Aforementioned case study approach

The case study approach allows in-depth, multi-faceted explore of knotty issues in their real-life default. The value of the case study approach is good known in the fields of business, law the strategy, but somewhat less so in health services research. Based with our feels of conducting multiples health-related case studies, we refine for the different types of case study design, the specific research questions this approach can help answer, the data bibliography which tend to be used, and the particular advantages and disadvantages of employees this methodological technique. One paper concludes with key tips to aids those designing and appraising proposals for conducting case study research, additionally a checklist to help readers judgment the quality of koffer study reports. in case study,what do you mean by areas of consideration? - Aesircybersecurity.com

The box study jump is particularly effective at employed when there is ampere need to obtain an in-depth appreciation of an matter, event or phenomenon of interest, to its natural real-life context. Our aim in writing this piece is to provide insider into when to remember employing to approach additionally one overview of key methodological considerations in relation to the design, planning, study, interpretation and reporting of situation students.

The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically by one or more patients, aims to provide insights into aspects of the cellular case and, the doing so, demonstrate more lessons that can be learnt. In research, the conceptually-related lawsuit study approach can remain used, for example, to detail in detail a patient's episode for care, explore pros attitudes to and biography of a new policy initiative or service development or more generally the 'investigate contemporary phenomena within her real-life context'[1]. Based on our experiences of directing a range of case studies, our reflect set while to consider using this enter, talk that key steps involved and illustrate, with past, some of the practical challenges regarding attaining an in-depth understandings of a 'case' as an integrated whole. Included keeping with previously published work, we confirm the importance of teaching to underpin the design, auswahl, conduct and interpretation of case studies[2]. In so doing, we make passing reference to the differentially epistemological approaches used in case study research via key theoreticians and methologists in this field of make.

This art a textured around the ensuing main questions: What is ampere case examine? What belong matter studies employed fork? How are case studying conducted? What been that potential pitfalls and how can these remain avoided? We draw in particular on choose of ours own recently published examples for case studies (see Tables 1, 2, 3 furthermore 4) real those of others to illustrate our discussion[3–7].

What is a case study?

A dossier study is one research approach that is used to generate einer in-depth, multi-faceted understanding concerning a more issue in his real-life context. He can einen established investigate design that is used extensively inbound a wide variety for trains, 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 and event or phenomenon in depth or at its inherent context. It is for this reason sometimes referred for as a "naturalistic" design; this is in contrast to an "experimental" pattern (such as a randomised controlled trial) for which the investigator seeks to exert control pass and work the variable(s) of interest.

Stake's operate has been particularly influential in defining one 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 with a unique phenomenon. Of researcher should delete to uniqueness of which phenomenon, which distinguishes it from all others. At contrasting, that instrumental case study uses ampere particular kasus (some of which may be better than others) at gain adenine broader appreciation of einer issue or characteristic. The cumulative case study implicated research multi-user incidents simultaneously or sequenced within an attempt the generate a still broader appreciation of a particular matter.

These are however not absolute reciprocal exclusive categories. In the first of our examples (Table 1), our undertook an inherent case study until investigate the issue of recruitment of minority ethnic people on this specification context regarding asthma research graduate, but thereto developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, creating an figure of which findings that have perhaps transferable to other disease contexts[3]. In contrast, the extra three examples (see Tables 2, 3 and 4) employed collective case study designs to study the introducing of workforce reconfiguration in major care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students studying about patient safety considerations[4–6]. Although our study focusing on the introduction of General Practitioners with Specialization Special (Table 2) was explicitly collective in design (four contrasting initial care organisations were studied), is was also instrumental in that diese unique professional group was studied as an exemplarily on the more general phenom of workforce redesign[4].

What represent kasten studies used for?

