Relationships among Span, Time Allocation, and Leadership of First-Line Managers and Nurse ...

186 Pages·2010·1.23 MB·English

by  Raquel M

Relationships among Span, Time Allocation, and Leadership of
First-Line Managers and Nurse and Team Outcomes

by

Raquel Marie Meyer

A thesis submitted in conformity with the requirements
for the degree of Doctor of Philosophy

Graduate Department of Nursing Science
University of Toronto

© Copyright by Raquel Marie Meyer 2010
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Relationships among Span, Time Allocation, and Leadership of First-
Line Managers and Nurse and Team Outcomes

Raquel Marie Meyer
Doctor of Philosophy
Graduate Department of Nursing Science
University of Toronto

2010
Abstract
Comparisons of raw span (i.e., number of staff who report directly to a manager) within and
across organizations can misrepresent managerial capacity to support staff because managers
may not allocate the same amount of time to staff contact. The purpose was to examine the
influence of alternative measures of managerial span on nurse satisfaction with manager’s
supervision and on multidisciplinary teamwork. The alternative measures were (a) raw span as a
measure of reporting structure and (b) time in staff contact as a measure of closeness of contact
by the manager. The main effects of the alternative measures, leadership, hours of operation, and
other covariates on outcomes were examined. The interaction effects of the alternative measures
with leadership and hours of operation were investigated. The study framework was based on
Open System Theory and the boundary spanning functions of managers. A descriptive,
correlational design was used to collect survey and administrative data from employees,
managers, and organizations. Managerial time allocation data were collected through self-
logging and validated through observation. Acute care hospitals were selected through purposive
sampling. For supervision satisfaction, the final sample size was 31 first-line managers and 558
nurses. For teamwork, the final sample size was 30 first-line managers and 754 staff. The
Leadership Practices Inventory, the Satisfaction with my Supervisor Scale, and the Relational
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Coordination Scale were used. Hierarchical linear modeling was the main type of analysis
conducted. Raw span interacted with leadership and hours of operation to explain supervision
satisfaction. Teamwork was explained by leadership, clinical support roles, hours of operation,
total areas, and non-direct reports, but not by raw span or time in staff contact. Large acute care
hospitals can improve satisfaction with supervision and teamwork by modifying first-line
management positions.
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Acknowledgements
Success as a doctoral student depends on the efforts of many people. I am deeply grateful to the many
individuals and organizations that enabled this journey and extend my sincerest thanks.

To my thesis supervisor and mentor Dr. Linda O’Brien-Pallas, for sharing your vast expertise and
experience, for believing in me, and for fostering my success. I will always hold you in high and fond
regard. To my committee members Dr. Diane Doran, Dr. David Streiner, Dr. Mary Ferguson-Paré, and
Dr. Christine Duffield, for sharing your expert knowledge and humour to skillfully guide this thesis. To
my thesis reviewers Dr. Linda McGillis Hall and Dr. Carol Brewer, for your constructive feedback. To
the staff at the Nursing Health Services Research Unit, for facilitating this thesis.

To the nurse managers, who graciously allowed me into their busy worlds, thank you so much for your
insights and for the vital contributions you make every day to our healthcare system. You made this
dissertation possible and I will always be grateful. To the front-line nurses and health care providers,
administrative staff, senior nurse leaders, and hospitals who also very generously participated, I am
extremely appreciative.

To the following, thank you for financial support: the Canadian Institutes for Health Research, the
Nursing Health Services Research Unit, the Canadian Health Services Research Foundation/Canadian
Institutes for Health Research Chair in Nursing/Health Human Resources, the Ontario Training Program
in Health Services and Policy Research, the Ontario Nursing Leadership Network, the Registered Nurses
Foundation of Ontario, the Nursing Research Interest Group, and the Ontario Nursing Informatics Group
as well as awards through the Lawrence S. Bloomberg Faculty of Nursing and University of Toronto.

