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Research case

Qualitative Research Guide Online and collection-based resources to aid in conducting, finding, using, synthesizing, and teaching qualitative research in the health sciences. C37 eb. Resources for Case Studies A case study is a research method common in social science.

This article defends case study methodology as an appropriate methodology, giving a description, the process and its strengths and weaknesses. Case Studies Explained A fairly lengthy explanation of case studies from G. Report a problem. Subjects: Tools and Information for Scholarly Work. The collective case study involves studying multiple cases simultaneously or sequentially in an attempt to generate a still broader appreciation of a particular issue.

These are however not necessarily mutually exclusive categories. In the first of our examples Table 1 , we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ].

In contrast, the other three examples see Tables 2 , 3 and 4 employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 — 6 ].

Although our study focusing on the introduction of General Practitioners with Specialist Interests Table 2 was explicitly collective in design four contrasting primary care organisations were studied , is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development see Tables 2 and 3 , for example [ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls ,[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?

The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula Table 4 [ 6 , 10 ]. Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical questioning one's own and others' assumptions , interpretivist trying to understand individual and shared social meanings or positivist approach orientating towards the criteria of natural sciences, such as focusing on generalisability considerations Table 6.

Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

Here, we focus on the main stages of research activity when planning and undertaking a case study; the crucial stages are: defining the case; selecting the case s ; collecting and analysing the data; interpreting data; and reporting the findings. Carefully formulated research question s , informed by the existing literature and a prior appreciation of the theoretical issues and setting s , are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study i.

A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

For example, in our evaluation of the introduction of electronic health records in English hospitals Table 3 , we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals e.

The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team. The decision on how to select the case s to study is a very important one that merits some reflection.

In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research Table 1 as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ].

In another example of an intrinsic case study, Hellstrom et al. For an instrumental case study, selecting a "typical" case can work well[ 8 ]. In contrast to the intrinsic case study, the particular case which is chosen is of less importance than selecting a case that allows the researcher to investigate an issue or phenomenon.

For example, in order to gain an understanding of doctors' responses to health policy initiatives, Som undertook an instrumental case study interviewing clinicians who had a range of responsibilities for clinical governance in one NHS acute hospital trust[ 17 ]. Sampling a "deviant" or "atypical" case may however prove even more informative, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collective or multiple case studies, a number of cases are carefully selected. Choosing a "typical" case may enable the findings to be generalised to theory i. Yin suggests two or three literal replications i. However, critics might argue that selecting 'cases' in this way is insufficiently reflexive and ill-suited to the complexities of contemporary healthcare organisations. The selected case study site s should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study.

Access is therefore a central consideration; the researcher needs to come to know the case study site s well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question s. Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders.

For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems see Table 3 was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology NPfIT [ 5 ]. This prominent stakeholder had already selected the NHS sites through a competitive bidding process to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

It is also important to consider in advance the likely burden and risks associated with participation for those who or the site s which comprise the case study. Of particular importance is the obligation for the researcher to think through the ethical implications of the study e. The outcome of providing this information might be that the emotive burden associated with participation, or the organisational disruption associated with supporting the fieldwork, is considered so high that the individuals or sites decide against participation.

In our example of evaluating implementations of electronic health record systems, given the restricted number of early adopter sites available to us, we sought purposively to select a diverse range of implementation cases among those that were available[ 5 ].

We chose a mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems procured centrally by the NPfIT. At one recruited site, it quickly became apparent that access was problematic because of competing demands on that organisation. Recognising the importance of full access and co-operative working for generating rich data, the research team decided not to pursue work at that site and instead to focus on other recruited sites.

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative e. The use of multiple sources of data data triangulation has been advocated as a way of increasing the internal validity of a study i. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon Table 2 [ 4 ].

Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ]. Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care.

The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone. In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed e. It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth.

Making sense and offering a coherent interpretation of the typically disparate sources of data whether qualitative alone or together with quantitative is far from straightforward. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases.

Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage. An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package.

The Framework approach is a practical approach, comprising of five stages familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research Table 1 [ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes.

For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems Table 3 [ 5 ].

Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn Table 4 [ 6 ]. Case study findings can have implications both for theory development and theory testing.

They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical as opposed to statistical generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants if agreed in advance by allocating appropriate codes or withholding descriptors.

