Modeling the Implementation of Third-Generation Universities Based on Technological Transformation and Innovation: A Grounded Theory Approach at Mazandaran University of Medical Sciences

Introduction

Universities have progressively expanded their missions as economic, social, and technological conditions have changed. The first-generation university is commonly associated with teaching and knowledge transmission, whereas the second generation added systematic research and knowledge production. The third-generation university extends these functions by seeking to create social and economic value from knowledge through entrepreneurship, technology transfer, commercialization, start-up formation, and sustained interaction with external stakeholders. Wissema (2009) describes this transition as a shift toward universities that operate as international knowledge hubs, while Etzkowitz (2003) conceptualizes the entrepreneurial university as an institutional form in which research groups and academic units increasingly engage with innovation and value creation.

The third mission is not simply an additional administrative task. It changes the relationship between the university and its environment. The Triple Helix framework emphasizes recursive interactions among universities, industry, and government as a mechanism for innovation and institutional transformation (Etzkowitz & Leydesdorff, 2000; Etzkowitz & Zhou, 2017). Likewise, the Mode 2 perspective emphasizes context-driven, application-oriented, and socially distributed knowledge production rather than a strict separation between academic science and practical problem solving (Gibbons et al., 1994). From this perspective, knowledge acquires wider value when it can be translated into technologies, services, organizational solutions, and other outputs that respond to societal needs.

Organizational transformation is central to this process. Clark (1998) identified several recurring features of entrepreneurial universities, including a strengthened steering core, an expanded developmental periphery, diversified funding, an engaged academic heartland, and an integrated entrepreneurial culture. Subsequent research has shown that university entrepreneurship is shaped by multiple levels of activity, including academic entrepreneurship, technology transfer, new venture creation, and the institutional and regional environment (Rothaermel et al., 2007). Entrepreneurship therefore depends not only on individual academic motivation but also on incentive systems, organizational structures, resources, governance, networks, and the wider innovation ecosystem.

The importance of these issues is particularly pronounced in medical universities. Such institutions simultaneously perform educational, research, clinical, public-health, and service missions. Their scientific outputs may have direct implications for prevention, diagnosis, treatment, health technologies, medical devices, pharmaceuticals, digital health, and health-system management. A third-generation orientation in this setting therefore concerns not only commercial outcomes but also the conversion of academic knowledge into usable solutions for patients, health organizations, and communities. Entrepreneurial and innovation ecosystems can facilitate this conversion by linking researchers to implementation partners, investors, regulators, health-service providers, and users (Cunningham et al., 2018; Guerrero et al., 2024).

At the same time, the transition toward a third-generation model is institutionally demanding. Traditional promotion systems may privilege publications over translational or entrepreneurial outputs; centralized bureaucracies may slow decisions; funding restrictions may limit experimentation; and limited skills in commercialization, intellectual property, negotiation, and project management may reduce the ability of academic staff to move ideas beyond the research stage. Evidence on entrepreneurial universities also indicates that regional competitiveness and innovation are connected to the university's capacity to mobilize resources and build external relationships (Audretsch, 2014; Guerrero et al., 2016). Student and faculty entrepreneurship similarly depends on an ecosystem that supports mentoring, opportunity recognition, networks, and venture development (Wright et al., 2017).

Mazandaran University of Medical Sciences operates within these general pressures while also facing the specific organizational and regional conditions of a medical university in northern Iran. A transferable model cannot be assumed to arise simply from importing frameworks developed in other national and institutional settings. The structure of health education, relationships with hospitals and health services, local economic capacity, governance arrangements, and region-specific health needs may alter both barriers and opportunities. A grounded, context-sensitive analysis is therefore appropriate for identifying how the causal forces, contextual conditions, intervening factors, strategic responses, and consequences are related within this institutional setting.

Accordingly, the present study sought to model the implementation of a third-generation university at Mazandaran University of Medical Sciences using grounded theory. The research question was: How can the implementation of a third-generation university at Mazandaran University of Medical Sciences be explained and modeled in relation to its causal conditions, contextual conditions, intervening conditions, strategies, and consequences?

Methods

Study design and setting

This applied qualitative study used the grounded theory approach described by Strauss and Corbin (1998). The study setting was Mazandaran University of Medical Sciences, and data collection was conducted in 2021. Grounded theory was selected because the study aimed to develop an explanatory model from participants' accounts rather than test a predetermined causal model.

