EIRP Proceedings, Vol 10 (2015)

Developing a Performance Evaluation Model of Trustees Boards in Iranian Universities of Medical Sciences

Haniye Sadat Sajadi¹, Mohammadreza Maleki², Mohammad Hadi³

Abstract: The critical role of the boards of trustee in the governance of universities clarifies the necessity of evaluating its performance. Despite the importance of such evaluation, evidence demonstrated few studies have been done on the model of board performance evaluation especially in Iran. Aim: This study was aimed to develop a model to evaluate the board performance in Iranian Universities of Medical Sciences. Methodology: The present study was a mix qualitative-quantitative study. The participants were all stakeholders of board performance evaluation. The study, firstly, focused on the world experiences about the models of the board performance evaluation in the universities. Then, this study tried to investigate the current and proposed model of the board performance evaluation in the Iranian Universities of Medical Sciences. Hence, data were collected through interviews, observation and relevant document analysis and analyzed using framework approach. After that, the clustering and rating of the proposed dimensions and indicators of the board performance evaluation was done using the concept mapping method. Finally, the study concentrated on the expert consensus about the initial proposed model of the board performance evaluation. A model was proposed to evaluate the board performance in Iranian Universities of Medical Sciences, which had eight parts and sixty-four indicators proposing for the board performance evaluation. This study helped to develop a valid model to evaluate the board performance evaluation in a special kind of university. Such model can be used to produce useful tool for evaluating the performance of the board.

Keywords: Performance evaluation; Board of trustees; University of Medical Sciences; Indicator; Concept mapping

1. Background

The modern societies have recognized that knowledge is the main source of wealth (Nagaraju & Suresh, 2008) and Connecticut’s future depends on the knowledge and skills of their citizens. Therefore, they have tried to move toward the knowledge-based societies. As a result of this movement, the need for knowledge workers in different parts of society has increased (Jamshidi, et all., 2012, pp.789-803). The increasing demand of knowledge worker highlights the role of the universities and higher education institutions more than ever before, because these organizations are the leading places for the knowledge acquisition/responsible to be engines of a knowledge-based societies (Mora & Vieira, 2007). Furthermore, the mission of universities in educating, researching and providing professional services (Kezar, 2006, pp. 968-1008) has made them as the main institutions to assist the societies in fulfillment their development programs (Mokhtarian, et all., 2008, pp. 75-111).

The mention important role of universities in the societies and the necessity of suitable responding to the global rapid changes of the university environment (Kelleher, 2006, pp. 1-7; Swansson, et all., 2005), have generated new challenges for these institutions which require new managerial approaches. Moreover, the unique structure of the academic institutions (Birnbaum & Edelson, 1989, pp. 27-29) and increasing demand for being more effectiveness (Kerr & Gade, 1989) put more emphasis on professional management, management development programs, and new forms of organization: new ways to solve new problems.

University governance is a relatively new paradigm, helping to solve institutional management and control problems in this new academic world. It is defined here as "a form of control that aligns the principal and agent to maximize organizational effectiveness (Jones, 2007). Today there is much more attention being paid to the overall university governance in general and to the role of the governing board in particular (Kelleher, 2006, pp.1-7). It is because governing boards play the pivotal role in governance as they help to ensure that management achieves the stated goals and objectives, as well as long-term survival (Langabeer & Galeener, 2008, pp. 5-22). Furthermore, the future of higher education is entrusted with governing boards (Kezar, 2006, pp. 968-1008). The governing board, which is different from executive board (Leblanc, 2004, pp. 436-341), is the most important kind of boards (Carver J, 2006). It was identified as the decision- and policy-making group that sits at the top of an organizational structure. This body possesses the highest organizational authority and is accountable for all organizational activities and outcomes (Nijmeddin, 2007).

The effect of board performance on university effectiveness demonstrates the need of evaluating board performance. Measuring board performance is obviously such a difficult activity (Collier, 2004, pp.12-17), but regarding to its potential benefits it is critical. Assessment of the board performance can help a board to operate more efficiently through recognizing its strength and weakness and proposing required improvement alternatives. This improvement can lead to better university effectiveness (Collier, 2004, pp.12-17; Kiel & Nicholson, 2005, pp. 613-631; Swiecicki, 2011, pp. 24-26; Minichilli, et all., 2007, pp. 609-622).

