Challenges of academic healthcare leaders in a higher education context in South Africa

Universities are in a highly competitive environment, needing strong academic leadership. Some heads of departments have been appointed into leadership positions in a healthcare faculty after having been mere academics for a few years. They are more likely to experience challenges. This study aimed to explore the views and understanding of heads of departments in a healthcare faculty on being appointed as academic leaders in a higher education context in South Africa. A qualitative design using 12 individual unstructured interviews was conducted with all the heads of departments in a health sciences faculty. Open coding was conducted and two themes emerged, focusing on the varied skills needed for academic leadership positions and developing leadership skills amongst senior academics. The findings indicated that development of senior academics in leadership should be undertaken by a knowledgeable professional in formal or informal settings, to encourage mentorship and more regular group meetings, while addressing the core role of a leader. Implications of these findings for a faculty of health sciences and suggestions for leadership succession in future are discussed.


Introduction
Effective leadership in any organisation is a crucial component of overall organisational success (Otara, 2015). The effective leadership of universities is a crucial issue for policy makers, leaders themselves and for university staff. Gibbs et al. (2009) state that leadership is a critical factor in sustaining and improving the quality and performance of universities. Research also shows that university leadership is fundamentally different from leadership in other contexts, and demands additional competencies. The opinion is held that there is far too little research on the leadership roles that exist in universities at departmental level (Bryman, 2007). Research is thus needed as individuals who take on leadership positions in academic health science faculties help facilitate the mission of those institutions (Detsky, 2011). It has been found that poor leadership leads to poor coordination of programmes in departments, thus having a negative effect on service delivery in universities. The current trends in higher education settings are that leadership positions are filled by academic staff who are appointed with limited experience in formal management or leadership roles and responsibilities (Parrish, 2015). Garwe (2014) states that heads of departments are mostly prominent academics who do not possess any formal training beyond their academic credentials, achievements and experiences in academia. These experiences are normally in teaching, research and community involvement (University of the Western Cape (UWC), 2015). Apart from holding a senior position, a staff member can be nominated by a department to serve as a head at some universities in the Western Cape. Furthermore, recruitment of academic leaders should take cognisance of the higher education context that is confronted with issues such as those of equity, inclusion and diversity, and stimulating the changes needed for the embedding of social justice (Spendlove, 2007). This situation requires strong academic leadership of heads of departments in universities. The term Head of Department applies to appointed post holders who have responsibility for either an academic department or school (Human resources, 2016).
Higher education is also caught up in a perfect storm of hiked student fees, exposed international recruitment, widening participation pressures and intensifying threats from international competitors (Lumby, 2013). Changes in technology, student demographics, funding or government regulation affect higher education institutions, and the need for certain leadership skills and traits is evident (Kelly, 2015). At a university in South Africa, a number of drivers of change in higher education also exist, namely: a change in the nature of the employment contracts, cost increases in student registrations and education, and the demand for more research outputs and publications. Changes in the international arena include an exponential increase in the rate of accumulation of knowledge and the consequent fragmentation and specialisation of academia, globalisation of academic and education markets, and new competitors entering the business of education (Otara, 2015). This therefore requires an understanding of how academic heads lead the different departments of, e.g. a health faculty in a university.
Academic leadership has been defined as 'the act of building a community of scholars to set direction and achieve common purposes through the empowerment of faculty and staff' (Wolverton and Gmelch, 2002: 35). Empowerment of heads of departments in leadership development is crucial to address the continuous changes in the academic environment and to effectively act as change agents in order to lead others. An academic leader could be required to demonstrates his/her influence through teaching and research. For years, shortcomings in the leadership area were attributed to the scarcity of sound research on the training and development of academic leaders (Conger and Benjamin, 1999). It could be argued that leadership development is a process that extends over many years, and that most academic leaders in the past have 'learned on the job' (Detsky, 2011: 88), rather than being selected for their leadership skills. Leadership development is furthermore a national priority in the South African context (Eckert and Rweyongoza, 2010).
Heads of department hold a pivotal role in universities in ensuring that strategic imperatives are translated into action rather than being rhetorical ambitions, in order to implement changes and outcomes of plans envisaged by the institution. Heads as senior academics should work closely with their deans to establish powerful partnerships that can bring about real change in universities (Brown and Denton, 2009). Consequently, the interests of faculties, staff and leaders converge towards common organisational aims (Otara, 2015).
Heads of departments need to develop different leadership skills to manage their departments. A more proactive approach is needed to identify leadership competencies and develop leadership throughout universities (Spendlove, 2007). It is also mentioned that new models of leadership are needed for the higher education sector that require a less hierarchical approach, and that take account of its specialised and professional context, market competition, government scrutiny and organisational restructuring (Jones et al., 2012).
Effective academic leadership needs specific skills to utilise communication skills, organisational culture and shared values in order to fulfil mutual trust (Otara, 2015). Leaders should not only direct reciprocal communication but also provide an effective communication network inside and outside universities. Mutual trust and respect provide an appropriate context and can be used to move the organisation towards individual and collective goal attainments (Bikmoradi, 2008). Academic leadership should be transformational towards a shared vision, and collaborative teamwork and respect (Atkinson et al., 2007).