Participants and sampling

The study population comprised faculty members and managers of Mazandaran University of Medical Sciences who had knowledge of and experience with third-generation universities, academic entrepreneurship, knowledge commercialization, and change management in higher education. Purposive, criterion-based sampling was used and continued until theoretical saturation was reached. Fifteen experts ultimately participated, including university presidents or senior leaders, deputies, managers, and faculty members.

Data collection

Data were collected through semi-structured interviews. Initial interview questions were designed around the study objectives, and follow-up questions were asked during the interviews in response to participants' statements. This flexible format allowed emerging concepts and relationships to be explored in progressively greater depth while retaining a common focus across interviews.

Data analysis

The interviews were analyzed using the open, axial, and selective coding procedures of grounded theory. First, initial concepts and open codes were extracted from the interview material. These codes were then organized into categories and subcategories during axial coding. Finally, selective coding was used to identify the core category and integrate the categories into a conceptual model for the implementation of the third-generation university. MAXQDA was used to manage, organize, and analyze the qualitative material.

Trustworthiness

Trustworthiness was addressed through credibility, dependability, confirmability, and transferability, consistent with the qualitative quality criteria described by Lincoln and Guba (1985). Participant review of findings, expert review of the research process, and detailed documentation of the analytical process were used to strengthen the rigor and transparency of the analysis.

Results

Participant characteristics

Fifteen faculty members and university managers participated in the qualitative interviews. The two most frequent age groups were 40–45 years and 46–50 years, each accounting for 40% of the participants; the remaining 20% were 51–55 years old. Regarding marital status, 86.7% were married and 13.3% were single. In terms of educational level, 66.7% held a master's degree and 33.3% held a doctoral degree.

Causal conditions

Axial coding indicated that the causal conditions influencing implementation of the third-generation university could be explained through several central themes. A major factor was the inefficiency of the traditional model of university education and research in developing entrepreneurial human resources, producing applicable knowledge, and responding to changing societal needs. Economic pressure, limited financial resources, and instability in university financing increased the need for new revenue models and economic use of scientific capacities. The growing complexity of health-system problems and needs further demonstrated the limited capacity of traditional university structures to respond effectively. In parallel, expansion of the knowledge-based economy and the growing role of knowledge and technology in value creation pushed medical universities toward commercialization, innovation, and health-technology development. Finally, the structural need to redefine the university mission—from teaching- and research-oriented toward entrepreneurial and community-oriented—was identified as a major causal condition. The axial categories and representative open codes are presented in Table 1.

Contextual conditions

Implementation of the third-generation university was also shaped by organizational, managerial, and environmental contextual conditions. The most important included a centralized and bureaucratic organizational structure, a dominant teaching- and research/publication-oriented culture, limited entrepreneurial skills in the university's human capital, and insufficient infrastructure for technological and innovative activities. Weak strategic approaches in governance and management, complex rules and procedures, and limited effective interaction with industry and other external organizations created additional challenges. Regional and geographical characteristics of Mazandaran were also identified as an important context for developing entrepreneurial and technological activities. These contextual conditions and their open codes are shown in Table 2.

Intervening conditions

A further set of intervening conditions could either facilitate or constrain the university's transformation. These included managers' attitudes and mental readiness for university transformation, the degree of managerial and policy support, faculty participation and responses, and the incentive, evaluation, and promotion systems affecting staff and faculty. Institutional capacity to manage innovation and entrepreneurship, interaction with industry and the health system, executive skills, and a climate of trust, participation, and organizational learning were also influential. Thus, appropriate structural conditions alone were not sufficient; the quality of management, supportive systems, collaborative culture, and human-resource readiness were also decisive. Table 3 summarizes the corresponding coding structure.

Strategies

The findings indicated that implementing the third-generation university required a coordinated set of organizational, educational, managerial, cultural, and economic strategies. Core strategies included developing entrepreneurship and innovation structures, revising educational programs to strengthen entrepreneurial skills, establishing incentives and rewards for technological and innovative activities, and expanding interaction with industry, the health system, and society. Faculty and staff empowerment, reengineering managerial processes, diversifying financial resources, reducing bureaucracy, increasing transparency, improving coordination, and building support infrastructure for innovation and commercialization were also identified. The detailed strategies are presented in Table 4.

