case study research ideas

What is case study research?

Last updated

8 February 2023

Reviewed by

Cathy Heath

Suppose a company receives a spike in the number of customer complaints, or medical experts discover an outbreak of illness affecting children but are not quite sure of the reason. In both cases, carrying out a case study could be the best way to get answers.

Organization

Case studies can be carried out across different disciplines, including education, medicine, sociology, and business.

Most case studies employ qualitative methods, but quantitative methods can also be used. Researchers can then describe, compare, evaluate, and identify patterns or cause-and-effect relationships between the various variables under study. They can then use this knowledge to decide what action to take.

Another thing to note is that case studies are generally singular in their focus. This means they narrow focus to a particular area, making them highly subjective. You cannot always generalize the results of a case study and apply them to a larger population. However, they are valuable tools to illustrate a principle or develop a thesis.

Analyze case study research

Dovetail streamlines case study research to help you uncover and share actionable insights

What are the different types of case study designs?

Researchers can choose from a variety of case study designs. The design they choose is dependent on what questions they need to answer, the context of the research environment, how much data they already have, and what resources are available.

Here are the common types of case study design:

Explanatory

An explanatory case study is an initial explanation of the how or why that is behind something. This design is commonly used when studying a real-life phenomenon or event. Once the organization understands the reasons behind a phenomenon, it can then make changes to enhance or eliminate the variables causing it.

Here is an example: How is co-teaching implemented in elementary schools? The title for a case study of this subject could be “Case Study of the Implementation of Co-Teaching in Elementary Schools.”

Descriptive

An illustrative or descriptive case study helps researchers shed light on an unfamiliar object or subject after a period of time. The case study provides an in-depth review of the issue at hand and adds real-world examples in the area the researcher wants the audience to understand.

The researcher makes no inferences or causal statements about the object or subject under review. This type of design is often used to understand cultural shifts.

Here is an example: How did people cope with the 2004 Indian Ocean Tsunami? This case study could be titled "A Case Study of the 2004 Indian Ocean Tsunami and its Effect on the Indonesian Population."

Exploratory

Exploratory research is also called a pilot case study. It is usually the first step within a larger research project, often relying on questionnaires and surveys . Researchers use exploratory research to help narrow down their focus, define parameters, draft a specific research question , and/or identify variables in a larger study. This research design usually covers a wider area than others, and focuses on the ‘what’ and ‘who’ of a topic.

Here is an example: How do nutrition and socialization in early childhood affect learning in children? The title of the exploratory study may be “Case Study of the Effects of Nutrition and Socialization on Learning in Early Childhood.”

An intrinsic case study is specifically designed to look at a unique and special phenomenon. At the start of the study, the researcher defines the phenomenon and the uniqueness that differentiates it from others.

In this case, researchers do not attempt to generalize, compare, or challenge the existing assumptions. Instead, they explore the unique variables to enhance understanding. Here is an example: “Case Study of Volcanic Lightning.”

This design can also be identified as a cumulative case study. It uses information from past studies or observations of groups of people in certain settings as the foundation of the new study. Given that it takes multiple areas into account, it allows for greater generalization than a single case study.

The researchers also get an in-depth look at a particular subject from different viewpoints. Here is an example: “Case Study of how PTSD affected Vietnam and Gulf War Veterans Differently Due to Advances in Military Technology.”

Critical instance

A critical case study incorporates both explanatory and intrinsic study designs. It does not have predetermined purposes beyond an investigation of the said subject. It can be used for a deeper explanation of the cause-and-effect relationship. It can also be used to question a common assumption or myth.

The findings can then be used further to generalize whether they would also apply in a different environment. Here is an example: “What Effect Does Prolonged Use of Social Media Have on the Mind of American Youth?”

Instrumental

Instrumental research attempts to achieve goals beyond understanding the object at hand. Researchers explore a larger subject through different, separate studies and use the findings to understand its relationship to another subject. This type of design also provides insight into an issue or helps refine a theory.

For example, you may want to determine if violent behavior in children predisposes them to crime later in life. The focus is on the relationship between children and violent behavior, and why certain children do become violent. Here is an example: “Violence Breeds Violence: Childhood Exposure and Participation in Adult Crime.”

Evaluation case study design is employed to research the effects of a program, policy, or intervention, and assess its effectiveness and impact on future decision-making.

For example, you might want to see whether children learn times tables quicker through an educational game on their iPad versus a more teacher-led intervention. Here is an example: “An Investigation of the Impact of an iPad Multiplication Game for Primary School Children.”

When do you use case studies?

Case studies are ideal when you want to gain a contextual, concrete, or in-depth understanding of a particular subject. It helps you understand the characteristics, implications, and meanings of the subject.

They are also an excellent choice for those writing a thesis or dissertation, as they help keep the project focused on a particular area when resources or time may be too limited to cover a wider one. You may have to conduct several case studies to explore different aspects of the subject in question and understand the problem.

What are the steps to follow when conducting a case study?

1. Select a case

Once you identify the problem at hand and come up with questions, identify the case you will focus on. The study can provide insights into the subject at hand, challenge existing assumptions, propose a course of action, and/or open up new areas for further research.

2. Create a theoretical framework

While you will be focusing on a specific detail, the case study design you choose should be linked to existing knowledge on the topic. This prevents it from becoming an isolated description and allows for enhancing the existing information.

It may expand the current theory by bringing up new ideas or concepts, challenge established assumptions, or exemplify a theory by exploring how it answers the problem at hand. A theoretical framework starts with a literature review of the sources relevant to the topic in focus. This helps in identifying key concepts to guide analysis and interpretation.

3. Collect the data

Case studies are frequently supplemented with qualitative data such as observations, interviews, and a review of both primary and secondary sources such as official records, news articles, and photographs. There may also be quantitative data —this data assists in understanding the case thoroughly.

4. Analyze your case

The results of the research depend on the research design. Most case studies are structured with chapters or topic headings for easy explanation and presentation. Others may be written as narratives to allow researchers to explore various angles of the topic and analyze its meanings and implications.

In all areas, always give a detailed contextual understanding of the case and connect it to the existing theory and literature before discussing how it fits into your problem area.

What are some case study examples?

What are the best approaches for introducing our product into the Kenyan market?

How does the change in marketing strategy aid in increasing the sales volumes of product Y?

How can teachers enhance student participation in classrooms?

How does poverty affect literacy levels in children?

Case study topics

Case study of product marketing strategies in the Kenyan market

Case study of the effects of a marketing strategy change on product Y sales volumes

Case study of X school teachers that encourage active student participation in the classroom

Case study of the effects of poverty on literacy levels in children

Get started today

Go from raw data to valuable insights with a flexible research platform

Editor’s picks

Last updated: 21 December 2023

Last updated: 16 December 2023

Last updated: 6 October 2023

Last updated: 5 March 2024

Last updated: 25 November 2023

Last updated: 15 February 2024

Last updated: 11 March 2024

Last updated: 12 December 2023

Last updated: 6 March 2024

Last updated: 10 April 2023

Last updated: 20 December 2023

Latest articles

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

Knowledge Base

Methodology

What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

Academic style
Vague sentences
Style consistency

See an example

Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

Provide new or unexpected insights into the subject
Challenge or complicate existing assumptions and theories
Propose practical courses of action to resolve a problem
Open up new directions for future research

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

Exemplify a theory by showing how it explains the case under investigation
Expand on a theory by uncovering new concepts and ideas that need to be incorporated
Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

Prevent plagiarism. Run a free check.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

Normal distribution
Degrees of freedom
Null hypothesis
Discourse analysis
Control groups
Mixed methods research
Non-probability sampling
Quantitative research
Ecological validity

Research bias

Rosenthal effect
Implicit bias
Cognitive bias
Selection bias
Negativity bias
Status quo bias

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, November 20). What Is a Case Study? | Definition, Examples & Methods. Scribbr. Retrieved April 17, 2024, from https://www.scribbr.com/methodology/case-study/

Is this article helpful?

Shona McCombes

Other students also liked, primary vs. secondary sources | difference & examples, what is a theoretical framework | guide to organizing, what is action research | definition & examples, unlimited academic ai-proofreading.

✔ Document error-free in 5minutes ✔ Unlimited document corrections ✔ Specialized in correcting academic texts

Case Study Topics on Various Academic Subjects

Table of contents

1 What Is a Case Study?
3.1 Top Notch Business Case Study Topics
3.2 MBA Case Study Topic Ideas
3.3 Education Case Study Topics
3.4 Psychology Case Study Topics
3.5 Environmental Science Case Study Topics
3.6 Management Case Study Topics
3.7 Case Study Topics for Marketing
3.8 Social Media Marketing Case Study Topics
3.9 Information Technology Case Study Topics
3.10 Human Rights Case Study Topics
3.11 Case Study Topics for Nursing
3.12 Conclusion

Choosing a topic for a case study can be difficult, but this list of case study topics on various academic subjects can help make the process a little easier. From Business to Law to History! This comprehensive list offers a diverse range of case study topics for anyone seeking to delve into the fascinating world of case studies.

Each topic includes a brief description of the subject, so students can get a better idea of what they will be studying if they want to write a case study.

What Is a Case Study?

A Case Study is an intensive analysis of an individual, group, event, or phenomenon. Case studies have become a valuable tool in psychology, sociology, and business research, offering an in-depth examination of a subject through qualitative or quantitative methods.

Whether you’re a student, researcher, or business professional, writing an effective case stud is essential to your success. If you are wondering how to write a case study, then read on. Follow these expert tips to create a clear, concise, and organized masterpiece that will captivate your audience and leave a lasting impression.

