Scaling Ambulatory Leadership Using Data-Driven Span-of-Control Modeling

As ambulatory services rapidly expand across both urban and rural areas, health systems face growing pressure to scale leadership thoughtfully while maintaining operational efficiency and care quality.

In this session, healthcare executives will learn how MU Health Care, an academic health system with an integrated community hospital and geographically dispersed clinics, designed and implemented a standardized span-of-control tool for ambulatory practice managers. Adapting an inpatient nursing model, we created an objective, weighted scoring tool using 23 data points, capturing clinical complexity, staffing models, patient volume and geographic factors. Through an iterative process involving pilot testing with leaders, we refined the tool to right-size clinic leadership across 29 ambulatory locations. This model also supports Magnet-aligned nursing leadership structures, clearly identifying when to deploy a nurse supervisor versus a charge nurse. Presenters will share practical applications, case data and the leadership strategy used to drive adoption across diverse settings. Attendees will leave with a replicable tool and a roadmap for applying objective workload criteria to leadership structure decisions.

This project offers a novel, practical solution for executive leaders navigating the challenge of growing ambulatory networks while maintaining sustainable leadership structures. By converting subjective workload assessment into a transparent, objective process, this model supports not only staffing decisions but also budget justification, succession planning and leadership development.