The way of the board performance evaluation has been examined widely in the literature (Collier, 2004, pp.12-17; Minichilli, et all., 2007, pp. 609-622; Cornforth, 2001, pp. 217-227; Curran & Totten, 2010, pp. 420-422; Deryl & Janine, 2011, pp. 33-56; Dulewicz, et all., 1995, pp.13-17; Dulewicz, et all., 1995, pp.1-19; Duncan & Victor, 2010, pp.293-306; Epstein & Roy, 2004, pp. 1-23; Levrau & Van den Berghe, 2007, pp. 58-85; Minichilli, et all., 2009, 55-74; Morgan, 2010, pp. 89-117; Nadler, 2004, pp. 102-111; Van den Berghe & Levrau, 2004, pp. 461-478; Wan & Ong, 2005, pp. 277-290). Review of this literature illustrated there is now an extensive literature on this issue beyond the higher education sector, but in the universities and academic centers, such evidence is sparse. The second problem with this board literature is that it is descriptive and based on single anecdotes-consultants' advice and limited studies were empirical one. Therefore, more empirical studies are required to answer how to evaluate the university's board performance, especially in Iran context. In response to this need, the present study attempted to develop a model to evaluate the board performance of universities of medical sciences (UMSs). The specific focus of the study is as follows:

• to identify the current models of the board performance evaluation of UMSs;

• to review the world experiences about the models of the universities’ board performance evaluation;

• to identify the current proposed model of the board performance evaluation of UMSs;

• to determine the importance of the proposed indicators of the board performance evaluation of UMSs;

• to validate the proposed mode of the board performance evaluation of UMSs.

2. Methodology

The present study was done through a mix qualitative-quantitative approach. It had three phases as follows:

Phase I: This qualitative phase was designed to cover the first three study objectives. So, firstly, to gather the world experiences about the models, dimensions and indicators of the board performance evaluation in the universities, a comprehensive review was done. The scope of this review was to seek evidences relating to evaluating board performance in the universities as well as healthcare organizations. We considered only empirical studies (till 2011) undertaken in the universities and educational institutions and also different organization of health sector published in English language. Different strategies used to identify relevant studies, including searching of electronic databases, reference scanning of relevant papers, hand-searching of the key journals and consultations with experts. Several key databases using suitable keywords were searched. Finally, a general Internet search using Google and Yahoo search engines was undertaken to find further information from unpublished research studies. The initial search was conducted in December 2011 and was updated in September 2012. To eliminate duplication, results from the different databases were placed into an Endnote software package. Because the literature on the board performance evaluation was mainly discursive and the studies rarely include objective, measurable outcomes commonly used in quantitative research, a narrative approach was used to synthesize the results of the studies. The input-process-output framework, that is a comprehensive framework to guide holistic evaluation of board performance, was used to summarize and interpret the study findings. Then, to investigate the current and proposed model of the board performance evaluation in the Iranian Universities of Medical Sciences, data gathering was done through face-to-face semi-structured interviews, observation and relevant document analysis. Participants were all stakeholders of board performance evaluation, which selected using purposeful and snowball sampling. All interviews were conducted by one of the research team (HSS) using an interview topic guide. This topic guide was developed on the basis of the findings from the literature review and the views of experts in the field. The interview topic guide was tested in a pilot interview with two participants. The results of the pilot were then used to construct additional sub-questions that allowed the researcher to obtain more focused information. All interviews were conducted between May and July 2012. They were audio-typed, transcribed verbatim, converted into text and analyzed using framework approach.

Phase II: This quantitative phase was designed to cover the forth study objective. Here, to cluster and rate the proposed dimensions and indicators of the board performance evaluation, the concept mapping method was employed. A sample of 45 participants, whom purposefully selected from all stakeholders of board performance evaluation, was asked to cluster and rate all proposed indicators of the board performance evaluation in response to two questionnaires. 22 completed questionnaires were returned (Response Rate: 49%). The data were analyzed using multidimensional scaling and clustering analyses. To produce maps, the Concept System 4.0.175 was used. At the final step, the participant consensus was followed using focus group discussion with stakeholders who were interviewed (n=10).

Phase III: This qualitative phase was designed to cover the fifth study objective. To reach the expert consensus about the labels and the importance of the dimensions and indicators of the board performance evaluation as well as the initial proposed model of the board performance evaluation, focus group discussion and nominal group session techniques were used. A sample of 10 participants, whom purposefully selected from all stakeholders of board performance evaluation, was asked to take part in the focus group and give their comments about the names, numbers and importance of proposed domain and indicators of the board performance evaluation. This focus group lasted three hours, was managed by one of the research team (HSS) and audio-typed. At the end of the focus group, the initial proposed model of the board performance evaluation was prepared. The validation of this model was tested through a nominal group session, with a sample of 7 participants, whom purposefully selected from all stakeholders of board performance evaluation. In this nominal group session that took 45 minute time, participants asked to give their opinions to reach a consensus. In this phase, data analyzing was done using SPSS software 16.0.