Begin your case study by introducing the subject and offering a riveting overview of the situation.

Paint a picture of the problem or issue at the center of your case study.

Outline the steps that were taken to address the problem.

Describe the results of the intervention.

Discuss any possible implications or future directions.

How to Find Awesome Case Study Topics?

One of the most important skills for any student is the ability to write in-depth analysis. This is especially important when it comes to academic writing. However, many students find it difficult to come up with topics for their case studies. If you are one of those students, don’t worry – we are here to help.

Crafting a great case study involves more than just choosing the right topic. There are countless case study topics, select one that is interesting to you, applicable in your field of expertise and allows for extensive research.

Now that you’ve chosen a topic, it’s time to really dive into the research phase. Make sure you have an in-depth understanding of what your writing. The content should be well-researched and well-informed. Start by reading as many articles and books as possible while taking notes along the way.

With your confident grasp of the subject, you’re ready to begin putting words on paper. Start with the rough draft – this will help you devise a basic shape or framework of your argument! Revisiting and refining this template comes next; ensure that each point is formulated clearly so there’s no room for confusion or misinterpretation.

Finally, you want to make sure that you have a good attitude and professional success. This means working hard and staying motivated. If you can do these things, you will become a student who stand outs from the crowd.

Case Study Ideas and Topics to Get Inspired

Our comprehensive list of case study topics is here to help! From students and researchers, to professionals across industries – these thought-provoking subjects can jumpstart creativity, enable deeper insights into research findings and steer you toward the next big breakthrough. Here are some topics and ideas you can get inspired from.

MBA Case Study Topic Ideas

The goal of an MBA case study is to help students understand the complexities of real-world business decision-making and develop their analytical and problem-solving skills using qualitative or quantitative research method. Here are some example marketing case study topics:

Investigating the effectiveness of customer relationship management strategies employed by corporations.
Examining the impact of corporate management specialists on organizational efficiency.
Analyzing the role of female personnel in the workforce and its impact on business.
Investigating the effectiveness of different training programs for employees.
Comparing and contrasting different motivational techniques for employees.
Analyzing the impact of organizational culture on employee productivity using qualitative or quantitative data.
Studying the effects of workplace stress of a particular company and related mental aspects.
Investigating the benefits of using technology to improve workplace efficiency.
Investing the discrimination faced by the female personnel workforce.
The importance of stakeholder engagement in shaping a company’s strategic management.

Education Case Study Topics

Education shapes the minds of our future, so it’s no surprise that case studies in this field can offer an insightful look into both present and potential opportunities.

From teachers learning how to use new technologies effectively in K-12 classrooms to policy makers developing strategies for education reform efforts, these thought-provoking topics highlight just some of the many facets within the ever evolving educational sector. Here are some education case study topics you can take note from:

Summer Camp Education: Worth the Investment?
The Correct Method for Research in the Scientific Community.
Strategic Thinking and Leadership Training in Education.
Research Methodologies and Their Effectiveness.
The Development Strategy for Education.
The Use of Technology in Teaching Methods.
The Influence of Culture on Education.
The Effect of Poverty on Education.
Homeschooling: The Pros and Cons.
Examining improper examination methods and how to improve the system.

Psychology Case Study Topics

The purpose of psychology case studies is to understand an individuals or a groups behaviour and emotions through in-depth study.

There are a wide range of topics and areas that can be explored in psychology. These are pertaining to abnormal psychology, developmental psychology, or cognitive psychology. While choosing a topic for psychology case study its important to select a topic that is compelling and informative. Here are some informative case study topics that you can choose from:

The Effects of Mental Aspects on Physical Health.
The Relationship between Childhood Abuse Victims and their Adult Lives.
Workplace Leadership and its Effect on Employee Mental Health.
Child Abuse Victims Standing Up to Their Abusers: Related Mental Aspects.
Anti-Discrimination Act Controversies and their Effects on Mental Health.
Female Personnel in the Workforce and their Mental Health.
Self-Defense Tactics and their Effects on Mental Health.
The Healthcare System in America and its Effects on Mental Health.
How to Motivate Children in Difficult Situations.
The Use of Psychology in Court Cases.

Environmental Science Case Study Topics

If you are interested in analyzing the real-world issues then its a good option to choose an environmental science case study options. These topics analyze real world issues using scientific data and analysis.

There are a wide range of topics that come under environmental science. For example how to promote environmental protection, green energy systems and how they impact the carbon dioxide emission reports, earthquake prevention systems, and more. Several times students are looking to purchase a case study online , and help with choosing a topic. Here are some case study topics that you can take inspiration from if you are an aspiring environmental scientist or practitioner.

The role of scientific community in promoting environmental protection.
The impact of business environment on environment.
The effectiveness of environmental protection policies and global warming campaigns.
The challenges of implementing policies for the protection of environment.
The role of environmental science in mitigating climate change.
The impact of climate change on businesses.
The role of environmental science in safeguarding biodiversity.
The impact of biodiversity loss on businesses.
The role of environmental science in ensuring sustainable development.
The impact of unsustainable development on business environment.

Management Case Study Topics

Management case studies offer a practical approach to problem-solving in the business field. They examine real-life scenarios, covering topics like organizational behavior, marketing, and finance.

Studying these case studies helps students and professionals develop effective strategies to address business challenges in today’s fast-paced global marketplace. It does not matter if you are interested in the data transfer methods or quality production differences.

Personnel Management Issues in The 21st Century.
The Changing Role of Human Resources in Organizations.
Global Human Resource Management Methods.
Managing a Multicultural Workforce.
How to Build an Anti Crisis Personnel Management to Navigate through Business Crisis.
The Impact of Technology on Management bias.
Employee Retention and Turnover.
The Role of Human Resources in Organizational Change.
Human Resources Management Bias and Performance Management.
The Challenges of Human Resources Management in the Nonprofit Sector.
Building Personnel Management Systems that are Effective for a Growing Business.

Case Study Topics for Marketing

Marketing case studies help individuals gain insight into real-life marketing challenges and strategies. They cover topics such as product development, brand management, advertising, strategic thinking for brand development, and individual purchasing decision making.

By examining successful companies in various industries and data analysis you can better understand the current marketing landscape and develop skills in market analysis.

Male target marketing methods and their effectiveness.
The different marketing styles of Steve Jobs and how they worked for or against him.
Online marketing dangers and how to avoid them.
Marketing research and its importance in marketing decisions.
Marketing methods and their effectiveness in different industries.
Physical marketing and its effectiveness compared to online marketing.
Marketing case studies and what we can learn from them.
The changing nature of marketing and its impact on businesses.
Marketing trends and how do they help german automotive industry.
How to use marketing to achieve business goals.
Free unlimited checks
All common file formats
Accurate results
Intuitive interface

Social Media Marketing Case Study Topics

In todays world, social media has become an important tool for business. It allows them to engage with their target audience from all over the world. Case studies based on the topic of social media management offer insights that are valuable and in-depth.

There can be several topics pertaining to social media, including influencer marketing, advertising, social media dangers, the influence of social media groups, and community management. Whether its MLA format or APA format case study , the first task is to decide on an interesting topic. These topics allow individuals to understand how to use insights to increase customer engagement and even drive website traffic growth for your business. Here are some topics pertaining to social media that you can take inspiration from:

The use of social media in marketing and how it allows for global management.
The Impact of Social Media on Business Operations and Customer Engagement.
The different types of social mediums and how they can be used for marketing purposes.
How can we use online social channels in order to improve customer support and management?
How to create effective social media marketing campaigns.
The use of social media analytics to measure the success of marketing campaigns.
The impact of social media on SEO and website traffic.
The use of online marketing and social platforms in e-commerce.
The dangers of online social platforms and how to avoid them.
Comparing Social Media Marketing Strategies: What is the Most Effective Approach for Your Business?

Information Technology Case Study Topics

One effective method of showcasing how IT solutions can tackle specific challenges faced by businesses or organizations is through the use of IT case studies. These studies enable us to concentrate not only on software development but also on other key elements like hardware, networks, and integrated IT solutions.

Given the significant role technology plays in today’s world. They cover a range of topics, including cloud computing, data transfer methods, and artificial intelligence.

The impact of information technology on organizational performance.
How can information technology can help eradicate improper examination methods.
How can we use information technology for mechanical engineering studies.
The impact of information technology on the organization’s ability to compete in the marketplace.
Can artificial intelligence revolutionize modern programming methods?
How information technology influences teaching methods?
The impact of information technology on the organization’s ability to innovate and marketing methods.
The impact of information technology on the organization’s ability to manage risk.
The use of information technology and tools in European middle schools.
How can information technology help in making police operations more efficient?

Human Rights Case Study Topics

Case studies in the field of human rights explore issues that are both complex and controversial. These are usually related to the context of human rights. They provide real world examples.

Some of the common case study topics includes age gap differences, gender-based violence, refugees and asylum-seekers.

What role does international law play on the use of death penalty.
The root cause of human trafficking and its many forms.
Challenges and successes of promoting and protecting LGBTQ rights.
The various dimensions of refugee crisis and how can government play an efficient role.
Complex issue surrounding the regulation of firearms.
Legal, ethical, and social implications of abortion.
Examining the impact on minimum wage increase on the labor.
Access to healthcare system and realization of human rights.
Effective strategies and approaches to motivate children in education.
Sustainable development strategies to promote social, economical, and environmental stability.

Case Study Topics for Nursing

There are different issues that nurses face in healthcare. Nursing case studies explore theories, principals, and practices in real world situations while analyzing the challenges and successes in the field of nursing.

