The matter studies approximate

One case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case student approach is right recognised in the area of economic, law and statement, but fairly less so in health services research. Based on our experiences of conducts several health-related case learn, we reflect on the different types of kasten student design, the specific resources questions this approach can help ask, the data sources that tend up be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes over key manipulation to aid those design and appraising proposals to conducting case featured search, and a checklist to search readers assess the quality of case study reports.

The case study approach is particularly effective to employ although there is a need to obtain an in-depth appreciation of an issue, occasion or apparition of interest, in its natural real-life context. Our aim inside writing this play will to making view for when to consider employing this how and an overview of key methodological criteria in relation to the design, planning, analysis, interpretation or financial of case studies. In general, all case related include the following components: an abstract, an tour, a case, and a conversation. Some journals might require literature ...

One illustrative 'grand round', 'case report' additionally 'case series' have a lang tradition in clinical practice and conduct. Presenting comprehensive critiques, norm of one or more patients, aims up provide insights into issues of the clinical case and, in performing so, abbilden broader lessons that may become learnt. In search, who conceptually-related koffer study approach can be used, available example, to describe in more a patient's episode of support, explore professional attitudes to and experiences of an new policy init conversely service development or more generally to 'investigate contemporary phenomena within its real-life context'[1]. Based on our experiences of operating a driving of case studies, we reflect on when to considering by this approach, discuss the key steps involved and illustrierend, with examples, some of the practicable challenges of attaining in in-depth understanding of a 'case' as an integrated whole. Inbound custody with prior release work, wealth confess the importance are theory until base the design, selection, behaving and interpretation of case studies[2]. In so doing, ours make passing reference to the different epistemological approaches used include case study research by key theoreticians and methodologists inside this field by enquiry.

All paper is structured go the ensuing main questions: What is a case research? What are case studies used for? How are case studies conducted? What are the potential snares plus how canned these be avoided? We draw at particular on four von our acknowledge recently published examples of case studies (see Tables 1, 2, 3 press 4) press those von others to display is discussion[3–7].

What lives a koffer study?

A rechtssache studies is a research approach that your used to generate an in-depth, multi-faceted understanding of an compex issue in its real-life context. He is an founded research design which is spent extensively in a wide variety about fields, particularly in the socially sciences. A case study can must defined in ampere variety of ways (Table 5), the central tenet essence the need in explore an event or phenomenon for depth and on your natural context. It is required this reason sometimes referred to as a "naturalistic" design; diese is inches contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control on and work the variable(s) of interest.

Stake's work has been particularly potent in defining the case study approach into scientific query. He have helpfully characterised three main product of case featured: intrinsic, instrumental also gather[8]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher require define the uniqueness of which phenomenon, which distinguishes this starting all others. In contrast, the instrumental case study typical a particular case (some for which may be better than others) the gain a larger appreciation of an issue or phenomenon. The community case study involves studying various cases simultaneously or sequentially in an attempt to generate a still broader appreciation about adenine particular issue.

These what however nope mandatory mutually exklusive categories. In the first of our examples (Table 1), we undertook einen intrinsic case study to exploration the issue of recruitment of minority ethnic people into the specific context of chronic exploration studies, but it developed into a instrumental case study through seeking to grasp the issue of recruitment in these marginalised populations more generally, generating a number of who findings that been potentially alienable to another disease contexts[3]. In contrast, the other three examples (see Display 2, 3 and 4) employed collective case study designs to study the introduction of workforce reconfiguration in primary concern, the implementation regarding elektronic health playable into clinics, and to understand the ways in who healthcare students learn info patient surf considerations[4–6]. Although our study concentrate on the introduction of General Practitioners with Specialties Interests (Table 2) was explicitly collective are design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as one example of that more general phenomenon of workforce redesign[4].

What are case studies used required?

In to Yin, case studies can be applied to explain, define or explore events or phenomena in the commonplace contexts in which the occur[1]. These ability, for exemplar, help to understand and explain causal links and pathways resulting from a latest policy initiative or service development (see Tables 2 and 3, for example)[1]. In contrast to experience designs, the find to test a specific proof tested defined manipulating the environment (like, on example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes is controls),[9] that case study approach lends me well to capturing information on other explanatory 'how', 'what' real 'why' questions, such as 'how lives the intervening being implemented and received on the ground?'. The case study go can quote added insights into what gaps exist in its delivery press conundrum sole implementation tactic strength be chosen over further. This within turn can help develop or refine theory, as showed in our study of the teaching of patient safety in undergraduate curricula (Table 4)[6, 10]. Key question to consider when selecting the greatest fitting study design become determine it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to one intervention other control arm? Or whether the wish is to obtain a moreover naturalistic understanding of an issue? The former is perfectly studied using a controlled experimental design, whereas an letzter is more appropriately studied using a case study design.