The role of heads of department as healthcare leaders
Senior academics (such as heads of department) have to act in building programmes and a community of scholars to set direction and achieve the expectations of stakeholders in the current challenging economic times (Otara, 2015). In this study, the faculty structure consisted of a dean, three deputy deans and eight departmental heads ( Figure 1). Brown (2011) suggests that advocacy and leadership bring about genuine change by using evidence-based practice and current research to convince people of the value of the desired changes and to make sure that the changes align fully with the institution's overall ambitions.  The environment of academic leadership needs collaborative and motivational leadership activities that require effective interpersonal skills. A senior academic leader could use interpersonal skills in academic personnel management, internal productivity, personal scholarship, and external and political relations. They are expected to have a vision to promote scholarship and health for all, to protect higher learning from stagnation and provide a sound basis for advancing the faculty and university at large in meeting the demands of the economy (Otara, 2015). These leaders, whose role is to manage both up and down (e.g. heads of school), have to 'do a balancing act' -having to monitor a budget, manage staff and students, conduct research and interact with senior management (Scott et al., 2008). Their task is to use their interpersonal skills to enhance the joint performance of people by making their strengths effective (Drucker, 2011).
In order to succeed at new teaching, research and leadership tasks, development of senior academics in headship positions is thus essential (Bikmoradi, 2008). The heads of departments in this study were inter alia accountable for student enrolment and throughput, staffing, research output in, e.g. staff publication output, community engagement and partnership development, staff development, academic planning and teaching, and learning, budgeting and work allocation (UWC, 2016). Gmelch (2013) highlighted that transitioning from an academic to an academic leader needs time and dedication. Academics also face personal challenges to respond to 'the call' to academic leadership. As previously mentioned, some academics are appointed to leadership roles without training or as a result of other seniors not wishing to take up these positions. It is unclear how they experience their position as academic leader. The aim of this article was thus to explore and describe the views and understanding of heads of departments in a healthcare faculty, on being appointed as academic leaders in a higher education context in a resource-constrained institution in South Africa. By sharing their views, more insight could be gained on issues that affect their roles as academic leaders.
Theoretical paradigm Ramsden (1998) is a qualitative researcher with a focus on effective leadership in higher education settings. His relational leadership-oriented theory makes clear distinctions between leaders and followers (Ramsden, 1998) and signifies the relationships in which people work together. He believed that dimensions of leadership are evidenced in every aspect of the academic development role. Specifically, he states that people with titles such as Head of Department are the ones tasked with formal leadership responsibilities, with a role in staff development (Smith, 2006). Certain general theoretical assumptions, adapted from the conceptual academic leadership development framework of Ramsden (1998) on effective academic leadership in higher education, were introduced in this study: Effective academic leadership requires a person to demonstrate leadership in teaching and research. Heads of departments need to develop different leadership skills to manage their departments. The environment of academic leadership needs reform through collaborative and motivational leadership activities that require effective interpersonal skills.

