In the early 2010s, competitive market logic was introduced into healthcare systems so as to achieve rapid improvements. This took place as improvement policies began to emphasize the notion of collaboration as a method of ensuring patient safety across organizational boundaries. This thesis addresses how staff, in their practical improvement work, balance economic values, on the one hand, against meaningful solutions for the patient, on the other. The research interest focuses on the particular interpretations about improvements that emerge in negotiations about change. These interpretations are foundational to the learning that simultaneously takes place. The aim of the thesis is to analyse and explain the pedagogical conditions that take place in improvement practices in a healthcare system in the 2010s. The thesis takes its theoretical point of departure in a pedagogical theory that describes how contextual conditions influence learning processes in a specific practice where communication is foundational for learning. The thesis uses critical discourse analysis as a methodological point of departure and builds on a model of improvement work, namely, the clinical microsystem. The first study consists of a literature review of the microsystem framework. Subsequently, three case studies were conducted at Jönköping county council, Sweden. Discussions of improvements at clinical meetings and improvement coaches’ reflections over their pedagogical approaches provide the empirical data for the case studies. The findings show that market logic gives rise to a number of displacement effects with respect to learning processes. Short-term profits are shown to supersede goals of a more profound development of knowledge. The composition of an improvement practice is of critical importance to the nature of the negotiation that takes place, and thus how the practice comes to successfully challenge things that are taken for granted and the power structures that exist within the practice. Improvement coaches themselves become pedagogical prerequisites under the influence of the prevailing conditions, as they promote different learning organizations. This thesis develops the conceptual framework that is instantiated by the clinical microsystem, and it also contributes to the social constructionist field of improvement science by establishing pedagogical and discursive perspectives on improvement and change. / Bridging the Gaps

In the early 2010s, competitive market logic was introduced into healthcare systems so as to achieve rapid improvements. This took place as improvement policies began to emphasize the notion of collaboration as a method of ensuring patient safety across organizational boundaries. This thesis addresses how staff, in their practical improvement work, balance economic values, on the one hand, against meaningful solutions for the patient, on the other. The research interest focuses on the particular interpretations about improvements that emerge in negotiations about change. These interpretations are foundational to the learning that simultaneously takes place. The aim of the thesis is to analyse and explain the pedagogical conditions that take place in improvement practices in a healthcare system in the 2010s. The thesis takes its theoretical point of departure in a pedagogical theory that describes how contextual conditions influence learning processes in a specific practice where communication is foundational for learning. The thesis uses critical discourse analysis as a methodological point of departure and builds on a model of improvement work, namely, the clinical microsystem. The first study consists of a literature review of the microsystem framework. Subsequently, three case studies were conducted at Jönköping county council, Sweden. Discussions of improvements at clinical meetings and improvement coaches’ reflections over their pedagogical approaches provide the empirical data for the case studies. The findings show that market logic gives rise to a number of displacement effects with respect to learning processes. Short-term profits are shown to supersede goals of a more profound development of knowledge. The composition of an improvement practice is of critical importance to the nature of the negotiation that takes place, and thus how the practice comes to successfully challenge things that are taken for granted and the power structures that exist within the practice. Improvement coaches themselves become pedagogical prerequisites under the influence of the prevailing conditions, as they promote different learning organizations. This thesis develops the conceptual framework that is instantiated by the clinical microsystem, and it also contributes to the social constructionist field of improvement science by establishing pedagogical and discursive perspectives on improvement and change. / Bridging the Gaps

In a society where the labour market is becoming increasingly knowledge intensive and more differentiated, education has assumed greater importance for the capitalist states integrative functions as for the competitiveness in the global economy. As a consequence, the educational system has become a key governing resource for the state to meet and manage different kinds of social changes and problems. Against this background the thesis raises the main question - “what kind of societal problems are the educational reforms studied here considered to be the solution of?” The aim of this thesis is to deepen the understanding of the changes of the formation of knowledge in Swedish upper secondary curriculum between the 1960s and 2010s. In what way attained these changes in view of knowledge legitimacy in relation to the socioeconomic context? And what do these changes mean in terms of the attribution of the positioning of upper secondary school pupils and teachers?   This thesis draws on a “classical” theoretical framework of curriculum theory (i.e. the frame-factor theory) this means that the analytical focus is directed at the relationship between the content of the curriculum and the social context. With theoretical and methodological inspiration from critical realism and critical discourse analysis (CDA) the thesis argue for an alternative way to theoretical and empirical examined this relationship. Three historical reform periods are used to explore the discursive changes in the formation of knowledge in the Swedish upper secondary education reforms.   The results show how changes in socioeconomic conditions, such as economic crisis, over time have acted as important triggers for governing mechanisms embedded in the control of the educational system. These changes and mechanisms, in turn, have resulted in some major discursive knowledge shifts between the reforms studied, from the 1960s combination of an economic-rational and an objective-subject knowledge discourse, through the deregulated goal-rational and socio-cultural oriented knowledge discourse of the 1990s towards the 2010s knowledge discourses that are characterized by an increased focus on learning outcomes and measurability. Against the background of these discursive shifts, the analysis also points to some underlying continuities in terms of a general “reform imperative”, based on a number of overarching values ​​such as efficiency and rationality. The result show how this imperative was embedded in all three educational reforms and has ruled the order of discourses about what was deemed to be legitimate curriculum knowledge, a professional teacher and a desirable pupil.