Chapter 50 Defining the deanship or the leadership of these institutions has always been an elusive task because this position lacks uniformity in content and function (Dupont 1968). Academic deans, although still charged with the intellectual leadership of their colleges, were also expected to be fiscal experts, fund raisers, politicians and diplomats (Tucker & Bryan 1988). Senior academics involved in managing a health professional education institution need to play several roles and exhibit many leadership traits. Role theory is commonly used to explain the relationship between the individual self and collective social structure of the society in general or organization in particular (Schuler 1975). His or her primary role evolved into the maintenance of balance between the various external and internal demands placed on the institution (Wolverton et al 2001). The difference between leadership and management in medical schools has been described by many as managers produce order and consistency in the organization and leaders produce change and movement (Northouse 2004). In practice, it is often the same person who operates in both capacities (Storey 2004). A dean’s challenge is to develop shared goals among a range of faculty, students and other groups who may frame the academic environment in varied ways (Lessor 2008). Aligning the various frames’ ‘schemata of interpretation’ and adjudicating frame disputes can be described as frame amplification or frame transformation activities (Goffman 1974). A challenging task for deans is how to manage effectively the faculty in a manner that is congruent with the external demands for change. The dean seeks external support for college goals by framing them to resonate within the understanding of nonacademic audiences such as parents and donors while harmonizing faculty interests with those of other significant audiences (Snow 2006). In medical colleges, the senior executive, i.e. dean, plays the dual roles of manager and leader. These positions are inter-related and inseparable – ‘two sides of the same coin’. Leadership can be thought of as the process of influencing the activities of an organized group in its efforts towards goal setting and goal achievement (Stoghili 1950), and the leader can be regarded as a manager of meaning (Smircich & Morgan 1982). In medical colleges, today’s deans need to change their manner of leadership from a transactional style, which comprises an exchange between leader and follower, to a transformational leadership, where the leader and followers share the same aspirations (Kotler 1996). Managing and leading a medical college require an adaptive, situational leadership style with a high degree of flexibility. Situational leadership was defined by Gilbert (2005) as ‘an approach based on the idea that there will be interactions in most situations between the leader’s attitude, the tasks to be undertaken, the strengths and weaknesses of the team and the environment in which the leader and team have to operate’. Situational leadership is an adaptive model in which leaders adopt their stance to the situation (Peck et al 2006). It is not that one is more superior or inferior to the other but rather that effective leaders appear to be able to utilize many styles appropriate to the situation (Mc Kinnan & Swanwick 2010). The culture of an educational institution learning environment is made and reproduced over time. It affects all aspects and constituents in the college: students, faculty and staff. Sensitivity of the leader to the college’s ‘hidden curriculum’ is an important task which can support or jeopardize the educational programme and the college mission (Hafferty 1998, Maudsley 2001). Medical colleges, with their multi-cultural, multi-ethnic students and faculty, are a fertile land for gossips and mistrust. Sometimes actions taken for the purpose of educational quality assurance (like faculty peer evaluation) can have a negative impact and create a culture of mistrust among faculty. This situation existed in one medical college, but the leadership changed it by suggesting that each faculty member ask a peer if they would observe his or her teaching and learning activities and give him or her constructive feedback. This led to the development of a culture of support, collegiality and trust. The fear from ‘scratch my back and I scratch yours’ was not observed.
How to manage a medical college
Introduction
The roles of the dean
The leader–manager and manager–leader
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“The Dean’s role is somewhat anomalous. For success in the school, it must go up, down, across and out and each part of the school and university must feel that it is getting full value from the Dean.”
“Transformational leadership is about strategy and people whereas transactional leadership revolves around systems and resources. Both are needed in an effective organization.”
“Transformational characteristics of a leader may be more appropriate in the earlier stages of a transition process with the transactional characteristics required to stabilize transformational change.”
“Less attention has been paid to the personal development of healthcare professionals, educational leadership, scholarship and organization development and changes.”