Conceptual and Empirical Item Hierarchies of a Managerial Complexity Tool (TOH-SOC).

Background: Healthcare management entails navigating considerable complexity, requiring managers to balance diverse and often competing responsibilities such as staff supervision, patient care, and resource allocation within evolving organizational contexts. Traditional measures rarely capture this multifaceted reality of managerial complexity. The Ottawa Hospital Model of Nursing Clinical Practice and Clinical Management Span of Control Decision-Making Indicators tool (TOH-SOC) provides a broad understanding of managerial span of control. Objective: To evaluate the extent to which the TOH-SOC items provide valid measurement of the latent construct of managerial complexity, and to examine the degree to which the empirical response patterns fit with the a priori specified hierarchical conceptual framework. Methods: This methodological study uses previously collected data from a convenience sample of 71 first-line healthcare managers, applying items from the TOH-SOC tool. An unrestricted polytomous Rasch model was used to evaluate response category functioning, model fit, targeting, reliability, and empirical item ordering. Polyserial correlation was applied to analyze the concordance between empirical estimates and conceptually expected item hierarchies. Results: Three items were found to have response categories that did not function as intended. In one case, this could justifiably be addressed by collapsing the response options. Two of the items with problematic response categories, as well as one additional item, were found to show misfit with the assumptions of the Rasch measurement model. Conclusion: Among first-line healthcare managers, 13 of the 16 items function well in reliably capturing lower levels of managerial complexity. However, further development of the TOH-SOC tool is required to ensure valid and reliable measurement across the full continuum of managerial complexity, and to strengthen its capacity for detecting changes over time.