Exploring turnover among first-line managers in healthcare: a cohort study of span of control, management performance and stress indicators.

Purpose: The purpose of this study is to examine if and how an expanded span of control, management performance and work-related stress indicators (control, support and relationships) influence the time until first-line managers leave their position.

Design/methodology/approach: A prospective longitudinal cohort design involving 87 first-line managers in a Swedish health-care region. Cox proportional hazards regression was used to analyse expanded span of control, work-related stress indicators and management performance as predictors of turnover.

Findings: The findings indicate that first-line managers who were categorized as having moderate concern and a need for improvement in the work-related stress indicators control and manager support had a significantly higher risk of turnover. In contrast, expanded span of control and the number of employees managed per first-line manager did not significantly influence turnover risk. In addition, the work-related stress indicator relationships was not significantly associated with risk of turnover.

Originality/value: This study expands the understanding of actual turnover among first-line managers in health care by exploring how organizational factors influence the decision to leave. Unlike previous research, which primarily examines turnover intentions, this study takes a longitudinal perspective, capturing real turnover events over time. The findings contribute to future research on organizational conditions, providing a basis for developing strategies to improve retention and working conditions for first-line managers in health care.