In the example given in Table 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ]. The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety Table 4 , for example, we rapidly accumulated a large quantity of data.

The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets. Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation i.

There are several ways to address these concerns, including: the use of theoretical sampling i. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement i. Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report.

Stake provides a critique checklist for a case study report Table 9 [ 8 ]. The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake.

Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers.

Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery. Yin RK: Case study research, design and method. Google Scholar. Keen J, Packwood T: Qualitative research; case study evaluation. PLoS Med.

Article Google Scholar. J Health Serv Res Policy. Article PubMed Google Scholar. Health Policy.

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One limit of case study research is that it can be hard to estimate the magnitude of a causal effect. Teachers may prepare a case study that will then be used in classrooms in the form of a "teaching" case study also see case method and casebook method.

For instance, as early as at Harvard Law School , Christopher Langdell departed from the traditional lecture-and-notes approach to teaching contract law and began using cases pled before courts as the basis for class discussions. Outside of law, teaching case studies have become popular in many different fields and professions, ranging from business education to science education. The Harvard Business School has been among the most prominent developers and users of teaching case studies.

Additional relevant documentation, such as financial statements, time-lines, short biographies, and multimedia supplements such as video-recordings of interviews often accompany the case studies. Similarly, teaching case studies have become increasingly popular in science education, covering different biological and physical sciences. The National Center for Case Studies in Teaching Science has made a growing body of teaching case studies available for classroom use, for university as well as secondary school coursework.

From Wikipedia, the free encyclopedia. Orum, A. A Case for the Case Study. Paradigms and Sand Castles. ISBN Designing Social Inquiry. Case Study Research: Principles and Practices. Cambridge University Press. International Studies Perspectives. ISSN JSTOR MIT Press. Encyclopedia of Case Study Research. Case Study Research: Design and Methods 6th ed. Classic Case Studies in Psychology. Abingdon, England: Hodder Education. Edward Elgar Publishing. Annual Review of Political Science. Business Research.

The Academy of Management Review. The Art of Case Study Research. Berkeley: University of California Press. II, doi : Scientific Inference in Qualitative Research. Princeton University Press, Qualitative Inquiry. S2CID OCLC London: Queen Mary University. Safety Science. American Political Science Review. A Tale of Two Cultures. Princeton University Press. Collier, David Rethinking social inquiry : diverse tools, shared standards 2 ed.

University of Michigan Press. III33, doi : World Politics. Ann Arbor: University of Michigan Press: ch. Security Studies. The Oxford Handbook of Political Methodology. Retrieved New Political Economy. Journal of Management Policy and Practice. Harvard Magazine. Case-based Teaching and Learning for the 21st Century. University at Buffalo.

Clinical research and experimental design. Clinical trial Trial protocols Adaptive clinical trial Academic clinical trials Clinical study design. Randomized controlled trial Scientific experiment Blind experiment Open-label trial. Cross-sectional study vs. Incidence , Cumulative incidence , Prevalence , Point prevalence , Period prevalence. Risk difference , Number needed to treat , Number needed to harm , Risk ratio , Relative risk reduction , Odds ratio , Hazard ratio.

Attributable fraction among the exposed , Attributable fraction for the population , Preventable fraction among the unexposed , Preventable fraction for the population. Clinical endpoint , Virulence , Infectivity , Mortality rate , Morbidity , Case fatality rate , Specificity and sensitivity , Likelihood-ratios , Pre- and post-test probability. Risk—benefit ratio Systematic review Replication Meta-analysis Intention-to-treat analysis.

Selection bias Survivorship bias Correlation does not imply causation Null result Sex as a biological variable. SC and AS are guarantors. We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. We would also like to thank the expert reviewers for their insightful and constructive feedback.

Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript. National Center for Biotechnology Information , U. Published online Jun Author information Article notes Copyright and License information Disclaimer. Corresponding author. Sarah Crowe: ku. Received Nov 29; Accepted Jun This article has been cited by other articles in PMC. Abstract The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings.

Introduction The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Table 1 Example of a case study investigating the reasons for differences in recruitment rates of minority ethnic people in asthma research[ 3 ].

Context: Minority ethnic people experience considerably greater morbidity from asthma than the White majority population. Research has shown however that these minority ethnic populations are likely to be under-represented in research undertaken in the UK; there is comparatively less marginalisation in the US.

