Quality Improvement (QI) in Healthcare: A Foucauldian Discourse Analysis Examining QI Through the Lens of Advanced Practice Nurses

Abstract

Quality improvement (QI) in healthcare increasingly guides the activities of healthcare organizations. Heavy attention and resource allocation to QI has had significant impacts on healthcare workers, including nurses. Clinical Nurse Specialists (CNSs) are healthcare professionals with unique backgrounds who can provide a lens to understanding how healthcare QI is shaped and experienced. Using Dean’s governmentality analytic framework, historical documents that trace the emergence of QI in healthcare are analyzed alongside transcripts of semi-structured interviews conducted with CNS participants. Results of this analysis reveal that discourses of hierarchy, regulation, and performance shape experiences and understanding of QI in healthcare. Impacts of these discourses are explored, with attention to how QI discourse limits CNS identity, subjugates nursing knowledge in QI spaces, and to how QI definitions of quality fundamentally differ from nursing-centered definitions, resulting in internal conflicts. The need to re-align QI with nursing knowledge and experience is argued.