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

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.