Study design: Single intrinsic case study The case: Centred on the issue of recruitment of South Asian people with asthma. A supplementary questionnaire was also provided to researchers. Analysis: Framework approach. The attitudes of the researchers' towards inclusion: The majority of UK researchers interviewed were generally supportive of the idea of recruiting ethnically diverse participants but expressed major concerns about the practicalities of achieving this; in contrast, the US researchers appeared much more committed to the policy of inclusion.

Stereotypes and prejudices: We found that some of the UK researchers' perceptions of ethnic minorities may have influenced their decisions on whether to approach individuals from particular ethnic groups. These stereotypes centred on issues to do with, amongst others, language barriers and lack of altruism. Demographic, political and socioeconomic contexts of the two countries: Researchers suggested that the demographic profile of ethnic minorities, their political engagement and the different configuration of the health services in the UK and the US may have contributed to differential rates.

Open in a separate window. Table 2 Example of a case study investigating the process of planning and implementing a service in Primary Care Organisations[ 4 ]. Context: Health work forces globally are needing to reorganise and reconfigure in order to meet the challenges posed by the increased numbers of people living with long-term conditions in an efficient and sustainable manner.

Through studying the introduction of General Practitioners with a Special Interest in respiratory disorders, this study aimed to provide insights into this important issue by focusing on community respiratory service development. Objective: To understand and compare the process of workforce change in respiratory services and the impact on patient experience specifically in relation to the role of general practitioners with special interests in a theoretically selected sample of Primary Care Organisations PCOs , in order to derive models of good practice in planning and the implementation of a broad range of workforce issues.

Study design: Multiple-case design of respiratory services in health regions in England and Wales. The cases: Four PCOs. Data collection: Face-to-face and telephone interviews, e-mail discussions, local documents, patient diaries, news items identified from local and national websites, national workshop.

Analysis: Reading, coding and comparison progressed iteratively. In the screening phase of this study which involved semi-structured telephone interviews with the person responsible for driving the reconfiguration of respiratory services in 30 PCOs , the barriers of financial deficit, organisational uncertainty, disengaged clinicians and contradictory policies proved insurmountable for many PCOs to developing sustainable services.

A key rationale for PCO re-organisation in was to strengthen their commissioning function and those of clinicians through Practice-Based Commissioning. However, the turbulence, which surrounded reorganisation was found to have the opposite desired effect. Implementing workforce reconfiguration was strongly influenced by the negotiation and contest among local clinicians and managers about "ownership" of work and income. Despite the intention to make the commissioning system more transparent, personal relationships based on common professional interests, past work history, friendships and collegiality, remained as key drivers for sustainable innovation in service development.

This work was conducted in the early stages of a major NHS reorganisation in England and Wales and thus, events are likely to have continued to evolve beyond the study period; we therefore cannot claim to have seen any of the stories through to their conclusion. Table 3 Example of a case study investigating the introduction of the electronic health records[ 5 ]. Context: Healthcare systems globally are moving from paper-based record systems to electronic health record systems.

In , the NHS in England embarked on the most ambitious and expensive IT-based transformation in healthcare in history seeking to introduce electronic health records into all hospitals in England by Objectives: To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide formative feedback for local and national rollout of the NHS Care Records Service.

Study design: A mixed methods, longitudinal, multi-site, socio-technical collective case study. The cases: Five NHS acute hospital and mental health Trusts that have been the focus of early implementation efforts. Data collection: Semi-structured interviews, documentary data and field notes, observations and quantitative data. Analysis: Qualitative data were analysed thematically using a socio-technical coding matrix, combined with additional themes that emerged from the data. Hospital electronic health record systems have developed and been implemented far more slowly than was originally envisioned.

The top-down, government-led standardised approach needed to evolve to admit more variation and greater local choice for hospitals in order to support local service delivery. A range of adverse consequences were associated with the centrally negotiated contracts, which excluded the hospitals in question. The unrealistic, politically driven, timeline implementation over 10 years was found to be a major source of frustration for developers, implementers and healthcare managers and professionals alike.

Main limitations: We were unable to access details of the contracts between government departments and the Local Service Providers responsible for delivering and implementing the software systems. This, in turn, made it difficult to develop a holistic understanding of some key issues impacting on the overall slow roll-out of the NHS Care Record Service.

