November 10, 2023 Span of control is creeping up in EVS

What the data says

The chart shows a doubling over the last two years of the number of EVS managers who have 35+ spans of control.

What it means 

1 - Increased ancillary spans of control can put a strain on employee retention.

• • Health systems are currently operating with unusually severe financial constraints. This puts pressure on ancillary departments such as EVS to cut costs, regardless of whether they are insourced or outsourced. As a particularly labor-intensive department, the cost reduction opportunities in EVS are thus generally focused on labor management.
  • This reduces formal advancement opportunities available to team members by growing in both role and title, which in turn leads to increased risk of employee turnover.
  • Even though the majority of EVS managers work for outsourced, third-party organizations, such as Sodexo, reducing growth opportunities for EVS managers can lead to a degradation in the pipeline of potential future leaders - some of whom could become direct employees.

2 - Increased ancillary spans of control can also put a strain on patient experience and      clinical recruiting.

• • Increased spans of control can lead to a decrease in patient experience scores and team member development, as less management time is available to coach team members, monitor daily process functions and to reinforce quality measures, and implement service recovery. 
  • Finally, as EVS and other ancillary jobs are a major entry point into the hospital for clinical roles such as lab technicians and CNAs (Certified Nurse Assistants; sometimes called Patient Care Technicians), losing team members can have sizable downstream impact, exacerbating an already challenging recruitment pipeline.

What the implications are for healthcare leaders

1 - To counter the strain on retention, reconsider dramatic increases in spans of control;        also consider creating new growth opportunities.

• • Despite the lack of options given financial constraints, executives should pause before increasing spans of control. It is a popular way to decrease administrative costs without affecting the service level capacity of frontline team members; however, once spans of control reach critical levels, such an approach becomes self-defeating as less interaction between manager and employees leads to an increase in turnover. 
  • Non-clinical leaders should consider implementing formal development programs that are directly connected to increases in skills, competencies, and responsibilities; ladders are one such example. When development programs within roles are built this way, they can provide the opportunity for team members to purposefully advance annually instead of once every few years; this has tremendous value to employees, many of whom believe they need to change organizations to find more near-term opportunities to advance.
  • All leaders should consider building development programs with more steps. This would give early-tenure employees valuable opportunities to grow and advance each year and enable them to showcase accomplishments on their resumés. Ideally, these steps are connected to compensation. In order to build these programs, leaders may need to collaborate with their contractual partners to establish a shared approach toward professional development opportunities.
  • Managers can also develop their team by providing informal advancement opportunities for employees based on their own skills and career goals; the result is a more empowered and engaged team overall.

2 - To counter the strain on clinical recruiting, consider creating formal pathways for EVS      team members (and similar) to grow into introductory clinical roles

• • For top-performing EVS employees, their work ethic and cultural fit with the organization is already established. To counter the risk of losing them, consider prioritizing them for scholarship and developmental opportunities to attend programs for transitioning into CNA or technician roles.

Areas for future analysis and discussion

• • What is the isolated impact of varying spans of control on retention in non-clinical areas?
  • How common is it for EVS and similar employees to transition into a clinical role?  What are the most proficient organizations doing to develop those opportunities?