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INTRODUCTION

We've been downsizing. They wanted to take out management. The motivation for the change was money. Supervision is being done by colleagues now. It's not the same as when it's being done by someone with the time and the knowledge base. There's also consultation to the senior staff that's been lost.

There are competing views on whether frontline supervisors improve or undermine coordination between workers. Organizational theorists such as Richard Hackman and Richard Walton have suggested that active supervision encourages workers to focus more on their vertical ties up and down the organizational hierarchy, distracting attention from lateral ties with their coworkers and thereby undermining teamwork.111 This view was especially prevalent in the 1980s and 1990s, when empowerment was a popular goal of many organizations and supervisors were widely suspected of standing in the way of achieving this goal.

But theorists in the human relations tradition such as Douglas McGregor and Rensis Likert argued, to the contrary, that supervisors play a critical role in achieving organizational effectiveness through their role in coaching and feedback.112 McGregor pointed out moreover that providing coaching and feedback can be far more time-intensive than the traditional directive style of supervision: "It is far quicker to hand a man a list of tasks to perform than to discuss with him the reasons for why these tasks need to be done." Consistent with McGregor's argument that it is more time-consuming to engage in coaching and feedback than simply to boss people around, Lyman Porter and Edward Lawler found that supervisors tend to take on a more facilitative style when their span of control is small (fewer employees to manage) and a more directive style when their span of control is large (more employees to manage).113 This suggests that to enable supervisors to play a less directive role and spend more time engaged in coaching and feedback, it helps to invest in higher levels of supervisory staffing.

What does this have to do with relational coordination? In a highly interdependent work process such as patient care, it is often difficult to disentangle the web of causality to determine how specific members of the care team are contributing in a positive or negative way to patient outcomes. For this reason, coaching and feedback can be powerful in helping care providers improve their coordination by better understanding how their actions can hinder or facilitate the patient care process. However, coaching and feedback are time-intensive and therefore difficult to accomplish in a meaningful way without a deliberate allocation of time to those tasks.

Supervisory staffing trends have moved in the opposite direction. In healthcare, supervisory spans of control have been on the rise. Cuts in supervisory staffing often are motivated by the belief that leaner supervisory structures are more empowering as well as more cost-effective. For those who are convinced that supervisors do not add value, cutting supervisors is ...

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