3. Results

Given the five study objectives, the results have been presented in five sections as follows:

A: The current models of the board performance evaluation of UMSs in the country

The findings demonstrated that despite the importance of the board performance evaluation, there was no comprehensive model to do this evaluation in Iran. The absence of such a model also reported by Kaske et al (Kaskeh & Mohebzadegan, 2011, pp. 165-202). Furthermore, the findings showed that there was limited evidence of evaluation the board performance of universities without any defined model (Kaskeh & Mohebzadegan, 2011, pp. 165-202; Azargash, et all., 2008, pp. 1-20; Damari, et all., 2013, pp. 36-41; Heydariabdi, 2000; Sajadi, et all., 2014, pp. 235–241). These evaluations mostly were done as a cross-sectional study and had not been as a formal process of the universities. It seems that, as Cogner and Lawer said (Cogner & Lawler, 2003, pp. 28), a few numbers of organizations conduct formal performance evaluations of their boards and it is a common problem around the world.

Insufficient knowledge of how to evaluate, undefined of evaluation objectives, the difficulty of the evaluation process and finally the special position of boards are some of the main reasons that avoid conduction board performance evaluation regularly. So, it is suggested to develop a comprehensive model of board evaluation, covering all aspects of an effective evaluation.

B: The world experiences about the models of the universities’ board performance evaluation

The finding highlighted key issues with respect to the theoretical models of the board performance evaluation both in health and educational contexts as below:

First of all, related to the nature of studies, a few numbers of the evidence demonstrates that, most of the current literature about the performance evaluation of health and universities’ board were descriptive, based on writer's perspective. Few of the articles on board evaluation are based on empirical data. This conclusion aligns with one of the writers who concluded that one of problems with the board performance literature refers to this fact that they are based on single anecdotes-consultants' advice or words of wisdom from former board members (Kezar, 2006, pp. 968-1008). Such limitation has been observed beyond these contexts (Cornforth, 2001, pp. 217-227).

The second finding of this review is related to the frameworks of the board performance evaluation. Similar to the literature outside the higher education and health sector, the reading of the selected studies reveals that there is no agreement among researchers on the best, integrated and comprehensive framework for identifying, measuring and discussing the board performance evaluation (Selim, et all., 2009; pp. 103). It seems that the differences in the context in which the board operates are responsible for this. The role of the context and its relationship with effective board performance has been examined by prior researches (Carver, 2006; Robinson, 2001).

The third finding of the present review was concerned about the dimensions of the board performance evaluation. This review showed that process dimension and its domains, similar to literature in the nonprofit sector, have received more attention by researchers and scholars to evaluate board performance in universities. Perhaps it is because focusing on process dimension to the board performance is more feasible and usable approach. Moreover, it can be said that because boards can add value to organizations through the transition process, attention to this dimension is important. This conclusion has been mentioned in prior studies (Kezar, 2006, pp. 968-1008).

The next finding of this review was about the domains of board performance evaluation. With the input-process-output approach in mind and the mapping of the selected studies, seven domains were recognized, including trustees, leadership and structure (in the input dimension); internal process and social/board dynamic (in the process dimension); outputs and outcomes (in the output dimension). Such classification with some differences was observed in those literatures which have employed input-process-output framework to investigate board performance (Cornforth, 2001, pp. 217-227; Epstein & Roy, 2004, pp. 1-23).

The final findings of our review concerned the indicators of the board performance evaluation in each dimension. Most of 60 identified indicators, aligned with those in other sectors. This similarity was especially more in indicators of structure, internal process, social dynamic and output domains. More details about the results of this section were reported previously (Sajadi, et all., 2013, pp. 92-98; Sajadi, et all., 2014, pp. 892-897).

C: The current proposed model of the board performance evaluation of UMSs

The findings of this section helped to propose a model to evaluate the board performance in Iranian UMSs, which had eight parts as well as sixty-four proposed indicators for the board performance evaluation. In this model, each part had been chosen to cover a part of the evaluation process. These parts were as below:

1- The evaluation’s objectives? The first question to be answered to evaluate the board is to establish what the board hopes to achieve. Clearly identified objectives enable the board to set specific goals for the evaluation and make decisions about the scope of the review. Therefore, it become relatively easier to decide whose performance will be evaluated, who the most appropriate people are to assess performance and the person or group best suited to conducting an evaluation. The importance of setting evaluation objectives has been pointed in previous studies (Blomberg, et all., 2004, pp. 25-29; Duncan-Marr & Duckett, 2005, pp. 340-344; Williams & Hammons, 1992, pp. 141-156). In the proposed model, it is suggested that the main objective of board evaluation should be set by two bodies: internal (The ministry of Health and Medical Education) and external (The Supreme Cultural Revolution Council).

2- The evaluation’s issues: Choosing what to evaluate is the second issue that should be covered in board evaluation process. Deciding what to evaluate is one of the most difficult and yet critical components of the evaluation process. In our study, three different domains were suggested to conduct a comprehensive board evaluation, including the board members, the board as a whole and the university. Previous studies mentioned to these domains, too (e.g. (Duncan-Marr & Duckett, 2005, pp. 340-344; Likins, 1979; McDonagh & Umbdenstock, 2006, pp. 377-389) .

