Design of a Conceptual Framework of Performance Improvement of Academic Department Chair CURRENT STATUS: POSTED

Background The academic department chair occupies a significant position within academic medicine. The present study was designed to identify major factors that may influence on effective performance of academic department chair. This factors is presented in the form of conceptual framework. Methods First, a literature review was conducted. Then, the perceptions of stakeholders were collected via two focus group discussions. Thematic analysis was used to analyze the data. In the next step, a framework was developed to help performance improvement of department chairs. Finally, the Performance Improvement Plan (PIP) was developed. Results Four theme statements were formulated. After that, the conceptual framework of performance improvement of academic department Chair developed. Based this conceptual framework, factors lead into performance improvement of academic department chair include: performance evaluation, job and work design, planning for change and resiliency, educational and non-educational support, motivational efforts, organization culture and organizational knowledge management. Conclusions We designed a framework for performance improvement of academic department chair. It

It is important because it recognizes the process that top managers would look out for maintain quality in academic departments. The main point of the framework is to choose the proper intervention to performance improvement of department chairs.

Background
The academic department is the crucial building block of universities (1), and, therefore, the leaders of departments play a vital roles in shaping the departmental culture in academic medicine institutions.They enable the execution of a variety of procedures such as scheduling and budgeting, recruitment and retention and creates real opportunities to move resources to support the academic infrastructure (2). Their role has been evolving in response to the varying landscape of health care reform, new technology, and advancement of knowledge in the field of medical education (3). To succeed in this environment, it is critical that department chair roles are continuing to develop for efficiency of department functions (4).Additionally, the requirement to provide a realistic and comprehensive system for performance improvement of academic department chair cause a rising need for adaptation strategies that should be implemented in higher education system (5). Based on the results of the study of Lieff et al (2013), access to a comprehensive network of support and guidance was the most important factor influencing the performance of department chairs (2). In recognition of the importance of this issue in the medical school of Tehran University of Medical Sciences (TUMS), one of the largest medical universities in Iran country, we have taken a comprehensive approach towards supporting the performance of academic department chairs. Therefore, we tried to create a Performance Improvement Committee (PIC). Moreover, we developed a professional learning community to encourage the exchange of information, insights, and concerns among academic department chairs. The support tools also was developed to help new and experienced department chairs with useful resources. Then the obvious next step would be to identify the factors affecting performance effectiveness of academic department chairs.
It is worth noting that there have been a number of researches attempting to address department chairs' roles and responsibilities, and challenges associated with this position in academic medicine (6)(7)(8)(9). But in the literature review, very few published works deal with the academic department chair performance improvement. The present study was designed to identify and describe major factors that may influence on effective performance of academic department chair. This factors is presented in the form of conceptual framework.

Theoretical framework
The performance improvement is one of the goal of quality management (10). it is important to use a scientific approach in seeking practical solutions to problems of employee performance management in organization (11). In this regard, several models have been designed to help organization discover new approaches to improve effectiveness. Human performance technology (HPT), also identified as human performance improvement (HPI), is one of them. This model is unique because of the integration of information from many disciplines (12). Different authors have defined the HPT from a variety of perspectives. Some have emphasized the process and others have placed the emphasis on the outcomes or final results (13). According to Dick and Wager (1995), the HPT is defined as a strong commitment to identifying the problems of organizational performance and developing solutions (14).Wilmouth, Prigmour and Berry (2002) provided categories of HPT models, including diagnostic models, process models and holistic models. The International Society for Performance Improvement (ISPI) model (2000) is an instance of a process model. The HPT models uses three intertwining spheres to characterize people, processes, and organization that represent the fundamental actions of the model. There is no single HPT model that can be universally applied to all business environments. Selecting the best HPT model can be a daunting task (15). Participants were engaged in FGDs using purposive sampling. E-mail invitations were sent to them to participate in the focus groups describing the purpose of the study. None of participants, who we contacted them, declined the offer to participate, but ultimate scheduling was based on accessibility on definite dates. Participants were all from the Tehran University of Medical Sciences. We collected opinions of the participants in an open-ended way. FGD sessions lasted around 90 minutes. Focus groups were organized and conducted by professional moderators using the discussion guide. The focus groups were audiotaped and transcribed. We asked open-ended questions to explore participants' perceptions of the barriers and opportunities for performance improvement of department chair. Thematic analysis was applied to analyze the data. In this study, the procedure proposed by Braun and Clarke (2006) in thematic analysis is considered. In this way, transcribed data were read several times, then, important features of data were coded. After that, researchers made comparisons between the data and created the thematic map by identify themes and subthemes (16). Peer checking was used in the data analysis phase of this study with two peers who are professional in educational management field (co-authors) for ensuring the credibility and trustworthiness of the study. In the third phases, a schematic conceptual framework was evolved as explanation of factors that led to performance improvement of department chair. Finally, the task force developed and customized a Performance Improvement Plan (PIP) for improvement of department chair function.

