Moving together – conditions for intercultural development at a highly diverse Swedish school

This thesis is a case study of a primary school in a highly diverse urban neighbourhood in Sweden. Basic pre-conditions for intercultural school development are studied by examining the overall organisation of teaching, learning and opportunities for collaboration in the investigated case. The study focuses on the targeted support measures to enhance learning for students with an immigrant background: Mother tongue instruction, Swedish as a Second Language, and tutoring in the mother tongue, as well as looking at pedagogical support provided by the school library. The latter has a mission to promote learning and inclusion, where non-native speakers of Swedish are a prioritised group. Communities of practice linked to the work organisation at a meso-level are investigated, and the collaborative relationships between professional groups at the school involved in the various support measures. Teacher relationships and categorisations implied by support measures impact the learning spaces that are shaped for students and the teaching spaces within which teachers work. Collaborative opportunities and convergence of concerns in the teaching spaces combine to shape the overall space for intercultural development. The raw data for the case study consists of interviews, national policy documents and additional information on local work organisation gained through documents and observations. Four articles resulted from the case study, each focusing a specific support measure. An overarching analysis is then made of findings from these articles and the other dimensions of the investigation. The analysis describes the organisation in terms of monocultural or intercultural school cultures, pointing to significant characteristics of the landscapes of practice, with respect to their overall implications for the spaces of school development. In the discussion, findings are considered in relation to research on professional development in education, collaboration, democracy and inclusive schooling. The relative positioning of languages and cultures is given particular attention, to ascertain if the school culture is monocultural or intercultural in the sense given by Lahdenperä (2008), and to what extent it could enable intercultural development. Such positioning plays a role interms of affordances for identity, participation and engagement discussed by Wenger (1998). This case study should be understood against the wider background of recent social developments in Europe linked to globalisation and technological changes. It is argued that looking at the concrete specifics which facilitate or obstruct school development, and simultaneously reflecting on how the different forms of teaching interrelate in the overall organisation and in policy may provide a useful vantage point from which structural changes can be contemplated.The discussion underlines the importance of the physical localisation of activities, continuity in personal contacts and time available for joint pedagogical reflection, as basic conditions for effective intercultural dialogue in the organisation. Finally, the impact of policy is considered, looking at connections between levels of policy, expressed in official steering documents, and conditions for teaching and learning at the level of an individual school.

Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.