Methods
The study was conducted at a higher education institution, a 52-year-old university in South Africa, known as the struggle university from the apartheid era. The enormous drive behind academics in a unique organisational culture has led to it being nationally known as having a research-driven status. Bailey (2014) found that across all types of organisations and all leadership levels, there is no significant difference between male and female leaders. In a faculty of health sciences, where the study was conducted, female leaders were dominant. The accessible population of deans and heads of departments served as the total sample (n ¼ 12). Unstructured individual interviews were conducted over a period of one month in a private room, while being audiotaped. The dean, three vice-deans, and heads from the departments of physiotherapy, nursing, social work, natural medicine, psychology, human ecology, sport science, and sport and recreation, partook in the study. The participants were three male and nine females. Interviews were conducted in their offices after the participants had given written informed consent. The question posed was: 'How do you understand your leadership role as head of your department?' Interviews were aimed at obtaining rich descriptions of their experiences in their leadership positions through probing, observation and field notes. We chose to focus on this relatively small set of academics that allowed in-depth insight into the phenomenon of leadership development in one of the largest faculties in the university. Steps of Tesch's (1990) descriptive analysis of open coding (Creswell, 2016: 198) were followed, by reading the transcripts and jotting down ideas that were triggered while reading. During re-reading, the focus was on the underlying meaning of the text and key thoughts were written down. A list of all themes was formulated, with categories. Anonymity was adhered to through omitting the names of participants from the transcripts. The researchers and an independent coder reached consensus on the coding. The interviews lasted between 45 and 60 minutes until data saturation was achieved and no new information emerged. The project was approved by the Ethics Committee of the university. Participants were informed that all information collected were kept under lock and key for two years after publication of the results.
Trustworthiness was ensured by prolonged engagement with the participants in the field and the interview sessions lasting up to 60 minutes. Credibility and confirmability were also ensured by the utilisation of the voice recorder to record all interview sessions. An independent coder assisted with coding. Field notes were written for all non-verbal cues observed during interview sessions conducted (part of the audit trail that added to triangulation of data in the analysis). Transferability was ensured in that a complete description of the research design and methodology used is available for future studies in similar settings.

Results
Participants in this study were predominantly female with a range of between 5 and 20 years of academic leadership experience. Two main themes emerged from the findings (Table 1).

Leadership developed over time
The leadership process involves a person inspiring and influencing other people to accomplish a shared goal, using a set of leadership skills and behaviours (Northhouse, 2013). As Head of Department, a person should have intrapersonal awareness, good interpersonal relationships and implement effective conflict management, decision making and problem solving. The development of these leadership skills is an ongoing process which is acquired over a period of time (Huber, 2014).
Most of the participants mentioned that the development of leadership skills was a continuous and ongoing process and that they grew in capabilities over time to fulfil their given roles and responsibilities. One participant commented: 'You learn as you go' (P3). This view is further confirmed by Day (2011), who suggests leadership skills are developed through constant dedicated daily practice, and that becoming an effective and efficient leader does not occur instinctively.

Leadership can be learned though different means
The participants stated that leadership skills can be acquired through various unstructured and structured means which require the involvement and participation of the leader for them to be meaningful. For instance, one participant stated that effective leadership skills can be developed through the [personal] 'Reflection' of the leader (P2). Still another participant specified that it can be developed through structured leadership development programmes through facilitation: 'I think it can be facilitated' (P1). It was also mentioned that a person: 'can attend workshops' (P4) to develop their leadership skills and that it can also be achieved through: 'a learning organisation' (P6).
The findings of this study suggested that a programme was needed that was context-specific in the health faculty. Several studies investigating the impact of leadership development programmes have demonstrated that through leadership development programmes, the skills and capabilities of members are significantly increased (Amagoh, 2009).

The importance of role models
A role model is defined as a person whose behavioural patterns, performance or achievement can be imitated (Dictionary.com, 2014), and who is self-aware, visionary and courageous, shows empathy and practises self-reflection (Webster, 2014). Role models in the academic environment are individuals who have a positive attitude towards junior colleagues, have a commitment for excellence and growth, and essentially stimulate those around them in, e.g. research activities (University College London, 2016).
One of the participants stated: 'You should be a good role model' (P12). Similarly, another participant was of the opinion that, in addition to being a good role model, a leader should assist his or her followers in discovering their individual inherent leadership qualities and abilities, since these are present in every person: 'It is about showing or almost being a role model and showing others that you know that we all actually have these qualities on the inside, we all have potential' (P9).
A role model should have a vision. It was mentioned: The person should have a vision. He should know where he takes the people to, and then of course you should have an idea how to get there. It's one thing to say -the vision is to make this department the best department in the world, but he should be realistic, he should be able to do it, you should have a clear path on how you can get there (P1).
It seemed that a role model was essential for guidance to heads of departments. A study conducted by Hoyt et al. (2012) also found that individuals experience a more positive leadership selfconfidence when they have role models guiding and inspiring them to become effective and efficient leaders.

