case study methodology

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Case study methodology

In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry. This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies see Tables 1 , 2 , 3 and 4 and those of others to illustrate our discussion[ 3 — 7 ].

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences.

A case study can be defined in a variety of ways Table 5 , the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design such as a randomised controlled trial in which the investigator seeks to exert control over and manipulate the variable s of interest.

Stake's work has been particularly influential in defining the case study approach to scientific enquiry. He has helpfully characterised three main types of case study: intrinsic , instrumental and collective [ 8 ]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher should define the uniqueness of the phenomenon, which distinguishes it from all others.

In contrast, the instrumental case study uses a particular case some of which may be better than others to gain a broader appreciation of an issue or phenomenon. 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. In such studies the research on the case uses another framework to further define the study and refine the approach. Case study is also described as a method, given particular approaches used to collect and analyze data. Case study research is conducted by almost every social science discipline: business, education, sociology, psychology. Case study research, with its reliance on multiple sources, is also a natural choice for researchers interested in trans-, inter-, or cross-disciplinary studies.

The Encyclopedia of case study research provides an overview:. The purpose of case study research is twofold: 1 to provide descriptive information and 2 to suggest theoretical relevance. Rich description enables an in-depth or sharpened understanding of the case.

Robert Yin , methodologist most associated with case study research, differentiates between descriptive , exploratory and explanatory case studies:. Explanatory : A case study whose purpose is to explain how or why some condition came to be, or why some sequence of events occurred or did not occur.

Exploratory: A case study whose purpose is to identify the research questions or procedures to be used in a subsequent study. See the open-access articles below for some published examples of qualitative, quantitative, and mixed methods case study research.

Mills, A. Encyclopedia of case study research Vols. Yin, R. Case study research and applications 6th ed. Ang, C. SAGE Open. Data collected from first-year undergraduates at a large private university were analyzed. Participants were given the adapted version of the Melbourne Centre for the Study of Higher Education Survey to self-report their learning experience and engagement in the university community.

In relation to student identity and overall student satisfaction, it is encouraging to state that their perceptions of studentship and course satisfaction were rather positive. Implications for practice, limitations, and recommendation of this study are addressed.

Baker, A. The article connects the three algorithms to an academic framework from musicology, urban studies, cultural economics, and sociology, and proposes a benchmark Algorithm D Music Cities definition , which offers a more holistic assessment of music activity in any urban context.

The article concludes by arguing that Algorithm D offers a much-needed definition of what comprises a music city because it builds on the popular political economy focus and includes the social importance of space and cultural practices. Brown, K. Populism seems to define our current political age. The term is splashed across the headlines, brandished in political speeches and commentaries, and applied extensively in numerous academic publications and conferences.

This pervasive usage, or populist hype, has serious implications for our understanding of the meaning of populism itself and for our interpretation of the phenomena to which it is applied. In particular, we argue that its common conflation with far-right politics, as well as its breadth of application to other phenomena, has contributed to the mainstreaming of the far right in three main ways: 1 agenda-setting power and deflection, 2 euphemisation and trivialisation, and 3 amplification.

Through a mixed-methods approach to discourse analysis, this article uses The Guardian newspaper as a case study to explore the development of the populist hype and the detrimental effects of the logics that it has pushed in public discourse. Droy, L. Sociological practitioners often face considerable methodological uncertainty when undertaking a quantitative analysis. This methodological uncertainty encompasses both data construction e. Methodological uncertainty can lead to results that are fragile and arbitrary.

Yet, many practitioners may be unaware of the potential scale of methodological uncertainty in quantitative analysis, and the recent emergence of techniques for addressing it. We present a case-study of a multi-strategy analysis, applied to the problem of estimating the long-term impact of s UK government-sponsored youth training.

We use this case study to further highlight the problem of cumulative methodological fragilities in applied quantitative sociology and to discuss and help develop multi-strategy analysis as a tool to address them. Ebneyamini, S. International Journal of Qualitative Methods. This article reviews the use of case study research for both practical and theoretical issues especially in management field with the emphasis on management of technology and innovation.

Many researchers commented on the methodological issues of the case study research from their point of view thus, presenting a comprehensive framework was missing. We try representing a general framework with methodological and analytical perspective to design, develop, and conduct case study research. To test the coverage of our framework, we have analyzed articles in three major journals related to the management of technology and innovation to approve our framework.

