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Centralization, mergers and cost reductions have generally led to increasing levels of span of control (SOC), and thus potentially to lower leadership capacity. The purpose of this paper is to explore how a large SOC impacts hospital staff and their leaders.

The study is based on a qualitative explorative case study of three large inpatient wards.

The study finds that the nursing staff and their frontline leaders experience challenges in regard to visibility and role of the leader, e.g., in creating overview, coordination, setting-up clear goals, following up and being in touch. However, large wards also provide flexibility and development possibilities.

The authors discuss the implications of these findings for decision makers in deciding future SOC and for future SOC research.

Only few studies have qualitatively explored the consequences of large SOC in hospitals.