Some people have a natural ability
It was mentioned by the majority of participants that even though leadership can be learned, the inborn or innate traits possessed by the leader still had an influence on their leadership style. A few participants indicated: 'I think there are born leaders' (P1, P5, P7). On the other hand, the development of leadership traits was mentioned: 'But I think, of course, people can develop into leaders' (P4). Another participant revealed: 'Some people have skills that they come with that make them good leaders; however, and I think that in professionalism there are people who are leaders as professionals' (P6). In the faculty, heads are registered at the Allied Health Care Council and South African Nursing Council, with a focus on qualities of professionalism. The combination of a natural ability and developing leadership was also mentioned: 'Well I think a bit of both. Let me say both. I think there are born leaders, but I think, of course, people can develop into leaders, yes' (P1). Leadership qualities needed are reported by Huber (2014) as personal values, integrity, levels of confidence, knowledge, self-awareness and emotional intelligence. The maturity of a Head of Department could be measured by emotional intelligence. Parish (2015) mentions that leaders in higher education who possess strong emotional intelligence are more respected by peers, colleagues and subordinates and perform more effectively as leaders. In this study, half of the heads were under the age of 40 years and it could be argued that they were still emerging leaders. More mature leaders usually have the predisposition for taking appropriate decisions and actions (Miner et al., 2012).

Environmental encouragement
The situation in which heads of departments fulfil their roles is important for successful leadership (Dinh et al., 2014). During the interviews, the majority of participants mentioned that they had the ability to lead other people; however, they needed a supported environment: 'provided that the person receives sufficient and appropriate support and backing in the context in which the leadership is taking place' (P7). Participants commented: 'Everyone can lead given the right environment/encouragement' (P8) and 'I would say creating a context where they can discover themselves, where they can find out what are their leadership skills . . . so I think to discover their own leadership styles and what they're doing, I think is important' (P1).
It seemed that a key question to be taken into consideration when assessing the leadership success of heads of departments, was whether an enabling environment was made available for them to be able to function at their utmost capacity. The question was indicated in the statement of one of the participants: 'Are there enough contexts created for leadership? I don't think so' (P5). Hersey et al. (2013) confirm that the leadership process is a function of the enabling factors in the environment in which the leadership is taking place, in addition to the leader and follower variables. It could therefore be assumed that, under the right circumstances, an individual's potentials and capabilities to be able to lead successfully could be demonstrated.
Heads could do a self-assessment to identify the appropriate and responsible actions needed in the specific situation in which they find themselves. However, some leaders commit to something before they know how to make it happen (Graf, 2015).
The findings from this theme indicated that leadership is influenced by both intrinsic factors (role model for others and inherent abilities) and extrinsic factors (contextual and environmental support factors).

Theme 2: How to reform the environment of academic leader
Theme 2 had three categories that referred to the reforming of the environment of academic leadership, namely: the need for having leadership development programmes, adequate resources in leadership development and promoting collaboration in leadership.

Need for academic leadership development programmes
Participants were of the opinion that they were well-informed and experienced healthcare professionals who were in a position of leadership. One of the ways to establish an enabling environment is through leadership training (Laschinger et al., 2009). Participants pointed out the need for a programme for them to be trained by a knowledgeable professional,

Responsibility for training
All participants mentioned the need for a leadership programme by an expert using different approaches to transfer essential information, skills and values.
Participants also reflected on their own role and responsibility, and mentioned the importance of being conscious of one's self-awareness and self-discovery during the process of developing effective leadership skills. This view was evident in one of the statements of a participant who shared: Well I think leadership is much more than training. Okay, we can be aware of what is a leader, a leader should do, should do this, and this, and this, you should manage, you should do this, you should manage time, you should . . . but I think leadership is also discovering of yourself, and your abilities. So it's for me more . . . I don't like the word 'training' (P1). This finding is in alliance with the view stated by the Department for Business Innovation and Skills (2012) that, through training, effective leaders are better able to implant in their followers the enthusiasm needed for them to work towards achieving their set goals and objectives.