Consequences

The identified consequences were positive and multidimensional, spanning scientific, economic, social, and organizational domains. Scientifically, the model was associated with more effective research, greater production of applicable knowledge, and more problem-oriented research. Economically, entrepreneurship, commercialization, knowledge-based companies, and dedicated revenues were linked to greater financial self-reliance and reduced dependence on government funding. Stronger interaction with society, industry, and the health system increased the university's role in addressing regional and national problems. Additional consequences included improved professional and entrepreneurial capabilities, better management, greater transparency and organizational efficiency, enhanced national and international standing, and a stronger culture of innovation and continuous learning. Table 5 summarizes the corresponding codes.

Core category and paradigmatic model

The open, axial, and selective coding process identified 'entrepreneurial transformation of the medical university toward the third generation' as the core phenomenon integrating the paradigmatic model. This category describes the transition from an institution focused primarily on education and research toward an innovative, entrepreneurial, value-creating, and socially responsive organization. The transformation is generated by the causal conditions identified above and unfolds within the organizational, cultural, infrastructural, managerial, regulatory, and regional context. Intervening conditions—including managerial support, faculty participation, incentives, institutional capacity, and external interaction—shape the extent to which the transformation can occur. The university responds through the identified educational, organizational, managerial, cultural, relational, and financial strategies, which in turn lead to the scientific, economic, social, human-capital, managerial, financial, reputational, and cultural consequences summarized above. Figure 1 presents the integrated paradigmatic model derived from the qualitative data.

Discussion

This study conceptualized third-generation university implementation as a multidimensional and gradual transformation rather than a discrete structural reform. The core category—entrepreneurial transformation of the medical university toward the third generation—captures a shift in institutional logic: the university remains responsible for education and research but becomes more explicitly oriented toward innovation, application, value creation, and response to health-system and societal needs. This interpretation is consistent with the entrepreneurial-university literature, which treats the third mission as an institutional reconfiguration linking academic work to innovation and external engagement (Etzkowitz, 2003; Etzkowitz & Zhou, 2017). It also fits Clark's (1998) argument that entrepreneurial transformation requires coordinated changes in steering capacity, organizational peripheries, funding, academic engagement, and culture.

The causal conditions identified in Table 1 show why such transformation becomes necessary. Participants emphasized the perceived limitations of traditional education and research, pressure on public financing, increasingly complex health needs, the knowledge-based economy, and the requirement to redefine the university mission. These themes closely match the broader transition from discipline-centered knowledge production toward more application-oriented and socially embedded forms of knowledge use described by Gibbons et al. (1994). Economic pressure should not be interpreted as the sole driver. Rather, the findings indicate that financial sustainability, social accountability, responsiveness to health needs, and technological innovation operate together. Audretsch (2014) similarly argues that the university's role in an entrepreneurial society extends beyond internal academic production toward knowledge-based economic and regional development.

The contextual conditions in Table 2 demonstrate that a university may formally endorse a third-generation mission while remaining constrained by its internal architecture. Centralization, long administrative chains, risk aversion, publication-centered incentives, infrastructure gaps, unstable management, complex regulations, and weak cross-boundary relationships can all reduce organizational responsiveness. This pattern is compatible with prior research showing that university entrepreneurship is embedded in institutional structures and environmental networks rather than being reducible to individual entrepreneurial behavior (Rothaermel et al., 2007). Guerrero et al. (2016) likewise link entrepreneurial university activity to regional competitiveness, implying that the local environment and the university's capacity to connect with it are analytically inseparable.

The intervening conditions in Table 3 further clarify why similar structural conditions may produce different outcomes. Managers' beliefs, practical support, faculty responses, promotion systems, innovation-management capacity, industry and health-system relationships, skills, trust, and psychological safety may amplify or weaken the effect of contextual conditions. In other words, infrastructure without supportive governance and incentives is unlikely to be sufficient. This is consistent with ecosystem perspectives in which entrepreneurial outputs depend on interactions among people, organizations, resources, and institutional rules. Wright et al. (2017), for example, describe student entrepreneurship as an ecosystem-dependent process rather than an isolated educational activity. Cunningham et al. (2018) similarly emphasize the role of actors in creating value across multi-stakeholder innovation systems.