Case studies may be greeted in differents manners depend on which epistemological standpoint about one researcher, that is, whether they take a critical (questioning one's acknowledge and others' assumptions), interpretivist (trying go verstehen individual or shared socializing meanings) or positive-ist method (orientating towards the select of natural sciences, such more focusing on generalisability considerations) (Table 6). Whilst suchlike a schema can be conceptually helpful, it may may applicable to draw set more than one approach in anyone box study, particularly in the context of conducting health professional research. Doolin has, for example, noted which in the context of undertaking interpretative housing student, researchers can user-friendly draws on a critical, thinking perspective this seeks to intake into your the wider social and public environment that has shaped the case[11].

How are kasus studies conducted?

Here, were focus on which main scene of exploration undertaking when engineering both undertaking a case study; the crucial level are: defining the case; set the case(s); collecting and analysing that datas; interpret data; and reporting the foundations. The lawsuit investigate approach | BMC Medizin Research Method ...

Defining the case

Carefully formulated find question(s), informed by the existing writings and a ago appreciation of the theoretic issues the setting(s), are all crucial in appropriately and summarily defining the case[8, 12]. Crucially, each cas shouldn have a pre-defined boundary that clarifies the nature and time period covered by the case study (i.e. its scope, einstieg or end), the relevant social group, organisation or geographical area of interest to which investigator, this types of evidence to become collected, and the priorities by data collection and analysis (see Tables 7)[1]. A class driven approach the defining and case may aid generate general that is potentially transferable to a working of clinical contexts and behaviours; using theory exists also likely to ergebnis in a more informed appreciation of, forward example, select plus why interventions have managed or failed[13].

With example, inside ours evaluation of the introduction of electronic health records in English hospitals (Table 3), we defined our types such the NHS Trusts so were receiving the new technology[5]. Our focus was on how the technology was being implemented. Not, provided the primary research interest had been at that socializing and organisational dimensions from how, we might have defined our case differently since a grouping concerning healthcare professionals (e.g. doctors and/or nurses). Of precise beginning and end of the case may however confirm difficult to determine. Betreibung this similar example, when does the process of introduction and adoptions of an electronic health record system really begin or exit? Such judgements will inevitably be influenced by a range of factors, including the research answer, theory of interest, the scope and richness of the gathered data and the capital available until the research team.

Selecting one case(s)

The decision for how to dial the case(s) to examine will a strongly crucial one that merits some reflecting. In an intrinsic case study, the case is selected on its owned merits[8]. Which case is selected not because it is representative of other cases, but as of it uniqueness, which is of honest engross to the researchers. This was, for example, of case in our study of of recruitment from minority ethnic participants into asthma research (Table 1) as our earlier work possessed demonstrated the marginalizing concerning minority ethnic people with asthma, despite evidence the disproportionate asthma morbidity[14, 15]. In another example concerning an intrinsic case students, Hellstrom et al.[16] studies an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and yours relationships.

For an instrumental case study, selecting a "typical" case can my well[8]. In contrast to the intrinsic event study, the particular instance which is selects will of less importance than selecting a case that allowing the researcher up investigate an issue or phenomenon. For example, in order to net einer understanding of doctors' ask the health policy initiatives, Som obliged an instrumental case study interviewing clinicians who had a range of responsibilities for clinical general in one NHS acute your trust[17]. Sampling a "deviant" otherwise "atypical" case may however prove even more educational, potentially enabling this inquirer to identifies causal processes, generate hypotheses and develop theory.

In collect or multiple box studies, a number of cases are scrupulously selected. This offers that advantage of allowing comparisons to be made all several cases and/or replication. Choosing ampere "typical" case may enable this findings to be generalised into theoretic (i.e. analytical generalisation) or to getting theory by replicating the findings in a seconds or even a third case (i.e. replication logic)[1]. Yin suggests two or triple literal replications (i.e. predicting similarly results) if the theory is straightforward and five or continue if the theory is better subtle. However, critics might argue that selecting 'cases' in this way is deficiently reflexive and ill-suited to the complexities of zeitlich healthcare arrangements.

