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

Figures & data

Table 1 The analytical framework and findings of each analytical phase

Question of inquiry	How do the coaches describe their roles and strategies that guide learning in QI work?	Which discursive patterns can be identified in light of the prevailing contextual conditions?	Why do the discourses that were identified occur in contemporary QI practices?
Analytical phase	Descriptive	Interpretive	Explanatory
Analytical focus	The coaches’ interactions with the staff groups	The influence of the healthcare system	The influence of QI ideas and contextual conditions
Central concepts	Metaphors	Strategic rationality and communicative rationality	Profound knowledge of improvement
Empirical questions	How do the coaches act so as to promote understanding of QI? How and to what purpose do the coaches adapt their support? What relationship with the staff is sought after? Are there any risks associated with their strategies?	How do organisational requirements influence the coaches’ actions? How do traditional healthcare structures influence the coaches’ approaches? How do norms and social relations influence the coaches’ approaches?	How are QI ideas and contextual conditions made manifest within the discourses? How and why do the discourses relate to each other as they do?
Findings	Three distinct pedagogical approaches were identified: the Chameleon, the Skipper and the Lawyer.	Three distinct discourses were identified: the Pointing discourse, the Bypassing discourse and the Guiding discourse.	The identified discourses take place due to a number of dominating quality claims and how these claims correlate with actual contextual conditions.

QI, quality improvement.

Fig. 1.  The identification of discourses.

A field of tension is constructed by three complementary pairs of characteristics that are found in strategic and communicative rationality (Fritzén, 1998; Habermas, 1987). The analysis situates each pedagogical approach in the continuum between the characteristics, which allows for the identification of three different discourse patterns: (1) a strategic pointing discourse, (2) a bypassing discourse that comprises of both strategic and communicative characteristics and (3) a communicative guiding discourse.

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