In this study we adopt a critical perspective and explore different coaching styles in quality improvement (QI) work in the provision of healthcare. Coaching has gained attention as an effective way to enhance QI in healthcare. This study investigates how coaching is realised in terms of learning: What kinds of learning ideals pervade QI coaching, and how is support for learning realised, given the prevailing conditions in a contemporary healthcare system? For the purpose of this case study, a group of coaches exchanged experiences about their pedagogic roles and the strategies that they employed, on four occasions, over a period of 4 months. The conversations were filmed and then analysed, using critical discourse analysis as an analytic framework. Three parallel styles of coaching were identified, which were symbolised by (1) a pointing, (2) a bypassing and (3) a guiding discourse. No persistent dominance of any one of the discourses was found, which suggests that there exists an ever-present tension between the pointing and guiding pedagogies of coaching activities. The findings indicate that QI coaching in healthcare is more complex than previous conceptualisations of coaching. Additionally, the findings present a new, ‘bypassing’ coaching style which the coaches themselves were not fully aware of.