Case studies are a platform to experience and learn from each other, here are some example topics to get inspired.

Reducing Nursing Stress: Effective Methods for Promoting Well-being in the Healthcare Environment.
The Crucial Role of Nursing In Healthcare system and Overall Health Outcomes.
The Advancement and Impact of Modern Nursing Methods.
Nurse-patient communication and How It Impacts Healthcare Outcomes.
The Impact of Technology on Preserving Patient Privacy.
The Critical Role of Patient Satisfaction in Healthcare Outcomes and Quality of Care.
Nurses’ Roles and Responsibilities In Ensuring a Positive Environment.
How does the Nurses’ Work Environments Impact Their Productivity.
Nursing Stress Reduction Methods and How They Can Impact Healthcare Outcomes.
Nurses’ Professional Organizations and How They Impact Nurses.

Choosing a topic for your case study doesn’t have to be intimidating – our list of topics covers various academic subjects and provides great ideas if you’re feeling stuck. Plus, by taking the time to research thoroughly, sketch out the problem parameters, and explore potential interventions and results.

With these steps in hand – and an optimistic outlook – you’ll surely become a leader among scholars and business professionals alike!

Readers also enjoyed

WHY WAIT? PLACE AN ORDER RIGHT NOW!

Just fill out the form, press the button, and have no worries!

We use cookies to give you the best experience possible. By continuing we’ll assume you board with our cookie policy.

Buy Me a Coffee

Home » Case Study – Methods, Examples and Guide

Case Study – Methods, Examples and Guide

Table of Contents

A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation.

It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied. Case studies typically involve multiple sources of data, including interviews, observations, documents, and artifacts, which are analyzed using various techniques, such as content analysis, thematic analysis, and grounded theory. The findings of a case study are often used to develop theories, inform policy or practice, or generate new research questions.

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

A single-case study is an in-depth analysis of a single case. This type of case study is useful when the researcher wants to understand a specific phenomenon in detail.

For Example , A researcher might conduct a single-case study on a particular individual to understand their experiences with a particular health condition or a specific organization to explore their management practices. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a single-case study are often used to generate new research questions, develop theories, or inform policy or practice.

Multiple-Case Study

A multiple-case study involves the analysis of several cases that are similar in nature. This type of case study is useful when the researcher wants to identify similarities and differences between the cases.

For Example, a researcher might conduct a multiple-case study on several companies to explore the factors that contribute to their success or failure. The researcher collects data from each case, compares and contrasts the findings, and uses various techniques to analyze the data, such as comparative analysis or pattern-matching. The findings of a multiple-case study can be used to develop theories, inform policy or practice, or generate new research questions.

Exploratory Case Study

An exploratory case study is used to explore a new or understudied phenomenon. This type of case study is useful when the researcher wants to generate hypotheses or theories about the phenomenon.

For Example, a researcher might conduct an exploratory case study on a new technology to understand its potential impact on society. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as grounded theory or content analysis. The findings of an exploratory case study can be used to generate new research questions, develop theories, or inform policy or practice.

Descriptive Case Study

A descriptive case study is used to describe a particular phenomenon in detail. This type of case study is useful when the researcher wants to provide a comprehensive account of the phenomenon.

For Example, a researcher might conduct a descriptive case study on a particular community to understand its social and economic characteristics. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of a descriptive case study can be used to inform policy or practice or generate new research questions.

Instrumental Case Study

An instrumental case study is used to understand a particular phenomenon that is instrumental in achieving a particular goal. This type of case study is useful when the researcher wants to understand the role of the phenomenon in achieving the goal.

For Example, a researcher might conduct an instrumental case study on a particular policy to understand its impact on achieving a particular goal, such as reducing poverty. The researcher collects data from multiple sources, such as interviews, observations, and documents, and uses various techniques to analyze the data, such as content analysis or thematic analysis. The findings of an instrumental case study can be used to inform policy or practice or generate new research questions.

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

Interviews involve asking questions to individuals who have knowledge or experience relevant to the case study. Interviews can be structured (where the same questions are asked to all participants) or unstructured (where the interviewer follows up on the responses with further questions). Interviews can be conducted in person, over the phone, or through video conferencing.

Observations

Observations involve watching and recording the behavior and activities of individuals or groups relevant to the case study. Observations can be participant (where the researcher actively participates in the activities) or non-participant (where the researcher observes from a distance). Observations can be recorded using notes, audio or video recordings, or photographs.

Documents can be used as a source of information for case studies. Documents can include reports, memos, emails, letters, and other written materials related to the case study. Documents can be collected from the case study participants or from public sources.

Surveys involve asking a set of questions to a sample of individuals relevant to the case study. Surveys can be administered in person, over the phone, through mail or email, or online. Surveys can be used to gather information on attitudes, opinions, or behaviors related to the case study.

Artifacts are physical objects relevant to the case study. Artifacts can include tools, equipment, products, or other objects that provide insights into the case study phenomenon.

How to conduct Case Study Research

Conducting a case study research involves several steps that need to be followed to ensure the quality and rigor of the study. Here are the steps to conduct case study research:

Define the research questions: The first step in conducting a case study research is to define the research questions. The research questions should be specific, measurable, and relevant to the case study phenomenon under investigation.
Select the case: The next step is to select the case or cases to be studied. The case should be relevant to the research questions and should provide rich and diverse data that can be used to answer the research questions.
Collect data: Data can be collected using various methods, such as interviews, observations, documents, surveys, and artifacts. The data collection method should be selected based on the research questions and the nature of the case study phenomenon.
Analyze the data: The data collected from the case study should be analyzed using various techniques, such as content analysis, thematic analysis, or grounded theory. The analysis should be guided by the research questions and should aim to provide insights and conclusions relevant to the research questions.
Draw conclusions: The conclusions drawn from the case study should be based on the data analysis and should be relevant to the research questions. The conclusions should be supported by evidence and should be clearly stated.
Validate the findings: The findings of the case study should be validated by reviewing the data and the analysis with participants or other experts in the field. This helps to ensure the validity and reliability of the findings.
Write the report: The final step is to write the report of the case study research. The report should provide a clear description of the case study phenomenon, the research questions, the data collection methods, the data analysis, the findings, and the conclusions. The report should be written in a clear and concise manner and should follow the guidelines for academic writing.

Examples of Case Study

Here are some examples of case study research:

The Hawthorne Studies : Conducted between 1924 and 1932, the Hawthorne Studies were a series of case studies conducted by Elton Mayo and his colleagues to examine the impact of work environment on employee productivity. The studies were conducted at the Hawthorne Works plant of the Western Electric Company in Chicago and included interviews, observations, and experiments.
The Stanford Prison Experiment: Conducted in 1971, the Stanford Prison Experiment was a case study conducted by Philip Zimbardo to examine the psychological effects of power and authority. The study involved simulating a prison environment and assigning participants to the role of guards or prisoners. The study was controversial due to the ethical issues it raised.
The Challenger Disaster: The Challenger Disaster was a case study conducted to examine the causes of the Space Shuttle Challenger explosion in 1986. The study included interviews, observations, and analysis of data to identify the technical, organizational, and cultural factors that contributed to the disaster.
The Enron Scandal: The Enron Scandal was a case study conducted to examine the causes of the Enron Corporation’s bankruptcy in 2001. The study included interviews, analysis of financial data, and review of documents to identify the accounting practices, corporate culture, and ethical issues that led to the company’s downfall.
The Fukushima Nuclear Disaster : The Fukushima Nuclear Disaster was a case study conducted to examine the causes of the nuclear accident that occurred at the Fukushima Daiichi Nuclear Power Plant in Japan in 2011. The study included interviews, analysis of data, and review of documents to identify the technical, organizational, and cultural factors that contributed to the disaster.

Application of Case Study

Case studies have a wide range of applications across various fields and industries. Here are some examples:

Business and Management

Case studies are widely used in business and management to examine real-life situations and develop problem-solving skills. Case studies can help students and professionals to develop a deep understanding of business concepts, theories, and best practices.

Case studies are used in healthcare to examine patient care, treatment options, and outcomes. Case studies can help healthcare professionals to develop critical thinking skills, diagnose complex medical conditions, and develop effective treatment plans.

Case studies are used in education to examine teaching and learning practices. Case studies can help educators to develop effective teaching strategies, evaluate student progress, and identify areas for improvement.

Social Sciences

Case studies are widely used in social sciences to examine human behavior, social phenomena, and cultural practices. Case studies can help researchers to develop theories, test hypotheses, and gain insights into complex social issues.

Law and Ethics

Case studies are used in law and ethics to examine legal and ethical dilemmas. Case studies can help lawyers, policymakers, and ethical professionals to develop critical thinking skills, analyze complex cases, and make informed decisions.

Purpose of Case Study

The purpose of a case study is to provide a detailed analysis of a specific phenomenon, issue, or problem in its real-life context. A case study is a qualitative research method that involves the in-depth exploration and analysis of a particular case, which can be an individual, group, organization, event, or community.

The primary purpose of a case study is to generate a comprehensive and nuanced understanding of the case, including its history, context, and dynamics. Case studies can help researchers to identify and examine the underlying factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and detailed understanding of the case, which can inform future research, practice, or policy.

Case studies can also serve other purposes, including:

Illustrating a theory or concept: Case studies can be used to illustrate and explain theoretical concepts and frameworks, providing concrete examples of how they can be applied in real-life situations.
Developing hypotheses: Case studies can help to generate hypotheses about the causal relationships between different factors and outcomes, which can be tested through further research.
Providing insight into complex issues: Case studies can provide insights into complex and multifaceted issues, which may be difficult to understand through other research methods.
Informing practice or policy: Case studies can be used to inform practice or policy by identifying best practices, lessons learned, or areas for improvement.