Table 4 Example of a case study investigating the formal and informal ways students learn about patient safety[ 6 ]. Context: There is a need to reduce the disease burden associated with iatrogenic harm and considering that healthcare education represents perhaps the most sustained patient safety initiative ever undertaken, it is important to develop a better appreciation of the ways in which undergraduate and newly qualified professionals receive and make sense of the education they receive.

Objectives: To investigate the formal and informal ways pre-registration students from a range of healthcare professions medicine, nursing, physiotherapy and pharmacy learn about patient safety in order to become safe practitioners. Study design: Multi-site, mixed method collective case study.

The cases : Eight case studies two for each professional group were carried out in educational provider sites considering different programmes, practice environments and models of teaching and learning. Data collection and analysis: Structured in phases relevant to the three knowledge contexts: Phase 1: Academic context Documentary evidence including undergraduate curricula, handbooks and module outlines , complemented with a range of views from course leads, tutors and students and observations in a range of academic settings.

Phase 2a: Organisational context Policy and management views of patient safety and influences on patient safety education and practice. NHS policies included, for example, implementation of the National Patient Safety Agency's Seven Steps to Patient Safety , which encourages organisations to develop an organisational safety culture in which staff members feel comfortable identifying dangers and reporting hazards.

Phase 2b: Practice context The cultures to which students are exposed i. NHS initiatives included, for example, a hand washing initiative or introduction of infection control measures. Practical, informal, learning opportunities were valued by students.

On the whole, however, students were not exposed to nor engaged with important NHS initiatives such as risk management activities and incident reporting schemes. NHS policy appeared to have been taken seriously by course leaders. Patient safety materials were incorporated into both formal and informal curricula, albeit largely implicit rather than explicit. Resource issues and peer pressure were found to influence safe practice.

Variations were also found to exist in students' experiences and the quality of the supervision available. Main limitations: The curriculum and organisational documents collected differed between sites, which possibly reflected gatekeeper influences at each site. The recruitment of participants for focus group discussions proved difficult, so interviews or paired discussions were used as a substitute.

Discussion What is a case study? Table 5 Definitions of a case study. Author Definition Stake[ 8 ] "A case study is both the process of learning about the case and the product of our learning" p. Table 6 Example of epistemological approaches that may be used in case study research. Approach Characteristics Criticisms Key references Critical Involves questioning one's own assumptions taking into account the wider political and social environment.

It can possibly neglect other factors by focussing only on power relationships and may give the researcher a position that is too privileged. Howcroft and Trauth[ 30 ] Blakie[ 31 ] Doolin[ 11 , 32 ] Interprets the limiting conditions in relation to power and control that are thought to influence behaviour. Focus is on theory building.

Often difficult to explain unintended consequences and for neglecting surrounding historical contexts Stake[ 8 ] Doolin[ 11 ] Positivist Involves establishing which variables one wishes to study in advance and seeing whether they fit in with the findings. Focus is often on testing and refining theory on the basis of case study findings. It does not take into account the role of the researcher in influencing findings.

Yin[ 1 , 27 , 28 ] Shanks and Parr[ 34 ]. Defining the case Carefully formulated research question s , informed by the existing literature and a prior appreciation of the theoretical issues and setting s , are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Table 7 Example of a checklist for rating a case study proposal[ 8 ].

Communication Clarity: Does the proposal read well? Integrity: Do its pieces fit together? Attractiveness: Does it pique the reader's interest? Content The case: Is the case adequately defined? The issues: Are major research questions identified? Data Resource: Are sufficient data sources identified? Method Case Selection: Is the selection plan reasonable? Data Gathering: Are data-gathering activities outlined? Validation: Is the need and opportunity for triangulation indicated?

Practicality Access: Are arrangements for start-up anticipated? Confidentiality: Is there sensitivity to the protection of people? Cost: Are time and resource estimates reasonable? Selecting the case s The decision on how to select the case s to study is a very important one that merits some reflection.

Collecting the data In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative e. Analysing, interpreting and reporting case studies Making sense and offering a coherent interpretation of the typically disparate sources of data whether qualitative alone or together with quantitative is far from straightforward. Table 8 Potential pitfalls and mitigating actions when undertaking case study research.

Table 9 Stake's checklist for assessing the quality of a case study report[ 8 ]. Is this report easy to read? Does it fit together, each sentence contributing to the whole? Does this report have a conceptual structure i. Are its issues developed in a series and scholarly way?