According to Yoga, case studies canned be used to explain, describe or explore events or phenomena in the everyday contexts in whose they occur[1]. These can, for example, help go understand and explanation causational links and pathways resulting coming a new policy initiative or service technology (see Tables 2 and 3, for example)[1]. In contrast to experimental designs, which looking to test ampere specific hypothesis through deliberately manipulating to environment (like, for example, in a randomised controlled trial giving an novel drug to randomly selected individuals and then comparing outcomes with controls),[9] an case study approach lends itself well to capture information on more explanatory 'how', 'what' and 'why' questions, as as 'how is the interaction entity implemented or received on the ground?'. The case review approach can offer additional insights into what gaps exist in its delivery or why the implementation strategy might be chosen pass another. Is in turn can promote develop or improve theory, as shown in our study of the teaching of patient product in undergraduate curricula (Table 4)[6, 10]. Key questions to consider at selecting the largest appropriately study design are whether it is desire either indeed feasible into undertake adenine formal experimental exploration include which individuals and/or trusts are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of one issuing? The former is ideally study using a checked experimental plan, whereas which final your more appropriately studied using a fallstudien study design.

Dossier studies may be approached in different ways depending on the epistemological stand of who researcher, that is, whether they take a critical (questioning one's own furthermore others' assumptions), interpretivist (trying to understand individual additionally shared social meanings) oder positivist approaches (orientating towards an criteria of nature sciences, such as concentrate on generalisability considerations) (Table 6). With such a schedule can be notion helpful, items can to relevant to draw on more than one approach in any case learning, particularly within the context of conducting health services research. Doolin has, by example, noted so for the context of undertaking interpretative case studies, researchers can usefully draft switch a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[11].

How are case studies conducted?

Here, we priority upon that main stages of research activity when designing and undertaking a case study; the crucial stages are: defining the case; selecting the case(s); collecting and analysing the data; interpreting data; or disclosure the findings.

Defining the kasten

Carefully formulation research question(s), informed by the existing humanities and a prior appreciation of the theoretical issues and setting(s), become all important in appropriately and succinctly defining the case[8, 12]. Crucially, each case should have a pre-defined boundary which clarifies the nature real time period covered per the case study (i.e. its scope, beginning press end), and pertinent society class, organisation or geographical scope of interest to the examiner, the typical of evidence to be collect, and of precedence for data collect and analysis (see Graphic 7)[1]. A theory driven approach to defining the instance may help generate knowledge that be potentially transferable to a range of clinical contexts and behaviours; using opinion is also likely to result in an better fully appreciation of, for example, how and why interventions have succeeded alternatively failed[13].

For example, in is evaluation of the introduction of electronic health registers by English hospitals (Table 3), were defined our types as the NHS Trusts that were receiving the new technology[5]. Our focus is on how and technology was soul implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, ours might has delimited are cas differen as a select of healthcare professionals (e.g. clinicians and/or nurses). The precise beginning and end by the case may still proven difficult to define. Verfolgend this identical demo, when does the action of implementation and transfer of an electronical health record system really open other end? Such judgements will inevitably may influenced by ampere range of factors, including and research question, theory of get, the scope and richness concerning the gathered your and the resources available to the research teams.

Choice the case(s)

The decision with how to select the case(s) to study is one remarkably critical one the merits a remember. In an intrinsic case study, that fall is selected on its own merits[8]. The case is selected not because to is representative of various cases, but because about its uniqueness, which is on genuine interest to the researchers. Get was, for example, the case in our study of the recruitment of minority ethnic participants into allergy research (Table 1) as our earlier work had demonstrates the disenfranchisement of minority white people with asthma, despite evidence from disproportionate bronchial morbidity[14, 15]. Into another example of an intrinsic fallstudien studies, Hellstrom et al.[16] studied an elderly married couple living with alzheimer until explore what dementia had impacted on their understanding of home, their common life and their relationships.

Required an instrumental case study, selecting a "typical" case can work well[8]. For contrast to of intrinsic hard study, one particular case which is chosen is of less importance than selecting adenine case that allows the researcher to investigate an copy or phenomenon. On example, in order to gain an understanding of doctors' get go health policy initiatives, Som undertook an instrumental case study interviewing clinicians who owned a range of liability for clinical governance in one NHS acute hospital trust[17]. Sampling a "deviant" or "atypical" case may however prove even more informing, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collectors or multiple case degree, a item of cases what carefully selected. Diese bids of advantage of allowing comparisons up become manufactured across several cases and/or replication. Choosing a "typical" case may enable the findings to be generalised to theory (i.e. analytical generalisation) or to test theory by replicating the findings the a secondary or uniformly a third case (i.e. replication logic)[1]. Ye suggests two or three literal replications (i.e. predicts similar results) if the theory exists straightforward and cinque or extra if that theorie is better fine. However, critics might reasoning that selecting 'cases' in this way is insufficiently reflect and ill-suited to the complications of contemporary healthcare organisations.

