I am looking for benchmark data relating to span of control for hospital departments. Anything you have on that would be appreciated.

Answer: The rate limiting factor in adding more people is reimbursement. If they had more revenue they would add more people

Long answer to your question but it’s worth the time to read and consider.

We have two issues here. One is optimal/effective staffing levels for specific units and one is management span of control.

We have found that employees will always complain that there are not enough people to do the work because that is the easiest default position to take (aka throw bodies at the problem). I’m fascinated that in Utah they have an FTE/AOB ratio of about seven and the first thing people complain about is that “there aren’t enough people.” This goes on, even though they have two more people per bed than most health systems we work with!

Also, it seems that when there are no financial pressures, healthcare organizations keep staffing ratios much higher than they need to be. It appears that the staffing ratios are less a function of what department managers really want/need and more a function of what the financial/business model dictates.

Please keep in mind that the ratios can easily be adjusted by controlling or “ratcheting down” headcount but if performed the wrong way without true efficiency gains (process improvements), you have an illusion of productivity enhancement.

PEOPLE HAVE NO IDEA WHAT THEY ARE ACTUALLY ABLE TO ACCOMPLISH IF THEY ONLY SET THEIR MIND TO IT. Which is why you see staffing levels in West Virginia at 4 FTE’s/AOB. They have no choice and have adjusted accordingly to “get er done”!

After the guidelines to strive for within specific functions are established, you get to management span of control which we believe is mostly talent dependent.

An “A” player at the manager or director level can handle probably twice as much complexity as a “B” player and three times as much as a “C” or “D” player.

I choose to think of it this way: As a runner, I once got my weekly mileage up to 70 miles per week. I did this for a few weeks until my body finally broke down. Conclusion: I don’t have enough talent. I’m at best a “B” level runner. Talented “A” level runners train at a consistent mileage of over 100 miles per week. Could I as a “B” talent have built up to 100 miles per week over a long period of time? Unrealistic and very unlikely.

As a “B” level runner, I can do about 40 miles per week maximum to optimize my fitness level for my talent level. Try to pile on more work for my talent level and I will eventually break down.

A recreational “C” runner can do about 20 miles per week.

A couch potato “D” can walk up to about 10 miles per week. If you tried to increase the span of control too quickly for the “C” and “D” people in this case you would see them eventually fail/break down as well.


For healthcare directors and other front-line managers, you need to consider how much complexity/span of control (mileage) you try to assign.

Our Leadership Decision-Tree Roadmap will help you adjust accordingly. Our research shows that the average healthcare organization only has a talent alignment success rate of 55% to 60%. If you can get this up to 80%+ by getting the right people (with talent) in the right roles (based upon degree of difficulty or complexity of each department) you will have a profound impact on performance “BY ANY MEASURE.” We will have this done for you by midsummer after the first phase of the Eye Charts.

My best,


P.S. Again, the rate limiting factor in headcount is reimbursement. If the healthcare system was able to increase its reimbursement for services it would figure out how to add more people.

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