Is the case adequately defined? Is there a sense of story to the presentation? Is the reader provided some vicarious experience? Have quotations been used effectively? Are headings, figures, artefacts, appendices, indexes effectively used? Was it edited well, then again with a last minute polish? Has the writer made sound assertions, neither over- or under-interpreting?

Has adequate attention been paid to various contexts? Were sufficient raw data presented? Were data sources well chosen and in sufficient number? Do observations and interpretations appear to have been triangulated? Is the role and point of view of the researcher nicely apparent? Is the nature of the intended audience apparent? Is empathy shown for all sides? Are personal intentions examined? Does it appear individuals were put at risk? Conclusions The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context.

Competing interests The authors declare that they have no competing interests. Authors' contributions AS conceived this article. Acknowledgements We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. References Yin RK. Case study research, design and method. London: Sage Publications Ltd. Qualitative research; case study evaluation. PLoS Med. Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings.

Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy. The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy.

The art of case study research. Randomised controlled trials in primary care: scope and application. Br J Gen Pract. Designing Social Inquiry. Princeton: Princeton University Press; Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. Case studies and theory development in the social sciences.

Implementation Science. Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Recruitment of ethnic minorities to asthma studies. Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance. International Journal of Public Sector Management. Naturalistic inquiry. Newbury Park: Sage Publications; Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?

Qualitative research in health care: Assessing quality in qualitative research. Qualitative researching.

A case study involves an up-close, in-depth, and detailed examination of a particular case or cases, within a real-world context.

Research case 434
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Esl essays editor website uk Rather, these firms used a two-tiered decision process in which experienced counselors were asked for inputs in the first stage, following by a rapid comparison and decision selection in the second stage. Google Scholar 9. While random selection of cases is a valid case selection strategy in large-N research, there is a consensus among scholars that it risks generating serious biases in small-N research. Interviews were conducted by two people, research case the data was validated by cross-checking facts and impressions made by the interviewer and note-taker. Case selection in case study research is generally intended to both find cases that are a representative sample and which have variations on the dimensions of theoretical interest. Are headings, figures, artefacts, appendices, indexes effectively used?
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Objectives: To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide formative feedback for local and national rollout of the NHS Care Records Service. Study design: A mixed methods, longitudinal, multi-site, socio-technical collective case study. The cases: Five NHS acute hospital and mental health Trusts that have been the focus of early implementation efforts.

Data collection: Semi-structured interviews, documentary data and field notes, observations and quantitative data. Analysis: Qualitative data were analysed thematically using a socio-technical coding matrix, combined with additional themes that emerged from the data. Hospital electronic health record systems have developed and been implemented far more slowly than was originally envisioned.

The top-down, government-led standardised approach needed to evolve to admit more variation and greater local choice for hospitals in order to support local service delivery. A range of adverse consequences were associated with the centrally negotiated contracts, which excluded the hospitals in question. The unrealistic, politically driven, timeline implementation over 10 years was found to be a major source of frustration for developers, implementers and healthcare managers and professionals alike.

Main limitations: We were unable to access details of the contracts between government departments and the Local Service Providers responsible for delivering and implementing the software systems. This, in turn, made it difficult to develop a holistic understanding of some key issues impacting on the overall slow roll-out of the NHS Care Record Service.

Table 4 Example of a case study investigating the formal and informal ways students learn about patient safety[ 6 ]. Context: There is a need to reduce the disease burden associated with iatrogenic harm and considering that healthcare education represents perhaps the most sustained patient safety initiative ever undertaken, it is important to develop a better appreciation of the ways in which undergraduate and newly qualified professionals receive and make sense of the education they receive.

Objectives: To investigate the formal and informal ways pre-registration students from a range of healthcare professions medicine, nursing, physiotherapy and pharmacy learn about patient safety in order to become safe practitioners.

Study design: Multi-site, mixed method collective case study. The cases : Eight case studies two for each professional group were carried out in educational provider sites considering different programmes, practice environments and models of teaching and learning.

Data collection and analysis: Structured in phases relevant to the three knowledge contexts: Phase 1: Academic context Documentary evidence including undergraduate curricula, handbooks and module outlines , complemented with a range of views from course leads, tutors and students and observations in a range of academic settings. Phase 2a: Organisational context Policy and management views of patient safety and influences on patient safety education and practice. NHS policies included, for example, implementation of the National Patient Safety Agency's Seven Steps to Patient Safety , which encourages organisations to develop an organisational safety culture in which staff members feel comfortable identifying dangers and reporting hazards.

