Reevaluation of problems and challenges in Iran University of Medical Sciences, the first step to an effective performance improvement

Background: In Iran, medical universities are responsible for providing medical education and health services as well as maintaining and improving population health through scientific and innovative methods. Identifying problems and challenges that hinder universities’ performance, and supporting them with innovative problem solving methods can help managers in achieving university goals. Rrecognizing and analyzing the university challenges are essential steps in development of effective systems for the existing and future needs. The university will be on the path of growth and development and achievement of its goals only if it reviews and re-engineers its organizational structure based on its mission and goals. Methods: This is an applied research aiming to identify and categorize the challenges that affect the performance of different sectors of Iran University of Medical Sciences. The participants of this qualitative study were experts, managers, directors and officers of different sectors of the university, including deputies, faculties and hospitals. In the first step, using an open-ended questionnaire, the challenges and problems of different units were examined. In the second step, in order to investigate the limiting role of these challenges on the performance of units, the affecting factors mentioned in the previous section were coded and categorized. In the last step, three rounds of focus group discussions were held to evaluate the accuracy of the obtained data. In all steps of the study, in order to benefit from the views of a wide range of experts and managers and officers with different experiences, purposive sampling was performed. The data collection continued until data reached saturation.Content analysis was undertaken to evaluate of the collected data. The reports were evaluated anonymously and units were not identified. Results: With a response rate of 90 percent from the university ynits, 215 problems were identified from the completed questionnaires. The identified problems were categorized into 3 themes of (i) lack of evidence-based management, (ii) inefficient bureaucracy, and (iii) organizational culture. Most of the mentioned problems were related to the lack of evidence-based management. Lack of meritocracy was mentioned across all three themes. Lack of effective monitoring and evaluation systems, and poor frameworks for applying evaluation results; excessive quantitative approach to evaluate performance; lack of efficient rewarding and punishing systems; legal, managerial, structural and process problems; defective staff education, communication and motivation, poor workforce performance and attitudes to organization; and insufficient professional commitment were among the most frequently indicated problems. Conclusion: According to the university workforce, the problems hindering the organizational performance roots in interrelated factors of inefficient bureaucracy, lack of evidence based  decision-making process, and adverse effect of organizational culture. Based on the results, by hindering the evidence based management, the university’s existing performance management system plays a role in shaping a static organization. Moreover, such culture causes resistance versus evidence based management. Finally, it seems that any change to solve the problems related to these three issues should be done by considering its possible simultaneous effects on the other factors.