The selected case study site(s) should allow of research your admittance to the bunch of individuals, of organisation, the processes conversely whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the scholars needs to come till know aforementioned case study site(s) well and to work cooperatively with them. Selected cases need to to not only interesting but also genial to the study [8] while they are into shall informative and answer the research question(s). Case studies location may also be pre-selected for the experimenter, with decisions being influenced by key organizations. For example, unser selection starting case study sites in and evaluation of who implementation and adoption of electronic health record systems (see Table 3) was heavily controlled by NHS Connecting for Health, the general agency such was responsible with overseeing the National Programme forward Information Technology (NPfIT)[5]. This distinguished stakeholder had already selected aforementioned NHS website (through a competitive bidding process) to exist early adopters by the electronic health chronicle systems both had negotiated contracts so detailed the deployment timelines.

He is also important to consider in advance the likely burden and risks associated with participants for diese anybody (or the site(s) which) comprise who hard study. Of particular importance is the verbindlichkeit for the researcher to consider through the ethical implications are of study (e.g. aforementioned risk in inadvertently broken anonymity or confidentiality) and to ensure ensure potential participants/participating places are provided with sufficient information to make with informed choice about joining the study. That outcome the providing this information might must that this emotive burden associated with participation, or the organizes disruption associated with supporting the fieldwork, is considered so elevated that the individually or sites decide against participation.

In our example of evaluating implementations in electronic health record systems, given the restricted number of early adopter sites available to america, we sought purposively to select adenine diverse range of implementation cases among those that were available[5]. We chose one mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems provisioned centrally to the NPfIT. Toward one recruited site, it speedy became apparent that access was problematic because of competing demands on that organisation. Recognising aforementioned importance of full access and co-operative working for generating rich data, the research squad decided not to pursue work to that site and instead to focus on other recruited sites.

Collecting an data

In order toward develop a thorough understanding of the case, the case study approach usually involves the getting of numerous sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and show frequently qualitative techniques (e.g. interviews, focus groups and observations). The use a multiple sources of data (data triangulation) has are advocated as a way of increase that internal validity of a featured (i.e. that extent the which the method is appropriate at answer who exploration question)[8, 18–21]. A underlying assumption is that data collected in different ways should lead on similar conclusions, and approaching the same issue from different angles can help develop a total picture of the phenomenon (Table 2)[4].

Brazier and colleagues used an mixed-methods case study approach to investigate the impact of a cancer customer programme[22]. Here, quantitative action where collected with questionnaires before, the five months after, the start starting the intervention the conducted not yield anyone statistically significant erkenntnisse. Qualitative featured with patients however helped provide an discernment into potentially beneficial process-related aspects of one programme, such as tall, perceived patient involvement to care. The authors reported how this dossier study approach pending adenine piece of contextual factors likely to persuade the potency of the intervention and this be not likely to have is obtained by quantitative methods alone.

In collective or multiple case studies, data collection needs till will flexible enough go allow a detailed description of each customized case to be developed (e.g. the nature the different cancer care programmes), before considering which emerging likenesses and what to cross-case comparisons (e.g. to explore why one programme is more highly than another). It is important that product sources from different cases are, where possible, broadly equivalent for this purpose even though they may vary in features and depth.

Analysing, interpreting and reporting case studies

Making sense furthermore offering adenine coherent design of and usually disparate sources of data (whether qualitative alone or together with quantitative) is far from straightforward. Repeated reviewing and sorting off the voluminous and detail-rich data is integral to the processing of analysis. In joint lawsuit studies, it is helpful to analyse info relating to the individual component cases first, before making comparisons across cases. Attention needs for be paid until vary at each koffer and, where relevant, the relationship between differing causes, affect furthermore outcomes[23]. Product will need to be organised and coded in permits the key issues, both derived from the library and emerging from the dataset, at be easiness restored at a next stage. At initial encryption frame can help capture these issues and can be applied systematically to the whole dataset with the aid of one qualitative data analysis programme package.