This study represents a general structure to guide, design, and fulfill a case study research with levels and steps necessary for researchers to use in their research. Lynch, R. Benefits of crowdsourcing for libraries: A case study from Africa.

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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. Stake RE: The art of case study research. Br J Gen Pract. Doolin B: Information technology as disciplinary technology: being critical in interpretative research on information systems.

Journal of Information Technology. Implementation Science. Som CV: 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. Lincoln Y, Guba E: Naturalistic inquiry.

Barbour RS: Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?. Mason J: Qualitative researching. Integr Cancer Ther. Qualitative research in health care. Malterud K: Qualitative research: standards, challenges, and guidelines.

Yin R: Case study research: design and methods. Yin R: Enhancing the quality of case studies in health services research. Health Serv Res. Green J, Thorogood N: Qualitative methods for health research. Book Google Scholar.

Blakie N: Approaches to Social Enquiry. Doolin B: Power and resistance in the implementation of a medical management information system. Info Systems J. Bloomfield BP, Best A: Management consultants: systems development, power and the translation of problems. Sociological Review. Shanks G, Parr A: Positivist, single case study research in information systems: A critical analysis.

Proceedings of the European Conference on Information Systems. Download references. 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. You can also search for this author in PubMed Google Scholar. Correspondence to Sarah Crowe. AS conceived this article. SC and AS are guarantors. This article is published under license to BioMed Central Ltd. Reprints and Permissions. Crowe, S. The case study approach. Download citation. Received : 29 November Accepted : 27 June Published : 27 June Skip to main content.

Search all BMC articles Search. Download PDF. 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 ] Full size table. Table 2 Example of a case study investigating the process of planning and implementing a service in Primary Care Organisations[ 4 ] Full size table. Table 3 Example of a case study investigating the introduction of the electronic health records[ 5 ] Full size table.

Table 4 Example of a case study investigating the formal and informal ways students learn about patient safety[ 6 ] Full size table. Discussion What is a case study? Table 5 Definitions of a case study Full size table. Table 6 Example of epistemological approaches that may be used in case study research Full size table. We use this case study to further highlight the problem of cumulative methodological fragilities in applied quantitative sociology and to discuss and help develop multi-strategy analysis as a tool to address them.

Ebneyamini, S. International Journal of Qualitative Methods. This article reviews the use of case study research for both practical and theoretical issues especially in management field with the emphasis on management of technology and innovation. Many researchers commented on the methodological issues of the case study research from their point of view thus, presenting a comprehensive framework was missing.

We try representing a general framework with methodological and analytical perspective to design, develop, and conduct case study research. To test the coverage of our framework, we have analyzed articles in three major journals related to the management of technology and innovation to approve our framework. This study represents a general structure to guide, design, and fulfill a case study research with levels and steps necessary for researchers to use in their research.

Lynch, R. Benefits of crowdsourcing for libraries: A case study from Africa. IFLA Journal. Many libraries in the Global South do not collect comprehensive data about themselves, which creates challenges in terms of local and international visibility. Crowdsourcing is an effective tool that engages the public to collect missing data, and it has proven to be particularly valuable in countries where governments collect little public data.

Whereas crowdsourcing is often used within fields that have high levels of development funding, such as health, the authors believe that this approach would have many benefits for the library field as well. They present qualitative and quantitative evidence from 23 African countries involved in a crowdsourcing project to map libraries.

The authors find benefits in terms of increased connections between stakeholders, capacity-building, and increased local visibility. These findings demonstrate the potential of crowdsourced approaches for tasks such as mapping to benefit libraries and similarly positioned institutions in the Global South in multifaceted ways.

Rashid, Y. Qualitative case study methodology enables researchers to conduct an in-depth exploration of intricate phenomena within some specific context. By keeping in mind research students, this article presents a systematic step-by-step guide to conduct a case study in the business discipline.

Research students belonging to said discipline face issues in terms of clarity, selection, and operationalization of qualitative case study while doing their final dissertation. These issues often lead to confusion, wastage of valuable time, and wrong decisions that affect the overall outcome of the research. This article presents a checklist comprised of four phases, that is, foundation phase, prefield phase, field phase, and reporting phase. Rather than discussing case study in general, a targeted step-by-step plan with real-time research examples to conduct a case study is given.

VanWynsberghe, R. Redefining Case Study. International Journal of Qualitative Methods, 80— In this paper the authors propose a more precise and encompassing definition of case study than is usually found. They support their definition by clarifying that case study is neither a method nor a methodology nor a research design as suggested by others. They use a case study prototype of their own design to propose common properties of case study and demonstrate how these properties support their definition.

