Critical theory provides valuable insights into how, partnership quality improvement projects between nurses in the global north and south may inadvertently lead to harm. While quality improvement initiatives are essential for enhancing healthcare outcomes, it is crucial to critically examine their potential unintended consequences too.
Critical theory is useful to analyse power dynamics, social inequalities, and structural determinants of health. In context of nurse led quality improvement projects, it offers a framework for understanding broader socio-political factors that influence QI implementation and outcomes.
It identifies three areas where quality improvement projects can inadvertently lead to harm:
Power Dynamics: It highlights the power differentials between stakeholders involved in quality improvement projects. Nurses, as change agents, may face power imbalances with others including healthcare professionals, imbalances historically formed and gender biased. These power dynamics can affect decision-making, resource allocation, and the inclusion of diverse perspectives, potentially compromising effectiveness and sustainability of quality improvement efforts.
Contextual Factors: It emphasizes the importance of considering local socio-cultural, economic, and political contexts in quality improvement projects. Neglecting factors such as gender inequality may result in interventions that are incongruent with the realities of the healthcare system and patient population, leading to unintended harm.
Ethical Implications: It prompts an examination of ethical implications arising from quality improvement projects. Nurses must critically reflect on potential unintended consequences, such as resource diversion, overburdening healthcare workers, or exacerbating health inequities, which may inadvertently harm health and professional practices.
Critical theory provides a more nuanced and comprehensive understanding of potential harm that can arise from well-intentioned initiatives. By critically examining power dynamics, context-specific considerations, and ethical implications patient safety and professional integrity can be informed. Integrating critical theory into design and delivery of quality improvement projects may help nurses foster ethical, equitable and sustainable improvements in healthcare systems.