Document Type



The objective of this study was to research the subject of ""span of control"" as it applies to the management of work, to assess factors impacting supervisory ratios, to assess Indian Health Service (IHS) staffing data to determine supervisory ratios, to identify relevant industry span of control supervisory ratios, and to make findings and recommendations. The purpose of this study was to assess whether or not the IHS\'s span of control is consistent with industry standards.The analysis required research on managerial span of control standards and ratios from variety of sources, including health care organization literature, Office of Personnel Management (OPM) documentary material, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards and manuals, and health care industry staffing data. The analysis also involved obtaining, processing, tabulating, and summarizing IHS agency-wide staffing data by occupational series, location, and function to determine span of control supervisory ratios, and similar data from the American Hospital Association (AHA) on staffing patterns.Corporate responsibilities are organized functionally, but direct health care operations are performed on a ""team"" basis. In the field of health care delivery, the literature does not specify recommended span of control. The statutory mandates do not speak to span of control. Rather, they support a mission, which is critical and complex. There was no data found on supervisory ratios for the private sector. The IHS staffing patterns at hospitals and health centers are consistent with the unique IHS mission.The authors recommend conducting a management review/case study to obtain a realistic view of the supervisory ratios for IHS hospitals and health centers. Case studies of the total staffing profile, (including non-IHS employees), the organizational structure, ""team"" responsibilities, and span of control at three IHS hospitals would be a useful starting point. Also, a roundtable conference on organization issues for health care delivery facilities may prove beneficial. This study suggests the need for an IHS health facility profile database. The database may include information on locations, organizations, FTEs, budget, program descriptions, workload measures, contracting/compacting data, CHS/fiscal intermediary data, etc., to support IHS Headquarters management and analysis needs.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (SSI-02).