Results
Based on the thematic analysis, four theme statements were formulated as follow: (1) factor related to human resource management, (2) factor related to organizational behavior management, (3) factor related to performance support system and, (4) factor related to change leadership and management.
Overarching themes, themes and sample subthemes statements and Participant quotes can be found in Table 1. The schematic conceptual framework of research to be conducted in this study is described in Figure 1. As mentioned in previous pages, conceptual model of the research is integrative while incorporated to identify proper feature for performance improvement of department chair. Factors lead into performance improvement of academic department chair include: performance evaluation, job and work design, planning for change and resiliency, educational and non-educational support, motivational efforts, organization culture and organizational knowledge management. The strategies of Performance Improvement Plan (PIP) for performance improvement of academic department chair in this study is showed in Table 2.

Discussion
The present study aimed to investigate effective factors on performance improvement of department chairs in TUMS. We have identified these factors and then an organizational model was developed based on identifying these factors. What points make this research different from previous studies conducted in this area are: 1) Identify the dimensions of performance improvement from the point of view of experts in academic center and 2) Provide a functional model which can be easily used in practice and 3) focus on both individual and organizational variables in designed model. Based on our results, performance appraisal is one of the most important components of any performance improvement structure. Our findings are consistent with other studies, which found department chairs agreed strongly that they have managerial role and responsibility and performance appraisal system is a prerequisite for ensuring the success of work performance (17)(18)(19). This qualitative finding corroborates the ideas of London (2011), who suggested if an organization is imagining quality management from its heads of departments, designing performance evaluation system for assessing the effectiveness of heads of department's performance is valuable (20). The results of this study showed that both organizational job and work design are factor affecting performance of academic department chair. Our findings are consistent with other studies which found well designed jobs and works have a constructive impact on the employees' motivation and performance, leading to the improvement of individual and group organizational performance, such as their participation, effective role modeling, and innovative achievement (21-22). Based on our results, both organizational culture and organizational value can improve department chair performance. Robbin and Judge (2011) reported that organizational culture is "a system of shared meanings held by members that distinguishes the organization from other organizations" (23). These results provide further support for the hypothesis that organizational culture is linked to performance.
However experts in the field of management claim that successful organizations are those that are able to promote cultural values which are generally along with their strategies (24-26). The result of the study of Koesmono (2014) revealed that organizational culture can affect organizational loyalty (27). However, the findings of the current study do not support the previous research suggesting organizational culture has a negative effect on the individual and organizational performance, contrary to many other studies that found that strong culture is associated with organizational effectiveness (28). The results of this study showed that development of approaches and techniques of organizational communication and organizational knowledge management in departments are essential for improvement of performance of department Chairs. This finding further supports the idea that an organization with knowledge management strategies will use assets more efficiently, and consequently, it is more likely to achieve better organizational performance (29). Inter-organizational communication will facilitate continuous communication with senior faculties and university administrators, led to a productive culture in which all members of the institution have a common commitment to the performance improvement (30). This study produced results which corroborate the findings of a great deal of the previous work that the more motivated staff is expected to be more productive and commitment (31). The result of study of Koesmono (2014) revealed that both extrinsic and intrinsic motivational efforts extensively influence the performance of employee (27). As a result of this research we, reemphasized here that it will be desirable for higher education organizations to providing educational support services for their department chair to improve performance and productivity with activities like prepare forum for the exchange of experiences, development of a formal orientation program for newly department chair, establishment of mentoring system and leadership development programs (32). The result of this study demonstrated that in addition to support that is exactly educational in nature, other non-educational support services are also required (e.g., logistic support). This result is consistent with those found by other studies suggesting supportive organizations are seen as taking self-importance in their staffs, rewarding them, and understanding and meeting their requests (33). According to Eisenberger et. al. (1986), organization support is "employees' perception of being valued and cared about by their organization" (34).
Culture of academic medicine undergoes rapid changes. As leaders of change, department chair plays a critical role in guaranteeing that the change efforts are effective (3,35). The result of the study showed that the leadership delivered by the department chair is an important factor for success. Hecht (2013) said "Department chairs' leadership must include vision and the skill to bring each member in the department into a group that can think collaboratively about the questions facing their discipline, department, and institution to remain competitive" (36). The findings of this study are subject to at least two limitations. First, results might not be generalizable to all academic department chair performance improvement programs. Although, we studied some frameworks or models about performance improvement which were generated by literature review. Second, the present study was performed in just one center. Although our data has been validated through the investigation among professionals within the research groups and peer checking. The study also does hold important implication for future research on educational management practices. Research is needed to test the efficacy of each of the strategies that discussed in this study, and to assess the impact of choice on improve organizational outcomes. Finally, our results provide useful guideline for policy maker, academic medicine agencies to be focus on this area.