Mentorship and/or coaching programme/various mentors (internal and external)
Mentorship is defined by Bailey-McHale and Hart (2013) as 'a relationship in which an individual nurtures another with values, knowledge and skills which will ultimately result in a judgement being made regarding the mentee's competence'. Mentorship was welcomed: 'Mentorship, I think mentorship, I think is important. I think you can do it . . . ' (P1). Some participants cited mentorship programmes as 'opportunities for developing leadership skills'.
Qualities of a good mentor which were highlighted by the participants include being knowledgeable, friendly, empathic, trustworthy, kind, collaborative and willing to share knowledge. They also mentioned that 'a good coach serves as a teacher, guide, counsellor and advisor' (P4). The following are some of the verbatim quotations given by the participants: 'ability to identify where I am lacking . . . my skills' (P6); 'understands me holistically' (P7); 'help me to look at myself' (P5); 'she's non-threatening' (P11); 'share maybe all my failures' (P2); 'somebody that's safe and on the outside' (P1); 'somebody that you get on well with' (P3); 'can share her experience and give advice which I then take or not take' (P3) and 'who can share their experience, and somebody who is prepared to nurture' (P9). Also, some other participants specified: 'we can learn a lot from each other' (P4); 'should monitor your development' (P8).
The above qualities mentioned by the participants in this study are similar to those described by Eby et al. (2010), that a good mentor is competent, caring, approachable, compassionate, committed, loyal and supportive.
A participant shared some personal experiences with having a mentor. According to her, she was able to receive supportive mentoring when she went to her mentor, when she needed guidance regarding a public speaking engagement: My coach guides me on . . . I need to do a public speech . . . I must publicly speak . . . and so she coached me and guided me through that thing [task-oriented] . . . I need to do public speaking but you know me, how do I do this? What is my best approach in terms of this? This person gives you the skills in terms of what you need to do to be a public speaker. The mentor understands me [relationship-oriented] (P5).
It seemed that the mentorship role could be played by more experienced peers and/or colleagues with whom one had a direct working relationship. Also, it was suggested that individuals in other departments could also serve as a role model that could help to establish the leadership skills that were required. One participant said: 'I look to the dean, whoever the dean is at the time, we've had a couple, but I do look to the dean for mentorship as well, and guidance. I occasionally talk to other head of departments' (P2).
Another participant mentioned senior academics that assist: 'Deans, line managers, heads of departments, external mentors and coaches, peers' (P6) as those who can play the role of a mentor. This finding is interesting because it suggested that the participants had a considerable amount of respect and regard for their contemporaries, and still saw themselves as mentees. This type of respect could foster an environment of partnership and collaboration which is needed for productivity and higher work output. Tuckey et al. (2012) advance that leaders have the capacity to mentor and guide their mentees in a cooperative mentorship relationship.

Shadowing
Shadowing has been documented to be an effective approach in developing the leadership skills of leadership apprentices. It has the benefit of allowing people to perceive first-hand, and to appreciate leadership skills which they learn from the experienced and effective leader (Arman et al., 2012;McDaniel et al., 2013).
Given the importance of shadowing in developing the leadership potentials of future leaders, participants in this study perceived that shadowing is a significant part of developing and improving the intrinsic leadership skills of an individual who is to take on a new position of leadership. The participant clearly specified: 'the next person coming in shadowing' (P1). Rothwell (2010) defines succession planning as 'any effort designed to ensure the continued effective performance of an organisation, division, department or work group by providing for the development, replacement and strategic application of key people over time' (Rothwell, 2010: 6).

Succession planning
In this study, the participants were of the view that fellow staff members were disinterested and dispassionate about being in the headship positions in their individual departments. Nevertheless, they advocated succession planning programmes as a way of preparing individuals for such positions. A participant reflected: I think [it] needs to be in place for HOD succession. Then, there must be some kind of a training for the next HOD who will come in because people don't want to be Heads of Departments . . . it's academic suicide (P8).
Another participant indicated: 'We should be identifying potential leaders within our faculty [and] to be nurturing those leaders' (P7). It seems as if a gap in the cultivation of the leadership capacities of future leaders in the institution existed.
The advantages of putting a succession plan in place in the faculty could secure talented leaders and sustained leadership. Literature confirms the benefits of succession as it: encourages appropriate and timely handover and transfer of information amongst staff; safeguards connection for administration processes; offers stimulating, growth-oriented, satisfying and worthwhile professional prospects; raises production and output and helps to circumvent loss of efficiency; encourages development of extraordinary achievers; and secures the engagement of talented members of staff (Mattone, 2013;Singer and Gail, 2010).

