Continuing to enhance the quality of case study methodology in health services research

Abstract

Case study methodology has grown in popularity within Health Services Research (HSR). However, its use and merit as a methodology are frequently criticized due to its flexible approach and inconsistent application. Nevertheless, case study methodology is well suited to HSR because it can track and examine complex relationships, contexts, and systems as they evolve. Applied appropriately, it can help generate information on how multiple forms of knowledge come together to inform decision-making within healthcare contexts. In this article, we aim to demystify case study methodology by outlining its philosophical underpinnings and three foundational approaches. We provide literature-based guidance to decision-makers, policy-makers, and health leaders on how to engage in and critically appraise case study design. We advocate that researchers work in collaboration with health leaders to detail their research process with an aim of strengthening the validity and integrity of case study for its continued and advanced use in HSR.

Climate action, staff engagement, and change management: A paediatric hospital case study

“…Specifically, consideration of one example in depth allows the complex relationships, contexts, and systems to be fully described. 6 This is important when wanting to understand how interventions are implemented in different contexts and how context shapes outcomes. Further, case studies encourage a systems thinking 7 approach to blend evidence-based policies, implementation science, and strategic planning.…”

Intra-organisational sustainable development policy integration processes in higher education through staff networks: a case study from the United Kingdom

“…A good practice case study was designed to gain an in-depth understanding of practices in one university (Sibbald et al , 2021). Good practice in sustainable development at universities refers to following and going beyond international standards and practice whilst also having processes for continuous improvement (McCowan et al , 2021).…”

Advancing qualitative health research approaches in applied nutrition research

“…Qualitative case study research is particularly valuable for applied nutrition scientists because this method can be used to explore or explain complex phenomena, develop theory or interventions or evaluate programs. 40,44 For example, applied nutrition scientists have used case study research to further understand important process aspects of implementing nutrition guidelines in intensive care units, 47 to gain understanding of the perspectives of stakeholders in the integration of nutrition into the catering operation of a global sporting event 48 and to explore issues regarding cafeteria service use following the implementation of nutrition guidelines in primary schools. 49 After deciding that a qualitative case study is an appropriate approach to answer the research question, the nutrition scientist will first need to identify the case or cases.…”

“…This qualitative design differs from others in that the emphasis is on the exploration of the phenomenon within its context through the collection and analysis of multiple data sources 40–43 . Given that patients (and their families) and clinicians’ experiences within healthcare systems are shaped and influenced by a range of contextual factors, case study provides the tools to discover and describe the complex relationships that exist between actors and their environments, organisations or social settings 44 . In the health sciences, three approaches for qualitative (or mixed methods) case study research have been employed and described elsewhere by Yin 41 , Stake 42 and Merriam 43 .…”

“…[40][41][42][43] Given that patients (and their families) and clinicians' experiences within healthcare systems are shaped and influenced by a range of contextual factors, case study provides the tools to discover and describe the complex relationships that exist between actors and their environments, organisations or social settings. 44 In the health sciences, three approaches for qualitative (or mixed methods) case study research have been employed and described elsewhere by Yin 41 , Stake 42 and Merriam. 43 Although each of these approaches seeks to develop an in-depth understanding and comprehensive, holistic description of the case (or cases) within its real-life and contemporary context, 38 there are key differences in in the paradigmatic assumptions and methodological principles underpinning each of these unique approaches to case study research, which are well-described elsewhere.…”