Advantages of Case Study Research

There are several advantages of case study research, including:

In-depth exploration: Case study research allows for a detailed exploration and analysis of a specific phenomenon, issue, or problem in its real-life context. This can provide a comprehensive understanding of the case and its dynamics, which may not be possible through other research methods.
Rich data: Case study research can generate rich and detailed data, including qualitative data such as interviews, observations, and documents. This can provide a nuanced understanding of the case and its complexity.
Holistic perspective: Case study research allows for a holistic perspective of the case, taking into account the various factors, processes, and mechanisms that contribute to the case and its outcomes. This can help to develop a more accurate and comprehensive understanding of the case.
Theory development: Case study research can help to develop and refine theories and concepts by providing empirical evidence and concrete examples of how they can be applied in real-life situations.
Practical application: Case study research can inform practice or policy by identifying best practices, lessons learned, or areas for improvement.
Contextualization: Case study research takes into account the specific context in which the case is situated, which can help to understand how the case is influenced by the social, cultural, and historical factors of its environment.

Limitations of Case Study Research

There are several limitations of case study research, including:

Limited generalizability : Case studies are typically focused on a single case or a small number of cases, which limits the generalizability of the findings. The unique characteristics of the case may not be applicable to other contexts or populations, which may limit the external validity of the research.
Biased sampling: Case studies may rely on purposive or convenience sampling, which can introduce bias into the sample selection process. This may limit the representativeness of the sample and the generalizability of the findings.
Subjectivity: Case studies rely on the interpretation of the researcher, which can introduce subjectivity into the analysis. The researcher’s own biases, assumptions, and perspectives may influence the findings, which may limit the objectivity of the research.
Limited control: Case studies are typically conducted in naturalistic settings, which limits the control that the researcher has over the environment and the variables being studied. This may limit the ability to establish causal relationships between variables.
Time-consuming: Case studies can be time-consuming to conduct, as they typically involve a detailed exploration and analysis of a specific case. This may limit the feasibility of conducting multiple case studies or conducting case studies in a timely manner.
Resource-intensive: Case studies may require significant resources, including time, funding, and expertise. This may limit the ability of researchers to conduct case studies in resource-constrained settings.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

Questionnaire – Definition, Types, and Examples

Observational Research – Methods and Guide

Quantitative Research – Methods, Types and...

Qualitative Research Methods

Explanatory Research – Types, Methods, Guide

Survey Research – Types, Methods, Examples

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, automatically generate references for free.

Knowledge Base
Methodology
Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating, and understanding different aspects of a research problem .

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyse the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

Prevent plagiarism, run a free check.

Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

Provide new or unexpected insights into the subject
Challenge or complicate existing assumptions and theories
Propose practical courses of action to resolve a problem
Open up new directions for future research

Unlike quantitative or experimental research, a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible.

However, you can also choose a more common or representative case to exemplify a particular category, experience, or phenomenon.

Exemplify a theory by showing how it explains the case under investigation
Expand on a theory by uncovering new concepts and ideas that need to be incorporated
Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews, observations, and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data .

The aim is to gain as thorough an understanding as possible of the case and its context.

In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis, with separate sections or chapters for the methods , results , and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyse its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

McCombes, S. (2023, January 30). Case Study | Definition, Examples & Methods. Scribbr. Retrieved 15 April 2024, from https://www.scribbr.co.uk/research-methods/case-studies/

Is this article helpful?

Shona McCombes

Other students also liked, correlational research | guide, design & examples, a quick guide to experimental design | 5 steps & examples, descriptive research design | definition, methods & examples.