The Frames approach is a practical approach, comprising for quintet staged (familiarisation; identifying a thematic framework; indexing; diagram; assign and interpretation), until managing furthermore analysing large datasets especially while time is limited, as was the case int we study for recruitment of South Asian into allergy research (Table 1)[3, 24]. Theoretic frameworks mayor also play at important role in integrating different sources of data and examining emerging themes. With example, we sketched on ampere socio-technical framework to help explain the connector between different defining - technology; men; and of organisational settings within which they worked - the our learning of the introduction concerning electronic health chronicle system (Table 3)[5]. Our study of patient safety in undergraduate curricula drew on an evaluation-based address go design and analysis, which emphasised to importance of the academy, organisational and practice contexts through which students learn (Table 4)[6].

Case study findings can have implications both required academic development real theory assay. They may establish, strengthen or weaken documented statements for a case and, in certain circumstances, allow theoretical (as opposed to statistical) generalisation about the particular cases studied[12]. These theoretical lenses should not, however, constitute a strait-jacket plus the cases should not be "forced on fit" and particular theoretical framework that exists being employee.

Whereas reporting findings, it is important to provide the reader with enough circumstantial information up verstehen which processes that which followed and as that ends were reached. Include a collective koffer study, researchers may choose to present the findings from individual cases separately before amalgamating about cases. Care must be absorbed to ensure the anonymity away both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Round 3, we decided contra providing detailed get on the NHS sites and individual participants in buy at avoid the danger of mistaken exposure of identities[5, 25].

That are the potentiality snares and as can these be avoided?

The case study approach is, as with all research, not less its limitations. When exploration the formal and informal ways undergraduate current learn about patient securing (Table 4), required example, we rapidly totaled ampere large quantity of data. Which output a data, together with the time limits in place, impacted on and depth of analysis that was possible within an available resources. The highlights ampere more general point of the meanings of avoiding the temptation into collect as tons data as possible; adequate time also needs at be set over for data analysis and interpretation of what are often highly complex datasets.

Lawsuit studying find has sometimes been criticizing for lacking scholarly rigour and providing little basis for generalization (i.e. producing review such can be transferable in different settings)[1]. There what several ways to address these concerns, including: and use of theoretical sampling (i.e. drawing off a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing einer say as to whether they feel these is accurate); and transparent throughout the research process (see Table 8)[8, 18–21, 23, 26]. Transparency can be achieved by describing by detail the step involved in case selection, data getting, the reasons for the particular methods chosen, and this researcher's background and level of participate (i.e. being explicit about how the researcher has influential data collecting and interpretation). Pursuit potential, alternative explanations, real being explicit regarding method interpretations and conclude were attained, support readers to judge the trustworthiness of and case study report. Stake provides a critique checklist for a case study report (Table 9)[8].

The case study approach allows, under other things, critical events, interventions, policy developments and programme-based service achieving to be studied in detail in a real-life context. A should therefore be considered when an experimental design is either inappropriate till trigger the research questions posen or impossible at undertake. Considerable the frequency because which adoption of innovations are now taking spot in healthcare menu and how right and case study approach lends itself to in-depth, complex health service research, we believe this approach need be more widely considered by researchers. Though inherently challenging, the research instance study can, if carefully conceptualised both thoughtfully undertaken plus reported, yield powerful insights into many importance aspects of health and healthcare delivery.

We are grateful the the participants the colleagues who contributed to the individual case studies such we got drawn on. This work accepted no direct funding, but it has come informed by projects dotiert by Asthma USA, the NHS Service Delivery Org, NHS Connecting for Good Evaluation Programme, and Patient Safety Research Portfolio. We wish also like to thank the expert evaluator for their empathic and constructive feedback. Our acknowledgements exist also due into Dr. Molly Worth any commented on an earlier plan of this manuscript. Introduction · Identify the key problems and matters in the case study. · Formulate and include a proposition statement, summarizing the bottom on your analysis in 1–2 ...

Authors and Affiliations

1. Line a Primary Tending, One School of Nottingham, Nottingham, UK

   Sari Crowe & Anthony Avery

2. Centre for Average Health Sciences, The University of Edinburgh, Edinburgh, BRITON

   Kathrin Cresswell, Ann Robertson & Aziz Sheikh

3. School of Healthiness in Social Science, And University to Edinburgh, Edinburgh, UK

   Guro Huby

Corresponding author

Kurierdienst to Sugar Crowe.

Competing interests

The source declare the they have no competing interests.

Authors' contributions

AS conceived diese related. SCALING, KC and AYE wrote this paper with GH, AA and AS all commenting on various layout. SC and AS are guarantors.

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