A framework for leadership and management of a medical school in South Africa

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Date
2004-12
Authors
Nel, Pieter Phillip Cornelius
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Publisher
University of the Free State
Abstract
English: In future, more emphasis will be placed on the outcomes of education and on its impacts on health care and health status. In this, leadership and management play a decisive role. It will be required of the leadership and management of a medical school to adapt to the changing needs and demands of medical education. Managers need to reassess their role and create an environment within which education and training can be conducted successfully. The complexity of medical and education institutions; the changes that have occurred and are still occurring; as well as the expectations of higher education and health institutions and bodies, demand that urgent and informed action be taken in leadership and on the management front. The question that has arisen was, “How can a medical school meet the demands for effective and efficient leadership and management in a changing environment, taking into consideration the unique features of academic institutions?” Against this background, the problem that was addressed, was that of a lack of a framework within which to fit the concept of leadership and management in a medical school. Therefore the aim of this study was to address the problem by designing such a framework for leadership and management in medical schools on which the leadership and management of a school could be modelled if a school should wish to do so. The objectives were to gain a deeper insight into approaches to leadership and management per se, particularly in institutions for higher education, including medical education and training; to gain an understanding of the changes impacting on higher education and the role that it plays in leadership and management; to determine criteria for a framework for academic leadership and management in a medical school; to test the criteria (by means of formulated statements) for leadership and management in a medical school; and to design a framework for leadership and management that can be implemented in any medical school in South Africa. Quantitative and qualitative approaches were used to complement each other; to provide a better understanding of the research problem; as well as to enhance the interpretability of the research findings. The methods which were used and which formed the basis of the study, comprised a literature review, and - as the empirical study - structured interviews and Delphi questionnaires. The focus of the literature study was on the higher education system and institutional management trends and challenges, as well as on certain perspectives of leadership and management, describing the meaning of leadership and management in an academic context; the characteristics and qualities of leaders and managers; as well as the challenges that the leadership and management group face. The literature review was used as a support for the design of the interview guide that was used during the structured interviews. Questions pertaining to aspects such as challenges which have to be faced; strategies that have to be followed in addition to the needs in order to successfully master the challenges; difficulties concerning leadership and management; the role that has to be played; as well as leadership qualities and managerial knowledge, skills and competencies needed for effective leadership and management; were included. Six participants were selected for the structured interviews by means of judgement sampling and formulated criteria. The analysis of the interview findings was done by the researcher according to scientific methods. The results were displayed in tables and were used, together with the criteria identified from the literature study, to compile the statements that were used in the Delphi questionnaire. The Delphi technique not only provides quantitative information about the subject of the study, but also qualitative information. The Delphi questionnaire which had been structured, included nine sections, namely challenges; strategies; roles; leadership qualities; managerial knowledge, skills and competencies; performance areas; management structures; infrastructure and facilities; as well as the aspects that have to be addressed in a framework for leadership and management. Six experts were selected from higher education institutions who occupied positions where they played a leadership role and/or were involved in academic management. The analysis of the various rounds of the Delphi process was done manually by the researcher. The results of the Delphi process are included in the Appendices. All the respondents in the empirical study consented to take part. Pre-testing of the interview guide and the Delphi questionnaire were done through pilot studies. These actions were undertaken to ensure the reliability, validity and trustworthiness of the study. The findings of the empirical study were reported on by means of a description and discussion of the structured interviews, followed by those of the Delphi study. These findings were used to compile a framework for leadership and management in a medical school. The premises for the academic leadership and management framework; the departure points for successful implementation; the different role-players who influence leadership and management in medical schools; as well as detailed formulations of the recommendations on each aspect included in the framework, were given. The researcher proposed two ways of how the recommendations made in the framework could be used, namely a sliding and a layering approach and/or by using them together with a planning indicator. Final conclusions were drawn, and the limitations of the study and recommendations were highlighted. With this study an attempt was made to contribute to effective and efficient academic leadership and management in Medical Schools in South Africa.