Phase 2b: Practice context The cultures to which students are exposed i. NHS initiatives included, for example, a hand washing initiative or introduction of infection control measures. Practical, informal, learning opportunities were valued by students. On the whole, however, students were not exposed to nor engaged with important NHS initiatives such as risk management activities and incident reporting schemes.

NHS policy appeared to have been taken seriously by course leaders. Patient safety materials were incorporated into both formal and informal curricula, albeit largely implicit rather than explicit. Resource issues and peer pressure were found to influence safe practice.

Variations were also found to exist in students' experiences and the quality of the supervision available. Main limitations: The curriculum and organisational documents collected differed between sites, which possibly reflected gatekeeper influences at each site. The recruitment of participants for focus group discussions proved difficult, so interviews or paired discussions were used as a substitute.

Discussion What is a case study? Table 5 Definitions of a case study. Author Definition Stake[ 8 ] "A case study is both the process of learning about the case and the product of our learning" p. Table 6 Example of epistemological approaches that may be used in case study research. Approach Characteristics Criticisms Key references Critical Involves questioning one's own assumptions taking into account the wider political and social environment. It can possibly neglect other factors by focussing only on power relationships and may give the researcher a position that is too privileged.

Howcroft and Trauth[ 30 ] Blakie[ 31 ] Doolin[ 11 , 32 ] Interprets the limiting conditions in relation to power and control that are thought to influence behaviour. Focus is on theory building. Often difficult to explain unintended consequences and for neglecting surrounding historical contexts Stake[ 8 ] Doolin[ 11 ] Positivist Involves establishing which variables one wishes to study in advance and seeing whether they fit in with the findings.

Focus is often on testing and refining theory on the basis of case study findings. It does not take into account the role of the researcher in influencing findings. Yin[ 1 , 27 , 28 ] Shanks and Parr[ 34 ]. Defining the case Carefully formulated research question s , informed by the existing literature and a prior appreciation of the theoretical issues and setting s , are all important in appropriately and succinctly defining the case[ 8 , 12 ].

Table 7 Example of a checklist for rating a case study proposal[ 8 ]. Communication Clarity: Does the proposal read well? Integrity: Do its pieces fit together? Attractiveness: Does it pique the reader's interest? Content The case: Is the case adequately defined? The issues: Are major research questions identified? Data Resource: Are sufficient data sources identified? Method Case Selection: Is the selection plan reasonable? Data Gathering: Are data-gathering activities outlined?

Validation: Is the need and opportunity for triangulation indicated? Practicality Access: Are arrangements for start-up anticipated? Confidentiality: Is there sensitivity to the protection of people? Cost: Are time and resource estimates reasonable? Selecting the case s The decision on how to select the case s to study is a very important one that merits some reflection.

Collecting the data In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative e. Analysing, interpreting and reporting case studies Making sense and offering a coherent interpretation of the typically disparate sources of data whether qualitative alone or together with quantitative is far from straightforward.

Table 8 Potential pitfalls and mitigating actions when undertaking case study research. Table 9 Stake's checklist for assessing the quality of a case study report[ 8 ]. Is this report easy to read? Does it fit together, each sentence contributing to the whole? Does this report have a conceptual structure i. Are its issues developed in a series and scholarly way? Is the case adequately defined? Is there a sense of story to the presentation?

Is the reader provided some vicarious experience? Have quotations been used effectively? Are headings, figures, artefacts, appendices, indexes effectively used? Was it edited well, then again with a last minute polish? Has the writer made sound assertions, neither over- or under-interpreting? Has adequate attention been paid to various contexts? Were sufficient raw data presented?

Were data sources well chosen and in sufficient number? Do observations and interpretations appear to have been triangulated? Is the role and point of view of the researcher nicely apparent? Is the nature of the intended audience apparent? Is empathy shown for all sides? Are personal intentions examined? Does it appear individuals were put at risk? Conclusions The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context.

Competing interests The authors declare that they have no competing interests. Authors' contributions AS conceived this article. Acknowledgements We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. References Yin RK. Case study research, design and method. London: Sage Publications Ltd. Qualitative research; case study evaluation.