1.
Department chair's performance can be influenced by factors such as organizational culture, motivational effort, change leadership, job satisfaction, effective task and work design, performance evaluation and educational and non-educational support for performance.

2.
Overall, we hypothesized that effective performance of the department chair may has positive effects on department operations, processes, or outcomes through the use of strategies, which are considered suitable for use in educational context.

Ethical Consideration
All participants were given information about the aims of the study. In addition, participants were informed that they could withdraw from the study at any time without any consequences. Written consent was obtained from all participants. Moreover, permission was obtained for recording interviews. Confidentiality was maintained through all steps of data collection and analysis. The educational development center of TUMS Institutional Review Board (IRB) reviews and approved that this research is conducted in accordance with all institutional and ethical guidelines.

Consent to publish
Not applicable

Availability of data and materials
Not applicable

Competing interests
No conflict of interest between stakeholders in this study.  "At our university, managerial work should be separated from the executive one. That is, if we expect scientific leadership from department chairs, they should not be involved in breaking the door lock and the color of the wall. Of course, Physical space is very important, but is it really the task of the department chair to do administrative work? It's the difference between the two" "We identified the duties and responsibilities of department chairs and deans. But we did not clarify our expectations of the faculty members. It seems that the clarity of their duties and our expectations is very helpful to the department chair and finally for faculty. We are an emotional community. It's definitely there are a situations that we stand on ceremony, especially in small groups. And in fact, if the managers want to be transformative and forward-looking, they must have specific job description of his members and ask them" 'We have to plan a staff training programs at the university. It is great, if we correct the selection process, but how long this process can go on from top to bottom. We must teach some people, this training programs should be carried out at the university level" · Balance between resp onsibility and authority · Formulation of academ ic department chair task and responsibility · Clarity of the roles and working procedures · Succession planning · Effective selection of academic department chairs · Analyzing organization structure based on needs and requirement Job and work design "I think it's important that the faculty is not with the department chair of the two sides. The faculty with the department chair seems are members of one team. It think that the university has the same deal with the Demonstrating organizational culture and values characterized by: Organizatio nal culture Factors faculty, it means the university's deputy is grateful for the support of the faculty and college supports the department chairs" "If there is a system that identifies these educational, research and scientific resources for colleges and design appropriate framework for educational justice, it helps to strengthen the morale culture in the department in order to better fulfill their role" "Creating accountability culture is very important, that means department chairs are committed to the group and the college and they consider the income of the organization to be its own income" "One of the ways to cope with these challenges is to have critique and trust culture both at the lower and upper levels of the university" "If the faculty members allocate all their time and energy in the university, the department problems will be solved. Overseas universities use full-time, part-time and so on. There are many different faculty members deployment in other university but this is not the case here" "The win-win debate is when we consider benefits to both sides. You create the resources and two years later, in the both the college evaluation and the evaluation of department chairs evaluate do they supply the resources you want. Now what did department chair do in two years?" "That is, any ability is a market, we are discuss about the market, but we are not in the business. It is great, if we make a showcase of educational product in the department and believe to academic marketing. We must improve consumer oriented culture in departments" "It's very important for us to design a four-year faculty program, ethics charter and moral codes for the university. I had many challenges, but nobody praised us. The creating moral culture is very important" "I thinks the culture of teamwork in departments is very weak. We need to strengthen teamwork culture in departments" · Accountability · Responsibility · Support and empathy · Organizational trust · Teamwork · Participation · Organizational commitment · Justice · Meritocracy · Critique and trust · Gratitude · Customer oriented related to organizatio nal behavior manageme nt "When we say that the department is a small college, that is, the department chair must meet with the financial officer, he must have meeting with the educational and internationalization deputy, as well as sit and get up with the student and cultural deputy" "As a department manager, we are still involving the problems of physical space and other things. These issue must be solved by an executive director, not the department chairs" Table 1: Overarching themes and sample of themes, sub-themes and participant quotes statements The Schematic Conceptual Framework of Academic Department Chair Performance Improvement