Afrikaans: In die toekoms sal meer klem geplaas word op die uitkomste van onderwys, asook op die impak daarvan op gesondheidsorg en die stand van gesondheid. In hierdie opsig speel leierskap en bestuur ‘n deurslaggewende rol. Daar sal van die leierskap en bestuur van ‘n mediese skool vereis word om aan te pas by die veranderende behoeftes en eise van die mediese onderwys. Dit is essensieel dat bestuurders hul rol in heroorweging moet neem en ‘n omgewing moet skep waarin onderwys en opleiding suksesvol kan geskied. Die kompleksiteit van mediese en opvoedkundige instellings; die veranderinge wat plaasgevind het en nog steeds besig is om plaas te vind; asook die verwagtinge van hoër onderwys en gesondheidsinstellings en –liggame, vereis dat dringende en ingeligte aksie op die leierskaps- en bestuursfront moet plaasvind. Die vraag wat opgeduik het, was die volgende: “Hoe kan ‘n mediese skool voldoen aan die eise om effektiewe en bekwame leierskap en bestuur in ‘n veranderende omgewing, terwyl die unieke kenmerke van akademiese instellings in aanmerking geneem word?” Teen hierdie agtergrond is die probleem wat aangespreek is, die gebrek aan ‘n raamwerk waarbinne die konsep van leierskap en bestuur in ‘n mediese skool kan inpas. Om daardie rede was die hoofdoel van hierdie studie om die probleem aan te spreek deur so ‘n raamwerk vir leierskap en bestuur in ‘n mediese skool te ontwerp. Die leierskap en bestuur van so ‘n skool sou die raamwerk as ‘n voorbeeld kon gebruik om ‘n model te ontwikkel indien die skool dit sou wou doen. Die doelwitte was om ‘n dieper insig in benaderinge tot leierskap en bestuur as sulks - veral in hoëronderwysinstellings - te verkry, insluitende mediese onderwys en opleiding; om ‘n begrip te vorm van die veranderinge wat ‘n uitwerking op hoër onderwys het, asook van die rol wat dit in leierskap en bestuur speel; om kriteria vir ‘n raamwerk vir akademiese leierskap en bestuur in ‘n mediese skool te bepaal; om die kriteria te toets (deur middel van geformuleerde stellings) vir leierskap en bestuur in ‘n mediese skool; en om ‘n raamwerk vir leierskap en bestuur te ontwerp wat in enige mediese skool in Suid-Afrika geïmplementeer kan word. Kwantitatiewe en kwalitatiewe benaderinge is gebruik om mekaar aan te vul; om ‘n beter begrip van die navorsingsprobleem daar te stel; asook om die interpreteerbaarheid van die resultaatbevindinge te verhoog. Die metodes wat gebruik is en wat die basis vir die studie gevorm het, het bestaan uit ‘n literatuuroorsig en – as die empiriese studie – gestruktureerde onderhoude en die Delphi-vraelyste. Die fokus van die studie was op die hoëronderwysstelsel en institusionele bestuursneiginge en -uitdaginge, asook op sekere perspektiewe van leierskap en bestuur, terwyl die betekenis van leierskap en bestuur in die akademiese konteks beskryf is; die karaktertrekke en kwaliteite van leiers en bestuurders; asook die uitdagings wat die leierskaps- en bestuursgroep in die gesig staar. Die literatuuroorsig is gebruik ter ondersteuning van die ontwerp van die onderhoudsgids wat gebruik is ter ondersteuning van die gestruktureerde onderhoude. Vrae wat betrekking het op aspekte soos uitdagings wat in die gesig gestaar moet word; strategieë wat gevolg moet word; die noodsaaklikhede wat benodig word om die uitdaginge suksesvol die hoof te bied; probleme rakende leierskap en bestuur; die rol wat gespeel moet word; asook leierskapskwaliteite en bestuurskennis, vaardighede en bekwaamhede wat essensieel is vir doeltreffende leierskap en bestuur, is ingesluit. Ses deelnemers is uitgesoek vir die gestruktureerde onderhoude volgens geformuleerde kriteria. Die analise van die bevindinge van die onderhoude is deur die navorser gedoen volgens voorgeskrewe wetenskaplike metodes. Die resultate is aangedui deur van tabelle gebruik te maak saam met die kriteria wat voortgespruit het uit die literatuurstudie om die stellinge wat in die Delphi-vraelys gebruik is, saam te stel. Die Delphi-tegniek voorsien nie alleen kwantitatiewe inligting rakende die onderwerp van die studie nie, maar ook kwalitatiewe inligting. Die Delpi-vraelys wat saamgestel is, het uit nege afdelings bestaan, naamlik uitdaginge; strategieë; rolle; leierskapseienskappe; bestuurskennis; vaardighede en bekwaamhede; prestasiegebiede; bestuurstrukture; infrastruktuur en fasiliteite; asook die aspekte wat aangespreek moet word in ‘n raamwerk vir leierskap en bestuur. Ses deskundiges verbonde aan hoëronderwysinstellings is uitgesoek waar hulle betrekkinge beklee het waarbinne hulle ‘n leierskapsrol gespeel het en/of in akademiese bestuur betrokke was. Die analise van die verskillende rondtes van die Delphi-proses is met die hand deur die navorser gedoen. Die resultate van die Delphi-proses is ingesluit in die Bylaes. Al die respondente in die empiriese studie het ingestem om deel te neem. Vooraftoetsing van die onderhoudsgids en die Delphi vraelys het plaasgevind deur middel van loodsstudies. Hierdie aksies is aangepak om die geldigheid, betroubaarheid en geloofwaardigheid van die studie te bepaal. Die bevindinge van die empiriese studie is gerapporteer deur middel van ‘n beskrywing en ‘n bespreking van die gestruktureerde onderhoude, gevolg deur dié van die Delphi-studie. Hierdie bevindinge is gebruik om ‘n raamwerk vir leierskap en bestuur in ‘n mediese skool saam te stel. Die voorafgaande stellings vir die akademiese leierskaps- en bestuursraamwerk; die vertrekpunte vir suksesvolle implementering daarvan; die verskillende rolspelers wat ‘n invloed uitoefen op leierskap en bestuur in mediese skole; asook gedetailleerde formulerings van die aanbevelinge rakende elke aspek wat in die raamwerk ingesluit is, is voorsien. Die navorser het twee metodes voorgestel waarvolgens die aanbevelinge wat in die raamwerk gemaak is, gebruik kon word, naamlik ’n “sliding” en ‘n “layering approach” en/of deur hierdie twee benaderinge saam met ‘n beplanningsaanwyser te gebruik. Finale gevolgtrekkings is gemaak en die beperkinge van die studie, asook die aanbevelings, is uitgelig. Met hierdie studie is gepoog om ‘n bydrae gelewer tot effektiewe en bekwame akademiese leierskap en bestuur in mediese skole in Suid-Afrika.
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Keywords
Academic leadership and management, Dean, Delphi study, Framework, Head of medical school, Health care, Health Professions Education, Higher education, Leadership and management group, Medical school, Structured interviews, Qualitative and quantitative approach, Thesis (Ph.D. (Educational Development))--University of the Free State, 2004
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