While the infrastructure and human resources can be managed given the budgetary provisions from central and state government, creation of an entrepreneurial culture, strong peer group and rigorous research standards requires different kinds of interventions. What will make a good university, a great one depends upon the values and the culture that permeates everyday discourse and decision making process in the University.
There are six major elements of cultural revitalization required for creating hunger for excellence and passion for providing high quality service to the people:
a. Leadership:
Every department, ward or lab provides enormous scope for showing leadership qualities at all levels. Unless initiatives are encouraged, mistakes are condoned, and risk-taking culture is nurtured, leadership will not evolve. The function of top leadership is to nurture initiatives and ideas at the lower level. It has been argued that if top leadership is not responsive and accountable to local level functionaries, then one should not expect local level functionaries to be accountable to common people whether patients or community members. If University would like to create a culture of social responsiveness, then it should also create indicators of accountability of top leadership to the lower level functionaries. The conventional university structure with top down style of functioning will not be compatible with this vision.
b. Entrepreneurship:
The entrepreneurial culture fosters risk-taking and trying things out for solving problems for which prior models may not exist. Given the difficult terrain and heterogeneous resources and endowments, classical health delivery models may not work in mountainous tracts. Research on location specific models will require action research approach and public-private partnership. Entrepreneurial culture will promote diversity of thinking and plurality in implementation. In addition, the mindset will not take absence of precedence as a reason for not trying things out. If some traditional healers have better diagnostic skills for certain diseases, then a futuristic university will not hesitate in inviting them to teach the students as guest faculty. Such initiatives will be taken automatically once it is understood that the purpose is to build a bridge between formal and informal science in a mutually respectful manner.
c. Peer Culture:
Most of the outstanding universities and research centres around the world focus on strengthening a strong peer culture as a means of governance for individual and collective behavior. If somebody is not publishing papers, peers who publish papers can make suggestions, provide help and persuade the non-performing colleagues to take up research projects. A horizontal process often is more helpful than vertical process. Peer culture also implies that leadership for various tasks should not be hierarchical in nature. An assistant professor may chair a committee in which full professors may be members and for that task, his/her leadership is accepted by everybody. The iterative leadership model reinforces peer culture. More people share their mistakes, pitfalls as well as positive experiences in peer culture driven organizations than otherwise. The unfortunate secretiveness and lack of mutual respect and professional dialogue are the inevitable consequences of the hierarchical organizations.
d. Pooling of resources and knowledge:
In any evolving institution, it is inevitable that not all departments will have all the resources required for efficient functioning. The culture of departmental ownership and putting restrictions for others to access such resources can lead to collective sub-optimisation of the results. Therefore, the sharing and pooling of resources should be encouraged with a sense of self-regulation accompanying such a culture. For managing inventory and proper records, every user should put down the exact details so that next user does not face any difficulty. Conventional store and purchase culture will need to be changed if inter-departmental pooling of resources and facilities has to be encouraged. Similar culture should permit the pooling of knowledge and data about patient care and other aspects of service delivery. The students of each department should have access to resources of all other departments in the interest of high quality research and clinical services.
e. Ethical standards and practices:
While medical ethics and responsibility for patients, nature and society have evolved very well in many reputed institutions, these aspects still remain subdued in many Indian institutions. Articulating ethical beliefs and matching them with good practices and norms is necessary for strengthening a healthy organizational culture. Be it the informed consent of patients for trial of new medicines or collecting data for research purposes or authorship of research papers, disclosure of research findings to the data providers, one needs very strong consciousness to develop good practices. This will ensure cooperation and trust of all stakeholders. The disposal of medical waste may be a technical issue but it is also an ethical issue. The best advantage of good ethical values is that more and more people regulate their own behavior according to internal norms rather than external rules. A good university achieve great results because people are driven from within and not so much from outside.
f. Accountability to society through inclusive innovation:
The current decade has been declared as the “Decade of Innovation” by Hon’ble Prime Minister and Hon’ble President of India. It is necessary therefore that those problems which affect disadvantaged people and for which the cost of delivery of existing solutions may be high are not neglected. One should not use indicators developed for high population density regions to monitor the services in low population density regions like mountains. Innovative solutions have to be developed for validating traditional knowledge, delivering existing solutions and for involving students and communities in massive healthcare initiatives. The preponderance of water borne diseases indicates lack of attention to sanitation and water purification. A university cannot take up large scale solution to these problems. But, it can develop models for providing such solutions through innovative approaches. There should be many action research initiatives to develop such models. The connection between university and society at large will become stronger if the policymakers at state and central level take cues from these models and replicate them for larger social good. Of late, universities are not taking lead in generating such models. A futuristic university has to put the goal of developing such models in its DNA.
Anil K Gupta