Search Menu
Browse content in Arts and Humanities
Browse content in Archaeology
Anglo-Saxon and Medieval Archaeology
Archaeological Methodology and Techniques
Archaeology by Region
Archaeology of Religion
Archaeology of Trade and Exchange
Biblical Archaeology
Contemporary and Public Archaeology
Environmental Archaeology
Historical Archaeology
History and Theory of Archaeology
Industrial Archaeology
Landscape Archaeology
Mortuary Archaeology
Prehistoric Archaeology
Underwater Archaeology
Urban Archaeology
Zooarchaeology
Browse content in Architecture
Architectural Structure and Design
History of Architecture
Residential and Domestic Buildings
Theory of Architecture
Browse content in Art
Art Subjects and Themes
History of Art
Industrial and Commercial Art
Theory of Art
Biographical Studies
Byzantine Studies
Browse content in Classical Studies
Classical History
Classical Philosophy
Classical Mythology
Classical Literature
Classical Reception
Classical Art and Architecture
Classical Oratory and Rhetoric
Greek and Roman Papyrology
Greek and Roman Epigraphy
Greek and Roman Law
Greek and Roman Archaeology
Late Antiquity
Religion in the Ancient World
Digital Humanities
Browse content in History
Colonialism and Imperialism
Diplomatic History
Environmental History
Genealogy, Heraldry, Names, and Honours
Genocide and Ethnic Cleansing
Historical Geography
History by Period
History of Emotions
History of Agriculture
History of Education
History of Gender and Sexuality
Industrial History
Intellectual History
International History
Labour History
Legal and Constitutional History
Local and Family History
Maritime History
Military History
National Liberation and Post-Colonialism
Oral History
Political History
Public History
Regional and National History
Revolutions and Rebellions
Slavery and Abolition of Slavery
Social and Cultural History
Theory, Methods, and Historiography
Urban History
World History
Browse content in Language Teaching and Learning
Language Learning (Specific Skills)
Language Teaching Theory and Methods
Browse content in Linguistics
Applied Linguistics
Cognitive Linguistics
Computational Linguistics
Forensic Linguistics
Grammar, Syntax and Morphology
Historical and Diachronic Linguistics
History of English
Language Evolution
Language Reference
Language Acquisition
Language Variation
Language Families
Lexicography
Linguistic Anthropology
Linguistic Theories
Linguistic Typology
Phonetics and Phonology
Psycholinguistics
Sociolinguistics
Translation and Interpretation
Writing Systems
Browse content in Literature
Bibliography
Children's Literature Studies
Literary Studies (Romanticism)
Literary Studies (American)
Literary Studies (Asian)
Literary Studies (European)
Literary Studies (Eco-criticism)
Literary Studies (Modernism)
Literary Studies - World
Literary Studies (1500 to 1800)
Literary Studies (19th Century)
Literary Studies (20th Century onwards)
Literary Studies (African American Literature)
Literary Studies (British and Irish)
Literary Studies (Early and Medieval)
Literary Studies (Fiction, Novelists, and Prose Writers)
Literary Studies (Gender Studies)
Literary Studies (Graphic Novels)
Literary Studies (History of the Book)
Literary Studies (Plays and Playwrights)
Literary Studies (Poetry and Poets)
Literary Studies (Postcolonial Literature)
Literary Studies (Queer Studies)
Literary Studies (Science Fiction)
Literary Studies (Travel Literature)
Literary Studies (War Literature)
Literary Studies (Women's Writing)
Literary Theory and Cultural Studies
Mythology and Folklore
Shakespeare Studies and Criticism
Browse content in Media Studies
Browse content in Music
Applied Music
Dance and Music
Ethics in Music
Ethnomusicology
Gender and Sexuality in Music
Medicine and Music
Music Cultures
Music and Media
Music and Religion
Music and Culture
Music Education and Pedagogy
Music Theory and Analysis
Musical Scores, Lyrics, and Libretti
Musical Structures, Styles, and Techniques
Musicology and Music History
Performance Practice and Studies
Race and Ethnicity in Music
Sound Studies
Browse content in Performing Arts
Browse content in Philosophy
Aesthetics and Philosophy of Art
Epistemology
Feminist Philosophy
History of Western Philosophy
Metaphysics
Moral Philosophy
Non-Western Philosophy
Philosophy of Language
Philosophy of Mind
Philosophy of Perception
Philosophy of Science
Philosophy of Action
Philosophy of Law
Philosophy of Religion
Philosophy of Mathematics and Logic
Practical Ethics
Social and Political Philosophy
Browse content in Religion
Biblical Studies
Christianity
East Asian Religions
History of Religion
Judaism and Jewish Studies
Qumran Studies
Religion and Education
Religion and Health
Religion and Politics
Religion and Science
Religion and Law
Religion and Art, Literature, and Music
Religious Studies
Browse content in Society and Culture
Cookery, Food, and Drink
Cultural Studies
Customs and Traditions
Ethical Issues and Debates
Hobbies, Games, Arts and Crafts
Lifestyle, Home, and Garden
Natural world, Country Life, and Pets
Popular Beliefs and Controversial Knowledge
Sports and Outdoor Recreation
Technology and Society
Travel and Holiday
Visual Culture
Browse content in Law
Arbitration
Browse content in Company and Commercial Law
Commercial Law
Company Law
Browse content in Comparative Law
Systems of Law
Competition Law
Browse content in Constitutional and Administrative Law
Government Powers
Judicial Review
Local Government Law
Military and Defence Law
Parliamentary and Legislative Practice
Construction Law
Contract Law
Browse content in Criminal Law
Criminal Procedure
Criminal Evidence Law
Sentencing and Punishment
Employment and Labour Law
Environment and Energy Law
Browse content in Financial Law
Banking Law
Insolvency Law
History of Law
Human Rights and Immigration
Intellectual Property Law
Browse content in International Law
Private International Law and Conflict of Laws
Public International Law
IT and Communications Law
Jurisprudence and Philosophy of Law
Law and Politics
Law and Society
Browse content in Legal System and Practice
Courts and Procedure
Legal Skills and Practice
Primary Sources of Law
Regulation of Legal Profession
Medical and Healthcare Law
Browse content in Policing
Criminal Investigation and Detection
Police and Security Services
Police Procedure and Law
Police Regional Planning
Browse content in Property Law
Personal Property Law
Study and Revision
Terrorism and National Security Law
Browse content in Trusts Law
Wills and Probate or Succession
Browse content in Medicine and Health
Browse content in Allied Health Professions
Arts Therapies
Clinical Science
Dietetics and Nutrition
Occupational Therapy
Operating Department Practice
Physiotherapy
Radiography
Speech and Language Therapy
Browse content in Anaesthetics
General Anaesthesia
Neuroanaesthesia
Clinical Neuroscience
Browse content in Clinical Medicine
Acute Medicine
Cardiovascular Medicine
Clinical Genetics
Clinical Pharmacology and Therapeutics
Dermatology
Endocrinology and Diabetes
Gastroenterology
Genito-urinary Medicine
Geriatric Medicine
Infectious Diseases
Medical Toxicology
Medical Oncology
Pain Medicine
Palliative Medicine
Rehabilitation Medicine
Respiratory Medicine and Pulmonology
Rheumatology
Sleep Medicine
Sports and Exercise Medicine
Community Medical Services
Critical Care
Emergency Medicine
Forensic Medicine
Haematology
History of Medicine
Browse content in Medical Skills
Clinical Skills
Communication Skills
Nursing Skills
Surgical Skills
Browse content in Medical Dentistry
Oral and Maxillofacial Surgery
Paediatric Dentistry
Restorative Dentistry and Orthodontics
Surgical Dentistry
Medical Ethics
Medical Statistics and Methodology
Browse content in Neurology
Clinical Neurophysiology
Neuropathology
Nursing Studies
Browse content in Obstetrics and Gynaecology
Gynaecology
Occupational Medicine
Ophthalmology
Otolaryngology (ENT)
Browse content in Paediatrics
Neonatology
Browse content in Pathology
Chemical Pathology
Clinical Cytogenetics and Molecular Genetics
Histopathology
Medical Microbiology and Virology
Patient Education and Information
Browse content in Pharmacology
Psychopharmacology
Browse content in Popular Health
Caring for Others
Complementary and Alternative Medicine
Self-help and Personal Development
Browse content in Preclinical Medicine
Cell Biology
Molecular Biology and Genetics
Reproduction, Growth and Development
Primary Care
Professional Development in Medicine
Browse content in Psychiatry
Addiction Medicine
Child and Adolescent Psychiatry
Forensic Psychiatry
Learning Disabilities
Old Age Psychiatry
Psychotherapy
Browse content in Public Health and Epidemiology
Epidemiology
Public Health
Browse content in Radiology
Clinical Radiology
Interventional Radiology
Nuclear Medicine
Radiation Oncology
Reproductive Medicine
Browse content in Surgery
Cardiothoracic Surgery
Gastro-intestinal and Colorectal Surgery
General Surgery
Neurosurgery
Paediatric Surgery
Peri-operative Care
Plastic and Reconstructive Surgery
Surgical Oncology
Transplant Surgery
Trauma and Orthopaedic Surgery
Vascular Surgery
Browse content in Science and Mathematics
Browse content in Biological Sciences
Aquatic Biology
Biochemistry
Bioinformatics and Computational Biology
Developmental Biology
Ecology and Conservation
Evolutionary Biology
Genetics and Genomics
Microbiology
Molecular and Cell Biology
Natural History
Plant Sciences and Forestry
Research Methods in Life Sciences
Structural Biology
Systems Biology
Zoology and Animal Sciences
Browse content in Chemistry
Analytical Chemistry
Computational Chemistry
Crystallography
Environmental Chemistry
Industrial Chemistry
Inorganic Chemistry
Materials Chemistry
Medicinal Chemistry
Mineralogy and Gems
Organic Chemistry
Physical Chemistry
Polymer Chemistry
Study and Communication Skills in Chemistry
Theoretical Chemistry
Browse content in Computer Science
Artificial Intelligence
Computer Architecture and Logic Design
Game Studies
Human-Computer Interaction
Mathematical Theory of Computation
Programming Languages
Software Engineering
Systems Analysis and Design
Virtual Reality
Browse content in Computing
Business Applications
Computer Security
Computer Games
Computer Networking and Communications
Digital Lifestyle
Graphical and Digital Media Applications
Operating Systems
Browse content in Earth Sciences and Geography
Atmospheric Sciences
Environmental Geography
Geology and the Lithosphere
Maps and Map-making
Meteorology and Climatology
Oceanography and Hydrology
Palaeontology
Physical Geography and Topography
Regional Geography
Soil Science
Urban Geography
Browse content in Engineering and Technology
Agriculture and Farming
Biological Engineering
Civil Engineering, Surveying, and Building
Electronics and Communications Engineering
Energy Technology
Engineering (General)
Environmental Science, Engineering, and Technology
History of Engineering and Technology
Mechanical Engineering and Materials
Technology of Industrial Chemistry
Transport Technology and Trades
Browse content in Environmental Science
Applied Ecology (Environmental Science)
Conservation of the Environment (Environmental Science)
Environmental Sustainability
Environmentalist Thought and Ideology (Environmental Science)
Management of Land and Natural Resources (Environmental Science)
Natural Disasters (Environmental Science)
Nuclear Issues (Environmental Science)
Pollution and Threats to the Environment (Environmental Science)
Social Impact of Environmental Issues (Environmental Science)
History of Science and Technology
Browse content in Materials Science
Ceramics and Glasses
Composite Materials
Metals, Alloying, and Corrosion
Nanotechnology
Browse content in Mathematics
Applied Mathematics
Biomathematics and Statistics
History of Mathematics
Mathematical Education
Mathematical Finance
Mathematical Analysis
Numerical and Computational Mathematics
Probability and Statistics
Pure Mathematics
Browse content in Neuroscience
Cognition and Behavioural Neuroscience
Development of the Nervous System
Disorders of the Nervous System
History of Neuroscience
Invertebrate Neurobiology
Molecular and Cellular Systems
Neuroendocrinology and Autonomic Nervous System
Neuroscientific Techniques
Sensory and Motor Systems
Browse content in Physics
Astronomy and Astrophysics
Atomic, Molecular, and Optical Physics
Biological and Medical Physics
Classical Mechanics
Computational Physics
Condensed Matter Physics
Electromagnetism, Optics, and Acoustics
History of Physics
Mathematical and Statistical Physics
Measurement Science
Nuclear Physics
Particles and Fields
Plasma Physics
Quantum Physics
Relativity and Gravitation
Semiconductor and Mesoscopic Physics
Browse content in Psychology
Affective Sciences
Clinical Psychology
Cognitive Psychology
Cognitive Neuroscience
Criminal and Forensic Psychology
Developmental Psychology
Educational Psychology
Evolutionary Psychology
Health Psychology
History and Systems in Psychology
Music Psychology
Neuropsychology
Organizational Psychology
Psychological Assessment and Testing
Psychology of Human-Technology Interaction
Psychology Professional Development and Training
Research Methods in Psychology
Social Psychology
Browse content in Social Sciences
Browse content in Anthropology
Anthropology of Religion
Human Evolution
Medical Anthropology
Physical Anthropology
Regional Anthropology
Social and Cultural Anthropology
Theory and Practice of Anthropology
Browse content in Business and Management
Business Ethics
Business Strategy
Business History
Business and Technology
Business and Government
Business and the Environment
Comparative Management
Corporate Governance
Corporate Social Responsibility
Entrepreneurship
Health Management
Human Resource Management
Industrial and Employment Relations
Industry Studies
Information and Communication Technologies
International Business
Knowledge Management
Management and Management Techniques
Operations Management
Organizational Theory and Behaviour
Pensions and Pension Management
Public and Nonprofit Management
Strategic Management
Supply Chain Management
Browse content in Criminology and Criminal Justice
Criminal Justice
Criminology
Forms of Crime
International and Comparative Criminology
Youth Violence and Juvenile Justice
Development Studies
Browse content in Economics
Agricultural, Environmental, and Natural Resource Economics
Asian Economics
Behavioural Finance
Behavioural Economics and Neuroeconomics
Econometrics and Mathematical Economics
Economic History
Economic Systems
Economic Methodology
Economic Development and Growth
Financial Markets
Financial Institutions and Services
General Economics and Teaching
Health, Education, and Welfare
History of Economic Thought
International Economics
Labour and Demographic Economics
Law and Economics
Macroeconomics and Monetary Economics
Microeconomics
Public Economics
Urban, Rural, and Regional Economics
Welfare Economics
Browse content in Education
Adult Education and Continuous Learning
Care and Counselling of Students
Early Childhood and Elementary Education
Educational Equipment and Technology
Educational Strategies and Policy
Higher and Further Education
Organization and Management of Education
Philosophy and Theory of Education
Schools Studies
Secondary Education
Teaching of a Specific Subject
Teaching of Specific Groups and Special Educational Needs
Teaching Skills and Techniques
Browse content in Environment
Applied Ecology (Social Science)
Climate Change
Conservation of the Environment (Social Science)
Environmentalist Thought and Ideology (Social Science)
Natural Disasters (Environment)
Social Impact of Environmental Issues (Social Science)
Browse content in Human Geography
Cultural Geography
Economic Geography
Political Geography
Browse content in Interdisciplinary Studies
Communication Studies
Museums, Libraries, and Information Sciences
Browse content in Politics
African Politics
Asian Politics
Chinese Politics
Comparative Politics
Conflict Politics
Elections and Electoral Studies
Environmental Politics
European Union
Foreign Policy
Gender and Politics
Human Rights and Politics
Indian Politics
International Relations
International Organization (Politics)
International Political Economy
Irish Politics
Latin American Politics
Middle Eastern Politics
Political Behaviour
Political Economy
Political Institutions
Political Methodology
Political Communication
Political Philosophy
Political Sociology
Political Theory
Politics and Law
Public Policy
Public Administration
Quantitative Political Methodology
Regional Political Studies
Russian Politics
Security Studies
State and Local Government
UK Politics
US Politics
Browse content in Regional and Area Studies
African Studies
Asian Studies
East Asian Studies
Japanese Studies
Latin American Studies
Middle Eastern Studies
Native American Studies
Scottish Studies
Browse content in Research and Information
Research Methods
Browse content in Social Work
Addictions and Substance Misuse
Adoption and Fostering
Care of the Elderly
Child and Adolescent Social Work
Couple and Family Social Work
Developmental and Physical Disabilities Social Work
Direct Practice and Clinical Social Work
Emergency Services
Human Behaviour and the Social Environment
International and Global Issues in Social Work
Mental and Behavioural Health
Social Justice and Human Rights
Social Policy and Advocacy
Social Work and Crime and Justice
Social Work Macro Practice
Social Work Practice Settings
Social Work Research and Evidence-based Practice
Welfare and Benefit Systems
Browse content in Sociology
Childhood Studies
Community Development
Comparative and Historical Sociology
Economic Sociology
Gender and Sexuality
Gerontology and Ageing
Health, Illness, and Medicine
Marriage and the Family
Migration Studies
Occupations, Professions, and Work
Organizations
Population and Demography
Race and Ethnicity
Social Theory
Social Movements and Social Change
Social Research and Statistics
Social Stratification, Inequality, and Mobility
Sociology of Religion
Sociology of Education
Sport and Leisure
Urban and Rural Studies
Browse content in Warfare and Defence
Defence Strategy, Planning, and Research
Land Forces and Warfare
Military Administration
Military Life and Institutions
Naval Forces and Warfare
Other Warfare and Defence Issues
Peace Studies and Conflict Resolution
Weapons and Equipment