3- The evaluation’s indicators: The third part of the proposed model, which was the main part of the board evaluation, comprised the indicators that should be measured in the board evaluation. 64 indicators were recognized in our study that most of them had been mentioned in literature.

4- The evaluation’s source of data: In each board evaluation, it is needed to decide the appropriateness of each potential source for gathering the required data of board evaluation. This means that the question of “who will be asked” should be answered in the board evaluation process. Literature introduces different sources to gather such data. In our model the options were the board members, the university’s president and her/his vice-chancellors and the board’s secretariat.

5- The evaluation’s method of data gathering: Depending on the degree of formality, the objectives of the evaluation, and the resources available, boards may choose between a range of qualitative and quantitative techniques. Each technique has its own advantages and disadvantages. The choice of techniques will depend on the board evaluation’s objectives, the board context, the available resources and etc. Given identified indicators, we suggested both qualitative and quantitative techniques as appropriate methods of data gathering in our proposed model.

6- The evaluator/s: The sixth consideration in establishing our model was to decide who the most appropriate person is to conduct the evaluation. Based on our results both internal (The ministry of Health and Medical Education) and external (The Supreme Cultural Revolution Council) evaluators were good choice to be selected for doing the board evaluation. It is also suggested a mixture of both internal and external evaluator

7- The way of using and publishing the evaluation’s results: “what do we want to do with the board evaluation’s results” was another important question that we are expected to consider it in our model. Different ways are addressed in the literature to use and publish the evaluation results. The findings of our study showed that it is sufficient to prepare a written and detailed report of the board evaluation’s results and deliver it to board members, the university management and the ministry.

8- The evaluation’s frequency: The last key question that must be answered for the board evaluation was how often the board should evaluate their performance. It means that the frequency of the board evaluation should be determined given the evaluation’s objectives, the current resources and etc. Annually evaluation was the most reported frequency of the board evaluation in the proposed model.

D: The importance of the proposed indicators of the board performance evaluation of UMSs

The 64 indicators of the board evaluation identifying in the previous phase were categorized and rated in this step. They were clustered in seven dimensions, including trustees’ characteristics (with 22 indicators), board leadership (with 3 indicators), board structure (with 4 indicators), board selection, development and evaluation (with 4 indicators), board relationships (with 8 indicators), board meetings (with 10 indicators) and board results (with 13 indicators). The weights of these dimensions were respectively 11, 12, 9, 10, 11, 12 and 35 percent of total weight. While previous studies mentioned less importance for the board result dimension, especially in public sectors, our finding indicated the most importance for this dimension. It seems that worries about the accomplishment the mission of the university’s board and the need for more attention to the board accountability have been caused such emphasis on the board result dimension.

E: Validation the proposed mode of the board performance evaluation of UMSs

Finally, the finding proposed a final model to evaluate the board performance evaluation. This model had eight parts including the objectives, required actions, frequency, issues, indicators, the sources and methods of data gathering, the way of the result using and publishing of the board performance evaluation. The main objective of the board evaluation was “identifying the board’s strengths and improvable area”. “Formation a central committee in the Ministry of Health and Medical Education, as an internal evaluator, and make the universities conduct the board evaluation” were the main required actions. The frequency of the board evaluation was considered “annually”. Three considered issues of the board evaluation were “the board members, the board as a whole and the university”. “64 indicators, categorized in 7 dimensions” were the content of the board evaluation. “The board members, the board secretariat, the university and the ministry” were chosen as the main sources of data gathering. “A mix of qualitative and quantitative methods with the main tools of interview, observation, document analysis and questionnaire” were suggested as the methods of data gathering. Finally, to use and publish the board evaluation’s results “preparing a complete report and delivering to the related authorities as well as selecting the best board on the base of the board evaluation result” was recommended.

4. Conclusion

This study helped to develop a valid model to evaluate the board performance evaluation in a special kind of university, namely, the UMS. This model has following features:

1- It covers all important issues to conduct a comprehensive evaluation of the board performance.

2- Since there was not found a good model to evaluate the board performance, the proposed model has been developed with the previous studies in mind and also given the special context of the UMSs.

3- To develop the proposed model, all efforts were made to engage all the board’s stakeholder and use their opinions and comments.

4- In the proposed model, a list of all indicators of the board evaluation was provided. These indicators were grouped and rated.

With the above features, the model can be used to produce useful tool for evaluating the performance of the board. It is suggested the performance of the board of universities to be evaluated with respect to the proposed model. According to the results of such evaluation and identified strength and improvement areas, appropriated corrective measures to be designed and done. This can concluded better university governance.

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