The strategic responses identified in Table 4 provide an integrated implementation agenda. They extend from visible innovation infrastructure—such as incubators, technology-transfer units, accelerators, laboratories, and innovation hubs—to less tangible but equally important changes in curriculum, incentives, capabilities, administrative processes, finance, and culture. The breadth of this strategy set is important because a third-generation university cannot be created through a single office or program. Technology-transfer structures are unlikely to be effective if faculty promotion rules continue to ignore innovation; entrepreneurship courses may have limited effect if students lack access to real projects and external mentors; and external partnerships may remain symbolic if legal and financial procedures prevent durable contracts. Recent work on university innovation and entrepreneurial ecosystems similarly emphasizes the need to analyze agents, institutions, regions, and impact together rather than as separate domains (Guerrero et al., 2024).

The consequences summarized in Table 5 also go beyond commercialization. Participants associated the model with more applied and problem-solving research, stronger social and health-system engagement, improved human capabilities, better management, financial self-reliance, institutional reputation, and organizational learning. This wider interpretation is important in a medical university, where innovation should ultimately be judged not only by market outcomes but also by its contribution to health needs and institutional performance. The Triple Helix perspective is relevant here because it conceptualizes innovation as a relational process involving university, industry, and government rather than a one-way transfer of academic discoveries (Etzkowitz & Leydesdorff, 2000). The present findings add that, in a health-science setting, the health system and society are also central operational partners.

Taken together, the model suggests that successful implementation requires alignment across five levels: the pressures that create a need for change, the context in which change occurs, the intervening factors that enable or inhibit it, the strategic actions adopted by the university, and the consequences that reinforce or undermine further transformation. The most important practical implication is therefore systemic alignment. Changes in infrastructure should be matched by changes in incentives; changes in curricula should be matched by experiential opportunities; external collaboration should be matched by legal and administrative flexibility; and financial diversification should be matched by transparent governance. The core category identified in Figure 1 captures this interdependence: entrepreneurial transformation is an institutional process rather than a stand-alone entrepreneurship program.

Conclusion

The study developed a grounded model for the implementation of a third-generation university at Mazandaran University of Medical Sciences. The model identifies causal, contextual, and intervening conditions that shape the university's transition, together with coordinated strategies and multidimensional consequences. The findings indicate that implementation requires simultaneous attention to mission, governance, culture, human capital, infrastructure, incentives, external relationships, financial resources, and organizational learning. In this model, the third-generation university is best understood as an entrepreneurial transformation of the medical university that links education and research more directly to innovation, health-system needs, society, and value creation.

Limitations and Recommendations

Several limitations should be considered when interpreting the findings. First, the findings were based on the views and experiences of experts and may therefore reflect cognitive biases, individual experiences, and the organizational conditions of the participants. Second, the self-reported nature of the data means that some responses may not fully represent existing conditions. Third, although the coding and analysis process was conducted systematically, some components or relationships may not have been fully identified. Finally, the study was conducted in a single medical university, which limits direct transfer of the findings to other universities and higher-education institutions.

Based on the findings, medical universities should consider redesigning educational, research, and managerial structures and integrating theoretical education with skills-based, entrepreneurial, and health-system-oriented learning. Sustainable financial resources may be strengthened through investment, private-sector collaboration, research funds, and knowledge-based economic activities. Organizational structures should be reviewed to reduce bureaucracy, delegate authority, strengthen incubators and technology-transfer offices, develop innovation infrastructure, reform incentive systems, and improve entrepreneurial capabilities. Systematic interaction with industry, the health system, and external organizations should be supported through durable collaboration frameworks and a culture of innovation, organizational learning, trust, and participation. Future research should use mixed methods, larger samples, and comparisons among different universities, and should further examine implementation barriers, facilitators, and the social, cultural, and economic consequences of the third-generation model.

Ethical Considerations

The study involved qualitative interviews with faculty members and university managers. Participant identities are not disclosed in the manuscript, and participant characteristics and findings are reported in aggregate form.

Conflict of Interest

The authors declare no conflict of interest.

Author Contributions

All authors contributed to the conception and development of the study, interpretation of the findings, critical revision of the manuscript, and approval of the final version.

Data Availability

Data supporting the findings may be requested from the corresponding author, subject to participant confidentiality and applicable institutional requirements.