Exploring academic leadership in medical schools and universities in Iran

Sammanfattning: Background: Medical education in Iran has been integrated into the health care system through a complex organizational change that included the formation of a single government division called the Ministry of Health and Medical Education. This division is responsible for both medical education and health services at the national level, whereas health care at the provincial level is provided by medical universities. Due to this restructuring, medical academic leadership in the country has been facing extensive tasks and responsibilities, as well as managerial, organizational, and cultural challenges. In general, it is difficult to manage a large organization comprising many medical universities and schools, hospitals, clinics, and health centers as is the case in Iran. The aim of the present research project was to study faculty members, academic leaders, and medical education experts in Iranian medical schools and universities with regard to their views on the requirement dimensions, challenges, organizational culture, values, and routines related to effective academic leadership. Methods: We used methodological and data triangulation, and performed two qualitative and quantitative studies. In the former we had an expert panel of 24 key informants in medical education and 18 in-depth interviews with academic leaders, and in the latter 125 academic leaders and 344 faculty members participated in two nationwide surveys. Findings: The requirements of effective academic leadership in Iranian medical schools and universities could be grouped into six themes: 1) shared vision, goals, and strategies; 2) teaching and research leadership; 3) transformational and collaborative leadership; 4) development and recognition performance; 5) fair and efficient management; 6) climate of mutual trust and respect. There are some barriers to effective academic leadership, for example politicization, instability, paradoxical management, lack of meritocracy, centralization, bureaucracy, and belief in misconceptions. Administrative management had a negative impact on academic leadership, indicated as lack of fair and efficient supervision, a climate not conducive to creativity and innovation, low motivation, and the absence of an efficient evaluation system. Results revealed that academic leadership is confronted with major multifaceted challenges, including the following: inefficacy of governmental academic leadership, an extensive set of missions and responsibilities, lack of concern about selection of managers, inappropriate management styles, mismatch between authorities and responsibilities and leadership capabilities, a tendency towards governmental management, boss-centered management, and low motivation. Discussion: Effective academic leadership in Iranian medical schools is hampered by politicization, centralization, conservativeness, lack of meritocracy, and instability of management. Consequently, medical school management needs to create a balance between academic freedom and authority in order to reconstruct its organizational culture and values. The most important factor that can promote effective academic supervision of Iranian medical schools is to ensure that appropriate managerial skills exist to tackle the tension between management, academic leaders, and faculty members. Iranian academic leadership needs to restructure itself into a department-based system that decreases the multiple levels of decision making, while increasing each department s autonomy in favor of participatory decision making and networking. The academic leaders have overwhelming tasks and responsibilities, and they are not sufficiently prepared to lead. Moreover, medical universities do not offer appropriate practical support for scientific endeavors and efforts that can result in international ranking. There is a need for development of academic leadership, including training and legislation regarding the prerequisites for managerial and teaching positions. Our research also suggests that it would be wise to have a more proportionate set of missions, responsibilities, and tasks. The Ministry should evaluate the advantages and disadvantages of its restructuring in order to support health care and move towards solving the critical need for leaders and leadership development. Conclusions: The requirements of academic leadership in a developing country like Iran can be considered to be the same as those existing in any Western country, with the addition of many negative effects of governmental management. Therefore, to achieve changes in Iran, it will be necessary to take into account more than the previous effects of organizational culture, values, and routines on effective leadership, especially during substantial restructuring. The academic leaders will have to contemplate altering the restructuring to focus on departmentbased and participative management, academic autonomy, and improvement of scientific culture in medical universities.