We analyse changes in the collective identity that Sweden’s largest labour union for teachers had during the period 1990–2017. The study is based on theory about how collective identity is constructed in adaptation and resistance to external categorical dimensions and internal group identification. We identify shifts in relation to how the union employ different aspects on teachers’ recognition, emotional engagement, and evaluation. Two clear cut-off points can be identified. The first point, which is clearly related to the impact of political reforms, took place in 2000 and is about increased demands with respect to transparency, legality, equality, efficiency, and attainment results. The second point took place in 2015, a year when Sweden con-fronted a new set of social challenges. The teaching profession was re-launched as a moral agent and in need of a trust-based steering approach.

The aim of this study is to reveal how teachers experience the effects of management by documents in their professional practice. Approximately one hundred primary school teachers were asked to describe their daily teaching work with special focus on the demands in terms of the production of documentation. The reports were analysed using a “profession theoretical” model which focuses on the following aspects of professional knowledge: recognition, emotional engagement, and evaluation of and responsibility for one’s own work. The results show that the teachers have experienced that the teaching profession has changed because of fixation on results, and fragmentation has resulted in a decrease in the levels of trust and a feeling that the work is boring. The internal pedagogic discourse is weakened because of the presence of an external legal discourse. Management by documents can thus be a factor that causes a professional regression.

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 realized in terms of learning: What kinds of learning ideals pervade QI coaching, and how is support for learning realized, given the prevailing conditions in a contemporary healthcare system? For the purpose of this case study, a group of coaches exchanged experiences of their pedagogic roles and the strategies that they employ, on four occasions, over a period of four months. The conversations were filmed and then analyzed, using critical discourse analysis as an analytic framework. Three parallel styles of coaching were identified, which were symbolized by (i) a pointing, (ii) a bypassing, and (iii) a guiding discourse. No persistent dominance of any one of the discourses was found, which suggests that there exists an ever-present tension between a pointing and a guiding pedagogy in the coaching activities. The findings indicate that QI coaching in healthcare is more complex than previous conceptualizations of coaching. Additionally, the findings present a new, ‘bypassing’ coaching style which the coaches themselves were not fully aware of.

Introduction: The clinical microsystem (CMS)approach is widely used and is perceived as helpfulin practice but, we ask the question: “Is its learningpotential sufficiently utilized?” Objectives: Toscrutinize aspects of learning within the CMSframework and to clarify the learning aspects theframework includes and thereby support theframework with the enhanced learning perspectivethat becomes visible. Methods: Literature on theCMS framework was systematically searched andselected using inclusion criteria. An analytical toolwas constructed in the form of a theoretical lensthat was used to clarify learning aspects that areassociated with the framework. Findings: Theanalysis revealed 3 learning aspects: (1) The CMSframework describes individual and social learningbut not how to adapt learning strategies forpurposes of change. (2) The metaphorical languageof how to reach a holistic health care system foreach patient has developed over time but can stillbe improved by naming social interactions totranscend organizational boundaries. (3) Powerstructures are recognized but not as a characteristicthat restricts learning due to asymmetriccommunication. Conclusion: The “lens” perspectivereveals new meanings to learning that enhance ourunderstanding of health care as a social system andprovides new practical learning strategies.

Based on learning as taken for granted in health care quality improvement, the aim was to identify discursive patterns in practice, and to discuss how these patterns create conditions for learning. Observations of quality improvement conversations were made at a clinic and analyzed through critical discourse analysis. Four different discursive patterns were found; a market pattern, a care-for-all pattern, a medical pattern and a value pattern. The order of discourse shows that the market pattern dominates the others while money is linked to quality control. The findings also showed a balance between discourse patterns when economical incentives were absent. In other words, the professionals can handle all complex, and sometimes contradicting, quality aspects when they don’t compete about money. We discuss that market principles impact on learning in terms of displacement effects which discourages long-term sustainable improvements.