Resources in leadership development
Administrator allocated to HOD to alleviate administrative burden As a means of lessening and easing the workload on the leader and to give the leader more focus time to develop leadership skills, it was stated, by one participant, that an administrator should be assigned to the leaders, 'They need an administrator that does the admin' (P5). This finding is in agreement with the standpoint of France (2012), who recommended that personal administrators or assistants should be assigned to leaders occupying executive leadership positions, so that these administrators/assistants can assist the leaders to be able to meet their work loads and responsibilities and, in turn, improve their productivity and creativity.
'Peer-groups'-meet and share Groups were pointed out as a means to develop leadership amongst senior academics: 'working in a group' (P12). One of the reasons for meeting more often in groups was pointed out as having consistency in development programmes: 'so you're practising a skill three times a year you know, by the time you get to your next PDS training, you've kind of forgotten what it was all about' (P9).

Formal and informal platforms on different levels
Leadership development should be planned through creating formal and informal platforms: 'the training needs to be formal, you need to read and do course work', and: [m]aybe it's more informal platforms, but . . . which we can do and you get together and you can do, people feel less intimidated by them and so you can sit down, it's kind of casual, it's kind of nice, yet there is structure to it and therefore you learn and those who really don't want to . . . someone can monitor who doesn't pitch for these initiative (P11).
During an interview, a participant queried whether a leadership programme should be compulsory if formal: [w]e work for an institution which pays us, so therefore it has a certain right as an institution to say, but look this is what I require from you, so therefore you've got to do this and on the other hand I also feel that we have the right as humans to pick what we are wanting to do (P7).
Participants mentioned that leadership development should be offered on different levels from beginner to intermediate to advanced: 'there's maybe levels of leadership, in some areas you're a good leader, in some areas you may not be a good leader' (P5) and 'leadership is when we're at different stages and so I strongly believe in the system of, there should be, you know, the intermediate, the advanced level and then the entrance level of training' (P3).

Collaboration in leadership
Leadership skills can be developed in a supportive environment for sharing and growth. Various participants expressed the need for a supportive, open environment that provides opportunities, and participants described the context of leadership as: 'non-threatening way, a supportive' (P1); 'creating a context where they can discover themselves, where they can find out what are their leadership skills' (P5); 'opportunity where we share as leaders what is it that we go through, how do we move forward, how did you address this, that kind of opportunities needs to be created; (P7); and 'openness and the opportunities that everybody has an opportunity to grow and develop into a leader' (P10).
The intentional and skilful management of relationships could enable academics to succeed individually while accomplishing a collective outcome. In a faculty of community and health sciences, interdisciplinary collaboration in education is essential, as was mentioned: 'Heads of department in the clinical settings should work along, and strengthen collaboration in that way' (P3).
New data-driven tools offer innovative approaches to help accelerate leadership by better assessing leadership qualities, creating opportunities for sharing ideas, understanding career patterns of successful leaders and learning what development works best (Canwell et al., 2015). Theme two highlights the need for relationship building and people development as part of academic leadership development. The focus tends to be on building communities of practice rather than just individuals. Scott et al. (2008) suggest that higher education needs excellent leadership at all levels of the organisation in order to remain competitive. As an academic has little direct authority or control over resources, people in these positions need to be particularly deft at 'leading through influence', and, therefore, their personal and interpersonal skills, networking, team work and conflict management are critical.

