First-line managers in healthcare are often responsible for large numbers of subordinates. This qualitative interview study examines how a large-scale reduction in managerial span of control, implemented through different organizational arrangements, was experienced by managers and their subordinates in a Swedish healthcare context. The study explores both the perceived consequences of reduced spans of control and associated mechanisms.
Interviews were conducted with six first-line managers and focus group interviews with 20 subordinates across five operational units in three publicly funded Swedish hospitals, where spans of control had been reduced following an organizational reform. An inductive content analysis was followed by a thematic analysis to identify patterns of consequences and enabling mechanisms.
Reduced spans of control were primarily experienced as improving managers' working conditions by increasing managerial availability, visibility and opportunities for individualized leadership. Three interrelated enabling mechanisms were identified: demand–resource rebalancing through reduced workload and fragmentation; enhanced relational leadership capacity enabled by increased time and relational bandwidth; and resource amplification when reductions were achieved through shared leadership arrangements. When reductions were not accompanied by adequate organizational support, managers experienced renewed pressures and were required to buffer imbalances between demands and resources. Overall, improved managerial conditions were associated with more supportive leadership practices and improved work environments for employees.
The study advances research on span of control by moving beyond structural metrics to explain how and under what conditions reductions in span of control shape leadership practices and work environment outcomes.