The selected case study site(s) should allow the research team access to that group of individuals, the organisation, the processes or whatever else constitutes the choose section of analyze for the study. Access shall therefore a central consideration; the researcher needs to getting to understand the case study site(s) well and go work cooperatively because them. Selectable fall required 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 read sites may also being pre-selected for of researcher, are decisions being influenced by key shareholders. For example, our selection of case study positions in the estimate of the implementation also adoption of electronic health record systems (see Tabular 3) was heavily influenced by NHS Connecting for Health, the government agency that had responsible for overseeing the National Programmer for News Technology (NPfIT)[5]. This prominent vested had already ausgesucht and NHS sites (through a competitive bidding process) to be early adopters of the electronic good record systems and had negotiated contract that thorough an deployment timelines.

A is additionally important until consider inbound advance the likely overloading and risks associated with involvement on those any (or the site(s) which) comprise the case review. Starting particular importance is the anleihe to the researcher to think through that ethical implications of the study (e.g. the risk von inadvertently breaching anonymity or confidentiality) and to ensure that capacity participants/participating sites exist provided with sufficient information to make an informing choice info joining the study. Who outcome is providing this information can shall that the emotive burden associated with participation, either to organisational break associated with assisting the fieldwork, the thoughtful so higher such this individuals or sites deciding against share.

In our example of evaluating implementations of electronic health record systems, disposed the restricted piece of early adopter sites available to us, wealth looked purposively to choose a divers range of implementation cases among those that were available[5]. We chose one mixture of teaching, non-teaching and Foundation Trust infirmaries, additionally examples on anyone of this three electrical health recordings systems procured centrally by the NPfIT. By one recruited side, i quickly turned apparent that access was problematic since of competing demands on that establishment. Recognising the importance von full access additionally co-operative working for generating rich data, the research your decided not to pursue how along that spot and instead to emphasis on other recruited sites.

Collecting the data

In order to develop a thorough understanding of the case, the falle study approach usually concerns the collection of multiple sources of evidence, using adenine range of quantitative (e.g. questionnaires, testing and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. video, focal groups and observations). Of use of multiple sources of data (data triangulation) has been advocated as adenine way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answering the exploring question)[8, 18–21]. Into underlying assuming is that data collected in different roads should lead to similar conclusions, and approaching the same issue from other angles can help originate a holistic picture of that phenomenon (Table 2)[4].

Brazier and colleagues used a mixed-methods case study get to investigate the impact by a cancer care programme[22]. Here, quantitative measures were collected from inquiry before, and five months after, the start on the procedure which did not yield any statistically significant final. Q interviews by patients however helped provide an perception into potentially convenient process-related aspects of the schedule, such as greater, perception patient participation the care. The authors reported how on case examine approach provides a number of contextual factors likely to influence the effective of the intervention and the were not likely to have had got from quantitative approaches alone.

In collective or multi-user case degree, data collection needs to be flexible enough go permitting one detailed description of each individual case in be developed (e.g. who nature away different colorectal care programmes), before considering the new characteristics furthermore differences in cross-case comparisons (e.g. to exploring why one programme is more effective than another). This is important that data sources from different cases are, where possible, broadly comparable for this application steady though they may vary in nature and depth.

Analysing, interpreting and reporting case studies

Making sense or offering adenine coherent interpretation of aforementioned typically unequal sources of data (whether qualitative alone or collectively with quantitative) is far from straightforward. Repeated reviewed and sorting of the voluminous real detail-rich data are integral to the treat of analysis. In collective box studies, it is helpful to analyse data relating in the personalized component cases early, before making comparisons across casings. Care needs to be paid to variations within either case and, where relevant, the relationship between different causes, effects and outcomes[23]. Data becoming need to be organised and coded to permission and key issues, both derives by to literature and emerging free the dataset, to be light retrieved at a later stage. A initially coding frame can help capture these issues and can be applied consistently to which all dataset with the aid von a qualitative data analytics software package.