To my father Ken Meyer and stepmother Lynn Brown, for your steadfast encouragement and for
supporting me in a myriad of ways. To my mother Cam Duhaime and stepfather Don Kishibe, for
instilling me with a strong work ethic and for cheering me on. To Amy, Louise, and Bob, for believing in
me and for the on-line support. To Barb Mildon, Christine Covell, Kim Sears, Joan Almost, Jessica
Peterson, and Doris Leung for friendship and laughter during the doctoral program adventure.

Finally and ever so importantly, to my husband Paul Barber, for unwavering love, support, and humour
and for weathering this journey alongside me – you are the wind beneath my wings.
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Table of Contents
Abstract..........................................................................................................................................ii
Acknowledgements......................................................................................................................iv
Chapter 1: The Problem...............................................................................................................1
Background of the Problem.............................................................................................1
Problem Statement............................................................................................................2
Purpose of the Study.........................................................................................................3
Literature Review.............................................................................................................3
Managerial Span...............................................................................................................4
Measurement and Analytical Issues.......................................................................11
Studies of Span as Reporting Structure and Staff Outcomes..............................13
Studies of Span as Closeness of Contact and Staff Outcomes..............................14
Managerial Time Allocation..........................................................................................16
Measurement Issues.................................................................................................16
Leadership.......................................................................................................................22
Studies of Managerial Span, Leadership, and Staff Outcomes...........................25
Gaps in the Literature and Study Rationale................................................................26
Chapter 2: Theory and Study Framework...............................................................................28
Theory..............................................................................................................................28
Assumptions..............................................................................................................28
Open System Theory Applied to Large Scale Organizations...............................29
Boundary Spanning.................................................................................................32
Outcomes...................................................................................................................33
Study Framework...........................................................................................................38
First-Order Relationships.......................................................................................42
Manager Level Covariates......................................................................................46
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Staff Level Covariates..............................................................................................51
Chapter 3: Method......................................................................................................................53
Design...............................................................................................................................53
Design and Data Collection Overview....................................................................53
Power.........................................................................................................................54
Setting and Sample...................................................................................................55
Data Collection Procedures.....................................................................................57
Risk and Benefits......................................................................................................59
Administrative Data........................................................................................................60
Managerial Work Logs...................................................................................................62
Instrumentation...............................................................................................................64
Leadership Practices Inventory..............................................................................64
Nurse Satisfaction with Manager’s Supervision...................................................65
Relational Coordination Scale................................................................................68
Data Analyses..................................................................................................................68
Data Entry and Cleaning.........................................................................................68
Levels of Analysis.....................................................................................................69
Study Objectives.......................................................................................................70
Knowledge Translation Plan..........................................................................................71
Chapter 4: Results.......................................................................................................................73
Instruments......................................................................................................................73
Leadership Practices Inventory..............................................................................73
Satisfaction with my Supervisor Scale...................................................................74
Relational Coordination Scale................................................................................74
Sample Description.........................................................................................................74
Descriptive Statistics of the Study Variables................................................................77
Satisfaction Findings.......................................................................................................84
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Objective 1: Main Effects for Satisfaction.............................................................84
Objective 2: Interaction Effects for Satisfaction...................................................87
Objective 3: Model Explaining Most Variation in Satisfaction...........................92
Teamwork Findings........................................................................................................93
Objective 1: Main Effects for Teamwork..............................................................93
Objective 2: Interaction Effects for Teamwork....................................................96
Objective 3: Model Explaining Most Variation in Teamwork............................98
Chapter 5: Discussion of Findings...........................................................................................100
Descriptive Findings.....................................................................................................100
Manager Sample.....................................................................................................100
Outcomes.................................................................................................................102
Raw Span and Outcomes.............................................................................................102
Time in Staff Contact and Outcomes..........................................................................103
Leadership and Outcomes............................................................................................103
Hours of Operation and Outcomes.............................................................................104
Three-Way Interaction Effects....................................................................................105
Covariates and Outcomes.............................................................................................107
Implications for Boundary Spanning..........................................................................109
Study Limitations and Strengths.................................................................................110
Future Knowledge Translation Plan...........................................................................112
Chapter 6: Summary, Recommendations, and Conclusions................................................113
Summary........................................................................................................................113
Recommendations for Research..................................................................................114
Recommendations for Theory Development..............................................................116
Recommendations for Organizational Policy and Managerial Practice.................116
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Conclusions....................................................................................................................120
References..................................................................................................................................121

