent swing in your management-staffing ratio.

SOURCE: Richard Hadden and Bill Catlette, co-authors, Contented Cows Give Better Milk, July 29, 2005.

LEARN MORE: A discussion of the number ofrevenue-producing employees a company should have versus “overhead” employees.

The information contained in this article is intended to provide useful information on the topic covered, but should not be construed as legal advice or a legal opinion. Also remember that state laws may differ from the federal law.

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