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

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.