The Oxford Handbook of Qualitative Research

A newer edition of this book is available.

< Previous chapter
Next chapter >

22 Case Study Research: In-Depth Understanding in Context

Helen Simons, School of Education, University of Southampton

Published: 01 July 2014
Cite Icon Cite
Permissions Icon Permissions

This chapter explores case study as a major approach to research and evaluation. After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process. The chapter emphasizes how important it is to design the case, to collect and interpret data in ways that highlight the qualitative, to have an ethical practice that values multiple perspectives and political interests, and to report creatively to facilitate use in policy making and practice. Finally, it explores how to generalize from the single case. Concluding questions center on the need to think more imaginatively about design and the range of methods and forms of reporting requiredto persuade audiences to value qualitative ways of knowing in case study research.

Introduction

This chapter explores case study as a major approach to research and evaluation using primarily qualitative methods, as well as documentary sources, contemporaneous or historical. However, this is not the only way in which case study can be conceived. No one has a monopoly on the term. While sharing a focus on the singular in a particular context, case study has a wide variety of uses, not all associated with research. A case study, in common parlance, documents a particular situation or event in detail in a specific sociopolitical context. The particular can be a person, a classroom, an institution, a program, or a policy. Below I identify different ways in which case study is used before focusing on qualitative case study research in particular. However, first I wish to indicate how I came to advocate and practice this form of research. Origins, context, and opportunity often shape the research processes we endorse. It is helpful for the reader, I think, to know how I came to the perspective I hold.

The Beginnings

I first came to appreciate and enjoy the virtues of case study research when I entered the field of curriculum evaluation and research in the 1970s. The dominant research paradigm for educational research at that time was experimental or quasi- experimental, cost-benefit, or systems analysis, and the dominant curriculum model was aims and objectives ( House, 1993 ). The field was dominated, in effect, by a psychometric view of research in which quantitative methods were preeminent. But the innovative projects we were asked to evaluate (predominantly, but not exclusively, in the humanities) were not amenable to such methodologies. The projects were challenging to the status quo of institutions, involved people interpreting the policy and programs, were implemented differently in different contexts and regions, and had many unexpected effects.

We had no choice but to seek other ways to evaluate these complex programs, and case study was the methodology we found ourselves exploring, in order to understand how the projects were being implemented, why they had positive effects in some regions of the country and not others, and what the outcomes meant in different sociopolitical and cultural contexts. What better way to do this than to talk with people to see how they interpreted the “new” curriculum; to watch how teachers and students put it into practice; to document transactions, outcomes, and unexpected consequences; and to interpret all in the specific context of the case ( Simons, 1971 , 1987 , pp. 55–89). From this point on and in further studies, case study in educational research and evaluation came to be a major methodology for understanding complex educational and social programs. It also extended to other practice professions, such as nursing, health, and social care ( Zucker, 2001 ; Greenhalgh & Worrall, 1997 ; Shaw & Gould, 2001 ). For further details of the evolution of the case study approach and qualitative methodologies in evaluation, see House, 1993 , pp. 2–3; Greene, 2000 ; Simons, 2009 , pp. 14–18; Simons & McCormack, 2007 , pp. 292–311).

This was not exactly the beginning of case study, of course. It has a long history in many disciplines ( Simons, 1980; Ragin, 1992; Gomm, Hammersley, & Foster, 2004 ; Platt, 2007 ), many aspects of which form part of case study practice to this day. But its evolution in the context just described was a major move in the contemporary evolution of the logic of evaluative inquiry ( House, 1980 ). It also coincided with movement toward the qualitative in other disciplines, such as sociology and psychology. This was all part of what Denzin & Lincoln (1994) termed “a quiet methodological revolution” (p. ix) in qualitative inquiry that had been evolving over the course of forty years.

There is a further reason why I continue to advocate and practice case study research and evaluation to this day and that is my personal predilection for trying to understand and represent complexity, for puzzling through the ambiguities that exist in many contexts and programs and for presenting and negotiating different values and interests in fair and just ways.

Put more simply, I like interacting with people, listening to their stories, trials and tribulations—giving them a voice in understanding the contexts and projects with which they are involved, and finding ways to share these with a range of audiences. In other words, the move toward case study methodology described here suited my preference for how I learn.

Concepts and Purposes of Case Study

Before exploring case study as it has come to be established in educational research and evaluation over the past forty years, I wish to acknowledge other uses of case study. More often than not, these relate to purpose, and appropriately so in their different contexts, but many do not have a research intention. For a study to count as research, it would need to be a systematic investigation generating evidence that leads to “new” knowledge that is made public and open to scrutiny. There are many ways to conduct research stemming from different traditions and disciplines, but they all, in different ways, involve these characteristics.

Everyday Usage: Stories We Tell

The most common of these uses of case study is the everyday reference to a person, an anecdote or story illustrative of a particular incident, event, or experience of that person. It is often a short, reported account commonly seen in journalism but also in books exploring a phenomenon, such as recovery from serious accidents or tragedies, where the author chooses to illustrate the story or argument with a “lived” example. This is sometimes written by the author and sometimes by the person whose tale it is. “Let me share with you a story,” is a phrase frequently heard

The spirit behind this common usage and its power to connect can be seen in a report by Tim Adams of the London Olympics opening ceremony’s dramatization by Danny Boyle.

It was the point when we suddenly collectively wised up to the idea that what we are about to receive over the next two weeks was not only about “legacy collateral” and “targeted deliverables,” not about G4S failings and traffic lanes and branding opportunities, but about the second-by-second possibilities of human endeavour and spirit and communality, enacted in multiple places and all at the same time. Stories in other words. ( Adams, 2012 )

This was a collective story, of course, not an individual one, but it does convey some of the major characteristics of case study—that richness of detail, time, place, multiple happenings and experiences—that are also manifest in case study research, although carefully evidenced in the latter instance. We can see from this common usage how people have come to associate case study with story. I return to this thread in the reporting section.

Professions Individual Cases

In professional settings, in health and social care, case studies, often called case histories , are used to accurately record a person’s health or social care history and his or her current symptoms, experience, and treatment. These case histories include facts but also judgments and observations about the person’s reaction to situations or medication. Usually these are confidential. Not dissimilar is the detailed documentation of a case in law, often termed a case precedent when referred to in a court case to support an argument being made. However in law there is a difference in that such case precedents are publicly documented.

Case Studies in Teaching

Exemplars of practice.

In education, but also in health and social care training contexts, case studies have long been used as exemplars of practice. These are brief descriptions with some detail of a person or project’s experience in an area of practice. Though frequently reported accounts, they are based on a person’s experience and sometimes on previous research.

Case scenarios

Management studies are a further context in which case studies are often used. Here, the case is more like a scenario outlining a particular problem situation for the management student to resolve. These scenarios may be based on research but frequently are hypothetical situations used to raise issues for discussion and resolution. What distinguishes these case scenarios and the case exemplars in education from case study research is the intention to use them for teaching purposes.

