More managers to front line staff has an impact well beyond cost of salaries

Asking how the ratio of management to front line staff has changed at a public hospital seemed like a straight-forward question.

In this era of obsession with hyper-efficiency, you’d think the Ministry of Health, the Local Health Integration Networks and the hospital boards would be asking this question, and asking it regularly.

Doesn’t everyone want more live bodies actually delivering diagnostics, acute care and rehab?

To be fair the Ministry breaks down data by what they describe as “unit producing personnel” (UPP) and those whose “primary function is the management and or support of the operation of the functional centre” (MOS). Oddly the terms themselves suggest that managers don’t actually produce anything, which is much further than we would certainly go. (Note to managers reading this – are you really okay with these terms?)

If all this confuses you, apparently it does for hospitals too. There have been past complaints about the consistency and subsequent validity of such data. In our recent survey of the changing ratios of managers to front line staff, several hospitals opted (with our permission) to give us the UPP/MOS data instead of interpreting themselves who was in fact a manager.

Conducting what we thought was a basic freedom of information request, we received data in various formats and continually got the question: what is management?

If hospitals are asking this of us, the question arises – is nobody internally asking these same questions? Who is providing oversight when nobody appears interested in the composition of staff? As the hospitals continually remind us, this is their biggest line item in the budget.

Yet many hospitals claimed that they had to do major work to answer our question. For example, Ontario Shores Centre for Mental Health Sciences charged us $300 to figure it out, claiming they had to do new computer programming to give us what we sought. At the other end of the spectrum was Quinte Health, who had our answer readily at hand and even waived the $5 freedom of information fee. Evidently the same question crossed some minds at that hospital too.

Given the data we received varied wildly we never attempted to assess a hospital as having the highest number of managers among those surveyed.

Given each hospital was asked to give us the information by year, it was clear that by their own interpretation, nine of them acknowledged that over the past five years they were in fact adding more management and administration relative to front line care. Two more supplied data that suggested more recent changes took place to restore previous higher levels of management.

Are the numbers significant? Yes and no.

The Chatham Kent Health Alliance is unlikely to rise or fall given the addition of one and a half more managers last year while two and half front line staff disappeared.

However, we live in a society where symbols are important.

We began this survey upon the complaints of front line staff who saw more managers showing up in the workplace instead of more help to address their own expanding workloads.

This week’s Ontario Hospital Association (OHA) study suggested there is a very significant cost to poor staff morale. Overall four out of every ten workers surveyed by their hospitals said they found most days at work quite/extremely stressful. One out of every four said they were likely to look for a new job within the coming year. Try explaining to these workers why Thunder Bay, for example, found the need to add almost 20 new management positions while cutting nearly 70 front line staff since 2009.

The cost of a few managers versus front line staff is likely not a big deal. The impact of such decisions on the functioning of the hospital likely will be.