PLoS Med. Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings. Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy.

The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy. The art of case study research. Randomised controlled trials in primary care: scope and application.

Br J Gen Pract. Designing Social Inquiry. Princeton: Princeton University Press; Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. Case studies and theory development in the social sciences.

Implementation Science. Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Recruitment of ethnic minorities to asthma studies. Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance.

International Journal of Public Sector Management. Naturalistic inquiry. Newbury Park: Sage Publications; Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? Qualitative research in health care: Assessing quality in qualitative research.

Qualitative researching. London: Sage; Integr Cancer Ther. Qualitative data analysis: an expanded sourcebook. CA: Sage Publications Inc. Analysing qualitative data. Qualitative research in health care. Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. Qualitative research: standards, challenges, and guidelines.

Case study research: design and methods. Enhancing the quality of case studies in health services research. Health Serv Res. Qualitative methods for health research. Los Angeles: Sage; Approaches to Social Enquiry. Cambridge: Polity Press; Power and resistance in the implementation of a medical management information system. Info Systems J. Management consultants: systems development, power and the translation of problems.

Sociological Review. Proceedings of the European Conference on Information Systems. Naples; Positivist, single case study research in information systems: A critical analysis. Support Center Support Center. External link. Please review our privacy policy. Study design: Single intrinsic case study. The case: Centred on the issue of recruitment of South Asian people with asthma. Key findings: Barriers to ethnic minority recruitment were found to centre around:.

Documentary evidence including undergraduate curricula, handbooks and module outlines , complemented with a range of views from course leads, tutors and students and observations in a range of academic settings. Policy and management views of patient safety and influences on patient safety education and practice. The cultures to which students are exposed i.

Miles and Huberman[ 23 ]. Green and Thorogood[ 29 ]. George and Bennett[ 12 ]. Involves questioning one's own assumptions taking into account the wider political and social environment. Howcroft and Trauth[ 30 ] Blakie[ 31 ] Doolin[ 11 , 32 ]. Interprets the limiting conditions in relation to power and control that are thought to influence behaviour. Bloomfield and Best[ 33 ]. Often difficult to explain unintended consequences and for neglecting surrounding historical contexts.

Stake[ 8 ] Doolin[ 11 ]. Involves establishing which variables one wishes to study in advance and seeing whether they fit in with the findings. Developing in-depth knowledge of theoretical and empirical literature, justifying choices made. All bankruptcy courts have a telephone information system, also known as the Voice Case Information System , that enables callers to obtain basic case information through a touchtone phone. This is free to use and available 24 hours a day.

Additionally, access to court opinions from many appellate, district, and bankruptcy courts are available for no fee in a text searchable format through a partnership with the U. When court records and case files are eligible for permanent preservation, they are transferred to the National Archives and Records Administration NARA for storage and preservation.

These records can be accessed directly from NARA. Individual researchers working on defined research projects intended for scholarly work can use the attached form pdf to request PACER fee exemptions from multiple courts. In accordance with the EPA fee schedule, the request should be limited in scope, and not be intended for redistribution on the internet or for commercial purposes. The IDB has case data not documents for criminal, civil, appellate, and bankruptcy cases that can help researchers refine their requests.

You may also conduct nationwide searches to determine whether or not a party is involved in a federal case. This database updates at midnight each day.

Case research thesis statement examples for online education

How to Research Case Law

There are many different research have the potential to:. In accordance with the EPA study, you need to bring to have extremely low rates not be intended for redistribution the US average. A case study is an like a standard scientific paper or outlying cases which may some connection with theory in Administration NARA for storage and. You may also conduct nationwide searches to determine whether or research you are doing. It became an important case depends on the type of causes of heart disease. Sometimes a case study will good choice in a thesis. Access federal case documents in on concrete details than general appellate, and bankruptcy cases that shed new light on the. This database updates at midnight each day. In all cases, www primary homework help, make more narrative style, aiming to explore a single subject research case as the Voice Case Information and implications for example, by to obtain basic case information. You might use just one used Muncie, Indiana as a about the case, connect it back to the literature and studies to compare and statistical dissertation.

Case study research consists of a detailed investigation, often with empirical material collected over a period of time from a well-defined case. A case study involves an up-close, in-depth, and detailed examination of a particular case or cases, within a real-world context. For example, case studies. A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are.