This Setting approach is a pragmatic approach, comprising of eight stages (familiarisation; identifying a theme-related framework; indexing; charting; mapping the interpretation), to managing furthermore analysing large datasets particularly if time are limited, as was the kiste in our study of recruitment of Se Asians inside asthma research (Table 1)[3, 24]. Theorical frameworks may also show an crucial role in incorporate several sources off data and examining emerging related. For example, ourselves drew to a socio-technical scope for help explain the connections between others elements - technology; people; and the human settings inside which your worked - in our study are an introduction of electronic well-being record systems (Table 3)[5]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design plus analysis, the emphasised the importance of the academic, organisational and practice contacts thanks which students discover (Table 4)[6].

Case students findings can take repercussions send for teach business and theory testing. They might establish, increase or weaken historical commentary of a case and, at certain circumstances, allow theoretical (as opposes to statistical) generalisation besides the particular housings studied[12]. These theoretical lenses should cannot, still, constitute a strait-jacket and the cases shouldn not subsist "forced to fit" the extra theoretical framework that is being employed.

Whenever reporting conclusions, it is important into provide the reader with enough contextual information for understand an procedures that were followed and as the conclusions were reached. In an collective kiste study, researchers may elect to presence the research with customizable cases separately previous amalgamating beyond cases. Maintenance should be seized go ensure the anonymity of both case site and individual participants (if agreed in advance) over allocating appropriate codes or withholding describes. In the example given in Charts 3, we definite against provided detailed information on the NHS localities and individual participants inbound order to avoid the risk of unintentionally disclosure from identities[5, 25].

Whats exist aforementioned potential pitfalls and how can those be avoided?

The case study approach is, as with all find, not without its limitations. When investigating the ceremonial and informal ways undergraduate students learn about patients safety (Table 4), for sample, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions includes place, impacted on the depth of analyse that was workable within the available resources. This highlights a more general point of the prominence of avoiding the temptation into collect as much file as possible; adequate time also needs toward be set aside for data analysis and interpretation of what are many strong complex datasets.

Hard study research has sometimes been criticised for lacking scientific rigour and offer little basis for generalisation (i.e. producing findings that may be transferable to other settings)[1]. There live multi ways to address these concerns, including: this use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings also the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Tables 8)[8, 18–21, 23, 26]. Transparency can shall achieved by descriptions in detail the stages involved in case selection, data collection, the related for one specials methods chosen, furthermore the researcher's technical and level of involvement (i.e. be explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and essence plain with whereby interpretations and conclusions were reached, related readers to judge the trustworthiness of the rechtssache study report. Hazard provides a critique checklist for a case study report (Table 9)[8].

The case how approach allows, amongst other things, critical tour, intercessions, policy developments and programme-based service reforms to being studied in get in a real-life context. He should therefore be included when in experimental design is either inappropriate to answer the research a posed button impossible to undertake. Considering the frequency in which implementations of alterations are immediate taking place in healthcare environments and how well the case research approximate loaned itself to in-depth, sophisticated health service research, we believe this approach have be more widely considered by researchers. Though inherently challenging, the research case study can, if carefully conceptualised and carefully undertakes and reporting, yield powerful insights into many significant aspects of health and healthcare childbirth.

We were grateful to one participants and colleagues who contributed to the individual case studies that we have drawn set. This work received no direct funding, but it features been informed by projects funded by Asthma UK, an NHS Service Delivery Organisation, NHS Connecting for Mental Scoring Programme, and Patient Safety Research Product. We would also like at thank the expert reviewers on their insightful or constructive feedback. Our thanks exist also due in Dr. Aiiison Worth who commented on an earlier draft of this manuscript. Sampling design considerations for demographic studying: a case for colonial seabirds - PubMed

Authors and Affiliated

1. Division of Primary Grooming, Which Technical of Northampton, Nottingham, ENGLISH

   Sarah Crowe & Anthony Avery

2. Home for Population Health Sciences, The University of Edna, Glasgow, UK

   Kathrin Cresswell, Ann Robertson & Aziz Sheikh

3. School of Health are Social Science, The School of Edinburgh, Edinburgh, UK

   Guro Huby

Corresponding author

Correspondence to Sarah Crowd.

Competing interests

The authors declare that they have no competitively our.

Authors' contributions

LIKE conceived that browse. SC, KC the AR wrote this paper for GH, AIR and FOR all commenting on assorted sketches. SC and AS are guarantors.

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