"Money talks" En kritisk diskursanalys av samtal om f rb ttringar i h lso- och sjukv rd

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.