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List of Tables

Table 1. Span at the Manager Level...............................................................................................6
Table 2. Operational Definitions of Span.....................................................................................12
Table 3. Components of the Literature Used to Derive the Study Framework............................41
Table 4. Data Collection Flow Chart............................................................................................54
Table 5. Managers’ Average Raw Span, Total Areas Assigned, and Surveys Analyzed.............75
Table 6. Managers’ Age, Tenure, Years of Experience, and Education.......................................76
Table 7. Nurses’ Designation, Age, Years of Experience, and Education...................................76
Table 8. Team Surveys by Occupation.........................................................................................77
Table 9. Team Surveys by Highest Education..............................................................................77
Table 10. Descriptive Statistics of Study Variables......................................................................78
Table 11. One-Way Analysis of Variance Model for Satisfaction...............................................84
Table 12. Fixed-Coefficient Regression Model Level-1 for Satisfaction.....................................85
Table 13. Fixed-coefficient Regression Model Level-1 for Satisfaction: Reduced Model..........85
Table 14. Raw Span. Intercepts-as-Outcomes Model for Satisfaction.........................................86
Table 15. Time in Staff Contact. Intercepts-as-Outcomes Model for Satisfaction.......................86
Table 16. Raw Span with Two-Way Interactions for Extended Hours of Operation. Intercepts-as-
Outcomes Model for Satisfaction.................................................................................87
Table 17. Raw Span with Two-Way Interactions for Compressed and Mixed Hours of Operation.
Intercepts-as-Outcomes Model for Satisfaction...........................................................88
Table 18. Time in Staff Contact Two-Way Interactions for Extended Hours of Operation.
Intercepts-as-Outcomes Model for Satisfaction...........................................................88
Table 19. Time in Staff Contact with Two-Way Interactions for Compressed and Mixed Hours of
Operation. Intercepts-as-Outcomes Model for Satisfaction.........................................89
Table 20. Raw Span with Three-Way Interaction for Extended Hours of Operation. Intercepts-as-
Outcomes Model for Satisfaction.................................................................................89
Table 21. Holm Procedure for Three-Way Interaction for Two Alternative Measures for
Satisfaction....................................................................................................................90
Table 22. Raw Span with Three-Way Interaction for Compressed and Mixed Hours of Operation.
Intercepts-as-Outcomes Model for Satisfaction...........................................................91
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Table 23. Summary of Between-Manager Variance Explained in Satisfaction Models with
Alternative Span Measures...........................................................................................93
Table 24. One-Way Analysis of Variance Model for Teamwork.................................................93
Table 25. Fixed-coefficient Regression Model Level-1 for Teamwork.......................................94
Table 26. 95% Confidence Intervals of Pairwise Differences in Mean Teamwork Scores..........95
Table 27. Raw Span. Level-2 Covariate Model Parameter Estimates for Teamwork..................96
Table 28. Time in Staff Contact. Level-2 Covariate Model Parameter Estimates for Teamwork96
Table 29. Time in Staff Contact with Two-Way Interactions for Extended Hours of Operation.
Level-2 Covariate Model Parameter Estimates for Teamwork....................................97
Table 30. Time in Staff Contact with Two-Way Interactions for Compressed and Mixed Hours of
Operation. Level-2 Covariate Model Parameter Estimates for Teamwork..................98
Table 31. Summary of Between-Manager Variance Explained in Teamwork Models with
Alternative Measures....................................................................................................98
Table 32. Level-2 Covariate Model Parameter Estimates for Teamwork....................................99
Table 33. Characteristics of Study Managers Compared to Other Studies................................101
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