Quality improvement reforms, technologies of government, and organizational politics : the case of a Swedish women’s clinic

This article argues that quality-improvement reforms in health care are political reforms that aim to reconstruct organizational power relations. The argument is based on a case study of how a small women's clinic in Sweden subjected itself to a Total Quality Management-inspired process organization in order to win a quality award. The quality-improvement activities at the clinic seek to establish a centralized, communitarian organization without mediating powers in the form of professional hierarchies. However, they also stimulate professionalization of formerly subjugated groups in the health-care hierarchy. The analytical perspective of governmentality is used to illustrate how distant authorities and the clinic are related according to a new technology of government within health care, one goal of which is an intrusive form of organizational steering. The case study also shows the limitations of this perspective because the reforms trigger other micro-political activities that are seemingly not derived from the technology of government