Pedagogical approaches in quality improvement coaching in healthcare: a Swedish case study of how improvement coaches approach learning in a contemporary healthcare system

Abstract

In this study we adopt a critical perspective and explore different coaching styles in quality improvement (QI) work in the provision of healthcare. Coaching has gained attention as an effective way to enhance QI in healthcare. This study investigates how coaching is realised in terms of learning: What kinds of learning ideals pervade QI coaching, and how is support for learning realised, given the prevailing conditions in a contemporary healthcare system? For the purpose of this case study, a group of coaches exchanged experiences about their pedagogic roles and the strategies that they employed, on four occasions, over a period of 4 months. The conversations were filmed and then analysed, using critical discourse analysis as an analytic framework. Three parallel styles of coaching were identified, which were symbolised by (1) a pointing, (2) a bypassing and (3) a guiding discourse. No persistent dominance of any one of the discourses was found, which suggests that there exists an ever-present tension between the pointing and guiding pedagogies of coaching activities. The findings indicate that QI coaching in healthcare is more complex than previous conceptualisations of coaching. Additionally, the findings present a new, ‘bypassing’ coaching style which the coaches themselves were not fully aware of.

• coaching
• quality improvement in healthcare
• critical discourse analysis

Acknowledgements

The study was funded by The Vinnvård Research Program and the Department of Pedagogy, Linnaeus University. For other conflicts of interest, none were declared.

Notes

1 In the present study, we use the concept ‘pedagogy’ to place emphasis on the contextual conditions that influence learning processes in specific, and culturally situated, practices, as formulated by Fritzell (1996).

2 In the present study, the term discourse refers to a particular way of speaking about, and understanding the world around us (Winther-Jørgensen & Phillips, 2000). Discourse includes language (written and spoken), symbols, non-verbal communication (gestures, movements, facial expressions) and visual images (Chouliaraki & Fairclough, 1999, p.38).

3 Note that if the coaches work on a regional or national arena, the coaches should rather be regarded as ‘external–external’ instead of being ‘internal–external’ as in the county council where they are employed.

4 Approval number: 2013/334-31.

5 Habermas’ theoretical framework has been used to explain how external conditions, as well as internal conditions, have to be considered in pedagogical practices (Fritzell, 1996).

6 All excerpts from the data material are marked with italics. Sometimes the authors have clarified the excerpts’ situational meaning by using uppercase words in brackets.