Complementing Managerialism Ideology with Leaderism Discourse: An Idea to Address Management and Leadership Challenges in the Iranian Health System.

Background: Managerialism and leaderism were introduced in response to the challenges in public service management, aiming to improve the management of public service organizations. These ap-proaches both have their own strengths and challenges. The purpose of this study was to examine the current and desired state of the Iranian health system and to find whether these approaches can be integrated to leverage their strengths and address some of the management and leadership challenges of the country's health system. Methods: In this qualitative study, semi-structured interviews were conducted with 43 senior managers of the health system, employees of three medical universities in Tehran, and experts in public management. The participants were selected using purposive sampling, and the snowball technique was used to increase the number of interviewees. The data were analyzed using the framework method in MAXQDA 18. Results: Structural changes, realization of managerialism, establishment of evidence-based in-formation systems, readiness of managers and employees, creating a climate of trust, identifica-tion, and recruitment of competent individuals, specialized training, delegation of sufficient au-thority to managers, building a culture conducive to an integrated approach, communication and cooperation, and benchmarking were identified as the prerequisites for complementing Manageri-alism Ideology with Leaderism Discourse. Conclusion: Complementing managerialism ideology with leaderism discourse can help solve some of the management and leadership challenges faced by the country's health system. But more important are the prerequisites that need to be satisfied in order to prepare the ground for integrating these approaches and capitalizing on their advantages.