Discussion
The findings indicated that leadership evolves over time while the person is in a certain position, thus gaining experience in her or his role. This role evolved in an environment of scarce resources, placing a responsibility on leaders to prioritise their tasks in leading their followers forward. Today's leader must manage a complex mix of accountabilities and interact with various stakeholders who require training in leadership. Although leadership can be developed through different means, it should be planned to cultivate specific skills and abilities of individuals through individual and collective learning and experiences, in diverse ways.
In this study, it was stressed that leadership role modelling is an important aspect of developing the leadership skills of emerging leaders. Those who demonstrate strong leadership capabilities wield a strong influence on their followers and are usually regarded as good role models, even in organisational settings. Although some academics may have certain strong personality traits, more and more faculties focus on leadership succession programmes, preparing future leaders. Selfleadership focuses on self-motivation that a person utilises to direct him or herself to achieve optimum performance (Jooste et al., 2015).
Although leaders should stay grounded in reality, they should also be open to unforeseen possibilities and to new ways of thinking and doing things. From the findings, it could be interpreted that leaders are much more likely to emerge in an environment that encourages leadership. This can be promoted through mentorship and coaching programmes that can be on a more formal basis. In an environment of an aging workforce, the leadership succession programme can make provision for those soon retiring to guide the younger, upcoming leaders. Upcoming leaders undertaking these developmental approaches must, however, also show a commitment to lead in the future, and to 'give back'.
The second theme indicated that the environment of leaders should be reformed. The first step for this would be to identify the need for academic leadership development programmes. The findings indicated an enthusiasm for development as leaders through mentoring, shadowing and leadership succession. It was acknowledged by the participants in this study that a well-informed, knowledgeable and experienced leader should have the ability to impart leadership skills on his or her followers, through diverse teaching and training strategies, to facilitate the acquisition of the prerequisite knowledge, skills and values in the followers. This confirmed the theoretical assumption in this study, that effective academic leadership requires a person to demonstrate leadership in teaching. Hence, leaders must recognise that, for them to be good mentors, they need to improve their skills, think strategically and involve people in the accomplishment of the goals and objectives of the team (Robertson, 2014). Shadowing is a technique used in developing promising future leaders and is different from mentorship. It entails an upcoming leader learning from an experienced and successful leader, by following him or her around and observing his or her day-to-day activities for a designated period of time (Rubino et al., 2014).
Resources are needed for leadership development. This is important as leadership development should not be planned for only a few, but for all those in the institution on different levels. In a high-performing work setting, more is spent on leadership development than on their counterparts (Canwell et al., 2015). Ways in which resources could effectively be used mentioned making use of assistant administrators. These could perhaps be made on a contract basis. It seems that collaboration between peers and a peer group becomes more and more important in an environment with challenges and competition, in which academics are more focused on publications and research output. This confirmed the assumption in this study that effective academic leadership requires a person to demonstrate leadership in research.
Collaboration in leadership was mentioned by participants; this turned the attention to team leadership and collaborative leadership. The key issue in these two approaches could be interpreted as having a shared vision and collaborative efforts to influence the direction of the future. Detsky (2011) states that, in addition to articulating a departmental mission, the head of a unit is its major cheerleader. It is important that the enthusiasm be visible to people within the unit and to those in the organisation outside the unit.

Conclusion and recommendations
The findings indicated experiences of participants on their internal and external environments as heads, which emphasise the need for a context-specific leadership succession programme to be developed. It is essential that the right persons enthusiastically take up positions as heads of departments, therefore candidates should be formally selected and undergo a leadership succession programme. This programme should incorporate allocating mentors to mentees, implement job shadowing and be offered with reference to a clear conceptual framework of the leadership process. The programme should take cognisance of the (i) motivation (mind) of heads of departments, and (ii) the external environment of the university, e.g. the creative use of available sources. The results of this study have practical value for future research, as they confirm the importance of obtaining funding to explore and develop a leadership programme to be offered in a health faculty. Heads of departments in health faculties could also form a forum that engages on how to lead others and continuously enhance their skills to meet the needs of an ever-changing environment (Eckert and Rweyongoza, 2010). Further research should be conducted on the effectiveness of leadership succession programmes in academic environments, the self-leadership activities of academic leaders in research and teaching domains, and leadership styles needed to influence the new generation towards a common vision. This study highlights the ongoing need for academic leadership development in higher education settings, which differs amongst individual leaders. The Head of Department will always be involved in teaching and research activities and must find a way to effectively reform their leadership skills. It could be argued that a generic leadership Swansea, Wales. Africa co-editor of the Journal of Nursing Management and editor and author of seven health care services management text books. Widely published in international and national journals.
Jose Frantz is the DVC Research and Innovation at the University of the Western Cape and Professor in the Department of Physiotherapy. Prior to being appointed the DVC Research and Innovation, she was appointed as the Dean of the Faculty of Community and Health Sciences. She has extensively published articles in the areas of health and educational administration.
Firdouza Waggie is a lecturer in the Faculty of Community and Health Sciences at the University of the Western Cape. She has been actively involved in interdisciplinary teaching and research projects in the faculty. She has presented on research projects of community engagement and has an interest in leadership development.