Next, they present several living myths about case study and refute them in relation to their definition. Finally, they discuss the interplay between the terms case study and unit of analysis to further delineate their definition of case study. The target audiences for this paper include case study researchers, research design and methods instructors, and graduate students interested in case study research.

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Case study methodology Case study research: Design and methods. The Academy of Management Review. Barbour RS: Checklists for improving rigour in qualitative research: a case of the tail wagging resume inglese italiano dog?. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. By providing a brief outline of the case studies in Boxes 1 and 2we demonstrate how effective case boundaries can be constructed and reported, which may be of particular interest to prospective case study researchers. Yin R: Enhancing the quality of case studies in health services research.
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The time you spend here is deeply introspective. You're not only working with case materials and assignments, but also taking on the role of the case protagonist—the person who's supposed to make those tough decisions. How would you react in those situations? We put people in a variety of contexts, and they start by addressing that specific problem.

In a small group setting In a small group setting. The discussion group is a critical component of the HBS experience. You're working in close quarters with a group of seven or eight very accomplished peers in diverse functions, industries, and geographies. In the classroom In the classroom. The faculty guides you in examining and resolving the issues—but the beauty here is that they don't provide you with the answers.

You're interacting in the classroom with other executives—debating the issue, presenting new viewpoints, countering positions, and building on one another's ideas. And that leads to the next stage of learning. Beyond the classroom Beyond the classroom. Once you leave the classroom, the learning continues and amplifies as you get to know people in different settings—over meals, at social gatherings, in the fitness center, or as you are walking to class. You begin to distill the takeaways that you want to bring back and apply in your organization to ensure that the decisions you make will create more value for your firm.

How Cases Unfold In the Classroom Pioneered by HBS faculty, the case method puts you in the role of the chief decision maker as you explore the challenges facing leading companies across the globe. Learning to think fast on your feet with limited information sharpens your analytical skills and empowers you to make critical decisions in real time. To get the most out of each case, it's important to read and reflect, and then meet with your discussion group to share your insights.

You and your peers will explore the underlying issues, compare alternatives, and suggest various ways of resolving the problem. Pioneered by HBS faculty, the case method puts you in the role of the chief decision maker as you explore the challenges facing leading companies across the globe.

Inside the Classroom. See how exchange with faculty and peers yields new insights into critical business trends. How to Prepare for Case Discussions. There's more than one way to prepare for a case discussion, but these general guidelines can help you develop a method that works for you. Read the professor's assignment or discussion questions Read the professor's assignment or discussion questions. The assignment and discussion questions help you focus on the key aspects of the case.

Ask yourself: What are the most important issues being raised? Read the first few paragraphs and then skim the case Read the first few paragraphs and then skim the case. Each case begins with a text description followed by exhibits.

Ask yourself: What is the case generally about, and what information do I need to analyze? Reread the case, underline text, and make margin notes Reread the case, underline text, and make margin notes. Put yourself in the shoes of the case protagonist, and own that person's problems. Ask yourself: What basic problem is this executive trying to resolve? Note the key problems on a pad of paper and go through the case again Note the key problems on a pad of paper and go through the case again.

Sort out relevant considerations and do the quantitative or qualitative analysis. Ask yourself: What recommendations should I make based on my case data analysis? Prepare Prepare. The key to being an active listener and participant in case discussions—and to getting the most out of the learning experience—is thorough individual preparation. Discuss Discuss. We've set aside formal time for you to discuss the case with your group.

These sessions will help you to become more confident about sharing your views in the classroom discussion. Participate Participate. Actively express your views and challenge others. Don't be afraid to share related "war stories" that will heighten the relevance and enrich the discussion.

Relate Relate. If the content doesn't seem to relate to your business, don't tune out. You can learn a lot about marketing insurance from a case on marketing razor blades! Apply Apply. Actively apply what you're learning to your own specific management situations, both past and future. This will magnify the relevance to your business. Note Note. People with diverse backgrounds, experiences, skills, and styles will take away different things.

Be sure to note what resonates with you, not your peers. Understand Understand. Being exposed to so many different approaches to a given situation will put you in a better position to enhance your management style. Frequently Asked Questions. 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.

Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. 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.

The case study approach is, as with all research, not without its limitations. 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's checklist for assessing the quality of a case study report[ 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. AS conceived this article. 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.

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