Country Case Studies

Then there are case studies of programs, projects, and even countries, as in international development, where a whole-country study might be termed a case study or, in the context of the Organization for Economic Co-operation and Development (OECD), where an exploration is conducted of the state of the art of a subject, such as education or environmental science in one or several countries. This may be a contemporaneous study and/or what transpired in a program over a period of time. Such studies often do have a research base but frequently are reported accounts that do not detail the design, methodology, and analysis of the case, as a research case study would do, or report in ways that give readers a vicarious experience of what it was like to be there. Such case studies tend to be more knowledge and information-focused than experiential.

Case Study as History

Closer to a research context is case study as history—what transpired at a certain time in a certain place. This is likely to be supported by documentary evidence but not primary data gathering unless it is an oral history. In education, in the late 1970s, Stenhouse (1978) experimented with a case study archive. Using contemporaneous data gathering, primarily through interviewing, he envisaged this database, which he termed a “case record,” forming an archive from which different individuals,, at some later date, could write a “case study.” This approach uses case study as a documentary source to begin to generate a history of education, as the subtitle of Stenhouse’s 1978 paper indicates “Towards a contemporary history of education.”

Case Study Research

From here on, my focus is on case study research per se, adopting for this purpose the following definition:

Case study is an in-depth exploration from multiple perspectives of the complexity and uniqueness of a particular project, policy, institution or system in a “real-life” context. It is research based, inclusive of different methods and is evidence-led. ( Simons, 2009 , p. 21).

For further related definitions of case study, see Stake (1995) , Merriam (1998), and Chadderton & Torrance (2011) . And for definitions from a slightly different perspective, see Yin (2004) and Thomas (2011a) .

Not Defined by Method or Perspective

The inclusion of different methods in the definition quoted above definition signals that case study research is not defined by methodology or method. What defines case study is its singularity and the concept and boundary of the case. It is theoretically possible to conduct a case study using primarily quantitative data if this is the best way of providing evidence to inform the issues the case is exploring. It is equally possible to conduct case study that is mainly qualitative, to engage people with the experience of the case or to provide a rich portrayal of an event, project, or program.

Or one can design the case using mixed methods. This increases the options for learning from different ways of knowing and is sometimes preferred by stakeholders who believe it provides a firmer basis for informing policy. This is not necessarily the case but is beyond the scope of this chapter to explore. For further discussion of the complexities of mixing methods and the virtue of using qualitative methods and case study in a mixed method design, see Greene (2007) .

Case study research may also be conducted from different standpoints—realist, interpretivist, or constructivist, for example. My perspective falls within a constructivist, interpretivist framework. What interests me is how I and those in the case perceive and interpret what we find and how we construct or co-construct understandings of the case. This not only suits my predilection for how I see the world, but also my preferred phenomenological approach to interviewing and curiosity about people and how they act in social and professional life.

Qualitative Case Study Research

Qualitative case study research shares many characteristics with other forms of qualitative research, such as narrative, oral history, life history, ethnography, in-depth interview, and observational studies that utilize qualitative methods. However, its focus, purpose, and origins, in educational research at least, are a little different.

The focus is clearly the study of the singular. The purpose is to portray an in-depth view of the quality and complexity of social/educational programs or policies as they are implemented in specific sociopolitical contexts. What makes it qualitative is its emphasis on subjective ways of knowing, particularly the experiential, practical, and presentational rather than the propositional ( Heron, 1992 , 1999 ) to comprehend and communicate what transpired in the case.

Characteristic Features and Advantages

Case study research is not method dependent, as noted earlier, nor is it constrained by resources or time. Although it can be conducted over several years, which provides an opportunity to explore the process of change and explain how and why things happened, it can equally be carried out contemporaneously in a few days, weeks, or months. This flexibility is extremely useful in many contexts, particularly when a change in policy or unforeseen issues in the field require modifying the design.

Flexibility extends to reporting. The case can be written up in different lengths and forms to meet different audience needs and to maximize use (see the section on Reporting). Using the natural language of participants and familiar methods (like interview, observation, oral history) also enables participants to engage in the research process, thereby contributing significantly to the generation of knowledge of the case. As I have indicated elsewhere ( Simons, 2009 ), “This is both a political and epistemological point. It signals a potential shift in the power base of who controls knowledge and recognizes the importance of co-constructing perceived reality through the relationships and joint understandings we create in the field” (p. 23).

Possible Disadvantages

If one is an advocate, identifying advantages of a research approach is easier than pointing out its disadvantages, something detractors are quite keen to do anyway! But no approach is perfect, and here are some of the issues that often trouble people about case study research. The “sample of one” is an obvious issue that worries those convinced that only large samples can constitute valid research and especially if this is to inform policy. Understanding complexity in depth may not be a sufficient counterargument, and I suspect there is little point in trying to persuade otherwise For frequently, this perception is one of epistemological and methodological, if not ideological, preference.

However, there are some genuine concerns that many case researchers face: the difficulty of processing a mass of data; of “telling the truth” in contexts where people may be identifiable; personal involvement, when the researcher is the main instrument of data gathering; and writing reports that are data-based, yet readable in style and length. But one issue that concerns advocates and nonadvocates alike is how inferences are drawn from the single case.

Answers to some of these issues are covered in the sections that follow. Whether they convince may again be a question of preference. However, it is worth noting here that I do not think we should seek to justify these concerns in terms identified by other methodologies. Many of them are intrinsic to the nature and strength of qualitative case study research.

Subjectivity, for instance, both of participants and researcher is inevitable, as it is in many other qualitative methodologies. This is often the basis on which we act. Rather than see this as bias or something to counter, it is an intelligence that is essential to understanding and interpreting the experience of participants and stakeholders. Such subjectivity needs to be disciplined, of course, through procedures that examine both the validity of individuals’ representations of “their truth”, and demonstrate how the researcher took a reflexive approach to monitoring how his or her own values and predilections may have unduly influenced the data.

Types of Case Study

There are numerous types of case study, too many to categorize, I think, as there are overlaps between them. However, attempts have been made to do this and, for those who value typologies, I refer them to Bassey (1999) and, for a more extended typology, to Thomas (2011b) . A slightly different approach is taken by Gomm, Hammersley, and Foster (2004) in annotating the different emphases in major texts on case study. What I prefer to do here is to highlight a few familiar types to focus the discussion that follows on the practice of case study research.

Stake (1995) offers a threefold distinction that is helpful when it comes to practice, he says, because it influences the methods we choose to gather data (p. 4). He distinguishes between an intrinsic case study , one that is studied to learn about the particular case itself and an instrumental case study , in which we choose a case to gain insight into a particular issue (i.e., the case is instrumental to understanding something else; p. 3). The collective case study is what its name suggests: an extension of the instrumental to several cases.

Theory-led or theory-generated case study is similarly self-explanatory, the first starting from a specific theory that is tested through the case; the second constructing a theory through interpretation of data generated in the case. In other words, one ends rather than begins with a theory. In qualitative case study research, this is the more familiar route. The theory of the case becomes the argument or story you will tell.

Evaluation case study requires a slightly longer description as this is my context of practice, one which has influenced the way I conduct case study and what I choose to emphasize in this chapter. An evaluation case study has three essential features: to determine the value of the case, to include and balance different interests and values, and to report findings to a range of stakeholders in ways that they can use. The reasons for this may be found in the interlude that follows, which offers a brief characterization of the social and ethical practice of evaluation and why qualitative methods are so important in this practice.

Interlude: Social and Ethical Practice of Evaluation

Evaluation is a social practice that documents, portrays, and seeks to understand the value of a particular project, program, or policy. This can be determined by different evaluation methodologies, of course. But the value of qualitative case study is that it is possible to discern this value without decontextualizing the data. While the focus of the case is usually a project, program, policy, or some unit within, studies of key individuals, what I term case profiles , may be embedded within the overall case. In some instances, these profiles, or even shorter cameos of individuals, may be quite prominent. For it is through the perceptions, interpretations, and interactions of people that we learn how policies and programs are enacted ( Kushner, 2000 , p. 12). The program is still the main focus of analysis, but, in exploring how individuals play out their different roles in the program, we get closer to the actual experience and meaning of the program in practice.

Case study evaluation is often commissioned from an external source (government department or other agency) keen to know the worth of publicly funded programs and policies to inform future decision making. It needs to be responsive to issues or questions identified by stakeholders, who often have different values and interests in the expected outcomes and appreciate different perspectives of the program in action. The context also is often highly politicized, and interests can conflict. The task of the evaluator in such situations becomes one of including and balancing all interests and values in the program fairly and justly.

This is an inherently political process and requires an ethical practice that offers participants some protection over the personal data they give as part of the research and agreed audiences access to the findings, presented in ways they can understand. Negotiating what information becomes public can be quite difficult in singular settings where people are identifiable and intricate or problematic transactions have been documented. The consequences that ensue from making knowledge public that hitherto was private may be considerable for those in the case. It may also be difficult to portray some of the contextual detail that would enhance understanding for readers.

The ethical stance that underpins the case study research and evaluation I conduct stems from a theory of ethics that emphasizes the centrality of relationships in the specific context and the consequences for individuals, while remaining aware of the research imperative to publicly report. It is essentially an independent democratic process based on the concepts of fairness and justice, in which confidentiality, negotiation, and accessibility are key principles ( MacDonald, 1976 ; Simons, 2009 , pp. 96–111; and Simons 2010 ). The principles are translated into specific procedures to guide the collection, validation, and dissemination of data in the field. These include:

engaging participants and stakeholders in identifying issues to explore and sometimes also in interpreting the data;

documenting how different people interpret and value the program;

negotiating what data becomes public respecting both the individual’s “right to privacy” and the public’s “right to know”;

offering participants opportunities to check how their data are used in the context of reporting;

reporting in language and forms accessible to a wide range of audiences;

disseminating to audiences within and beyond the case.

