Too many managers: major threat to CQI in hospitals

Some hospitals are rushing into continuous quality improvement (CQI) without understanding the pitfalls, one of which is the issue of empowerment. To prevent middle managers from inappropriately reinvolving themselves in the activities of empowered front-line workers, empowerment of employees must be accompanied by a substantial decrease in the number of middle managers. Despite its importance, however, this move is rarely undertaken for two reasons: first, a failure to analyze management "spans of control" in the context of empowerment; second, the fear that staff reductions will imperil the CQI implementation. This article presents case studies of effective and ineffective management to demonstrate that without span of control adjustments, empowerment will fail, whereas appropriate adjustments will allow it to succeed even beyond expectations.