For further discussion of the ethics of democratic case study evaluation and examples of their use in practice, see Simons (2000 , 2006 , 2009 , chapter 6, 2010 ).

Designing Case Study Research

Design issues in case study sometimes take second place to those of data gathering, the more exciting task perhaps in starting research. However, it is critical to consider the design at the outset, even if changes are required in practice due to the reality of what is encountered in the field. In this sense, the design of case study is emergent, rather than preordinate, shaped and reshaped as understanding of the significance of foreshadowed issues emerges and more are discovered.

Before entering the field, there are a myriad of planning issues to think about related to stakeholders, participants, and audiences. These include whose values matter, whether to engage them in data gathering and interpretation, the style of reporting appropriate for each, and the ethical guidelines that will underpin data collection and reporting. However, here I emphasize only three: the broad focus of the study, what the case is a case of, and framing questions/issues. These are steps often ignored in an enthusiasm to gather data, resulting in a case study that claims to be research but lacks the basic principles required for generation of valid, public knowledge.

Conceptualize the Topic

First, it is important that the topic of the research is conceptualized in a way that it can be researched (i.e., it is not too wide). This seems an obvious point to make, but failure to think through precisely what it is about your research topic you wish to investigate will have a knock-on effect on the framing of the case, data gathering, and interpretation and may lead, in some instances, to not gathering or analyzing data that actually informs the topic. Further conceptualization or reconceptualization may be necessary as the study proceeds, but it is critical to have a clear focus at the outset.

What Constitutes the Case

Second, I think it is important to decide what would constitute the case (i.e., what it is a case of) and where the boundaries of this lie. This often proves more difficult than first appears. And sometimes, partly because of the semifluid nature of the way the case evolves, it is only possible to finally establish what the case is a case of at the end. Nevertheless, it is useful to identify what the case and its boundaries are at the outset to help focus data collection while maintaining an awareness that these may shift. This is emergent design in action.

In deciding the boundary of the case, there are several factors to bear in mind. Is it bounded by an institution or a unit within an institution, by people within an institution, by region, or by project, program or policy,? If we take a school as an example, the case could be comprised of the principal, teachers, and students, or the boundary could be extended to the cleaners, the caretaker, the receptionist, people who often know a great deal about the subnorms and culture of the institution.

If the case is a policy or particular parameter of a policy, the considerations may be slightly different. People will still be paramount—those who generated the policy and those who implemented it—but there is likely also to be a political culture surrounding the policy that had an influence on the way the policy evolved. Would this be part of the case?

Whatever boundary is chosen, this may change in the course of conducting the study when issues arise that can only be understood by going to another level. What transpires in a classroom, for example, if this is the case, is often partly dependent on the support of the school leadership and culture of the institution and this, in turn, to some extent is dependent on what resources are allocated from the local education administration. Much like a series of Russian dolls, one context inside the other.

Unit of analysis

Thinking about what would constitute the unit of analysis— a classroom, an institution, a program, a region—may help in setting the boundaries of the case, and it will certainly help when it comes to analysis. But this is a slightly different issue from deciding what the case is a case of. Taking a health example, the case may be palliative care support, but the unit of analysis the palliative care ward or wards. If you took the palliative care ward as the unit of analysis this would be as much about how palliative care was exercised in this or that ward than issues about palliative care support in general. In other words, you would need to have specific information and context about how this ward was structured and managed to understand how palliative care was conducted in this particular ward. Here, as in the school example above, you would need to consider which of the many people who populate the ward form part of the case—nurses, interns, or doctors only, or does it extend to patients, cleaners, nurse aides, and medical students?

Framing Questions and Issues

The third most important consideration is how to frame the study, and you are likely to do this once you have selected the site or sites for study. There are at least four approaches. You could start with precise questions, foreshadowed issues ( Smith & Pohland, 1974 ), theories, or a program logic. To some extent, your choice will be dictated by the type of case you have chosen, but also by your personal preference for how to conduct it—in either a structured or open way.

Initial questions give structure; foreshadowed issues more freedom to explore. In qualitative case study, foreshadowed issues are more common, allowing scope for issues to change as the study evolves, guided by participants’ perspectives and events in the field. With this perspective, it is more likely that you will generate a theory of the case toward the end, through your interpretation and analysis.

If you are conducting an instrumental case study, staying close to the questions or foreshadowed issues is necessary to be sure you gain data that will illuminate the central focus of the study. This is critical if you are exploring issues across several cases, although it is possible to do a cross-case analysis from cases that have each followed a different route to discovering significant issues.

Opting to start with a theoretical framework provides a basis for formulating questions and issues, but it can also constrain the study to only those questions/issues that fit the framework. The same is true with using program logic to frame the case. This is an approach frequently adopted in evaluation case study where the evaluator, individually or with stakeholders, examines how the aims and objectives of the program relate to the activities designed to promote it and the outcomes and impacts expected. It provides direction, although it can lead to simply confirming what was anticipated, rather than documenting what transpired in the case.

Whichever approach you choose to frame the case, it is useful to think about the rationale or theory for each question and what methods would best enable you to gain an understanding of them. This will not only start a reflexive process of examining your choices—an important aspect of the process of data gathering and interpretation—it will also aid analysis and interpretation further down the track.

Methodology and Methods

Qualitative case study research, as already noted, appeals to subjective ways of knowing and to a primarily qualitative methodology, that captures experiential understanding ( Stake, 2010 , pp. 56–70). It follows that the main methods of data gathering to access this way of knowing will be qualitative. Interviewing, observation, and document analysis are the primary three, often supported by critical incidents, focus groups, cameos, vignettes, diaries/journals, and photographs. Before gathering any primary data, however, it is useful to search relevant existing sources (written or visual) to learn about the antecedents and context of a project, program, or policy as a backdrop to the case. This can sharpen framing questions, avoid unnecessary data gathering, and shorten the time needed in the field.

Given that there are excellent texts on qualitative methods (see, for example, Denzin & Lincoln, 1994 ; Seale, 1999 ; Silverman, 2000 , 2004 ), I will not discuss all potential relevant methods here, but simply focus on the qualities of the primary methods that are particularly appropriate for case study research.

Primary Qualitative Data Gathering Methods

Interviewing.

The most effective style of interviewing in qualitative case study research to gain in-depth data, document multiple perspectives and experiences and explore contested issues is the unstructured interview, active listening and open questioning are paramount, whatever prequestions or foreshadowed issues have been identified. This can include photographs—a useful starting point with certain cultural groups and the less articulate, to encourage them to tell their story through connecting or identifying with something in the image.

The flexibility of unstructured interviewing has three further advantages for understanding participants’ experiences. First, through questioning, probing, listening, and, above all, paying attention to the silences and what they mean, you can get closer to the meaning of participants’ experiences. It is not always what they say.

Second, unstructured interviewing is useful for engaging participants in the process of research. Instead of starting with questions and issues, invite participants to tell their stories or reflect on specific issues, to conduct their own self-evaluative interview, in fact. Not only will they contribute their particular perspective to the case, they will also learn about themselves, thereby making the process of research educative for them as well as for the audiences of the research.

Third, the open-endedness of this style of interviewing has the potential for creating a dialogue between participants and the researcher and between the researcher and the public, if enough of the dialogue is retained in the publication ( Bellah, Madsen, Sullivan, Swidler, & Tipton, 1985 ).

Observations

Observations in case study research are likely to be close-up descriptions of events, activities, and incidents that detail what happens in a particular context. They will record time, place, specific incidents, transactions, and dialogue, and note characteristics of the setting and of people in it without preconceived categories or judgment. No description is devoid of some judgment in selection, of course, but, on the whole, the intent is to describe the scene or event “as it is,” providing a rich, textured description to give readers a sense of what it was like to be there or provide a basis for later interpretation.

Take the following excerpt from a study of the West Bromwich Operatic Society. It is the first night of a new production, The Producers , by this amateur operatic society. This brief excerpt is from a much longer observation of the overture to the first evening’s performance, detailing exactly what the production is, where it is, and why there is such a tremendous sense of atmosphere and expectation surrounding the event. Space prevents including the whole observation, but I hope you can get a glimmer of the passion and excitement that precedes the performance:

Birmingham, late November, 2011, early evening.... Bars and restaurants spruce up for the evening’s trade. There is a chill in the air but the party season is just starting....

A few hundred yards away, past streaming traffic on Suffolk Street, Queensway, an audience is gathering at the New Alexandra Theatre. The foyer windows shine in the orange sodium night. Above each one is the rubric: WORLD CLASS THEATRE.

Inside the preparatory rituals are being observed; sweets chosen, interval drinks ordered and programmes bought. People swap news and titbits about the production.... The bubble of anticipation grows as the 5-minute warning sounds. People make their way to the auditorium. There have been so many nights like this in the past 110 years since a man named William Coutts invested £10,000 to build this palace of dreams.... So many fantasies have been played under this arch: melodramas and pantomimes, musicals and variety.... So many audiences, settling down in their tip-up seats, wanting to be transported away from work, from ordinariness and private troubles.... The dimming lights act like a mother’s hush. You could touch the silence. Boinnng! A spongy thump on a bass drum, and the horns pipe up that catchy, irrepressible, tasteless tune and already you’re singing under your breath, ‘Springtime for Hitler and Germany....’ The orchestra is out of sight in the pit. There’s just the velvet curtain to watch as your fingers tap along. What’s waiting behind? Then it starts it to move. Opening night.... It’s opening night! ( Matarasso, 2012 , pp. 1–2)

For another and different example—a narrative observation of an everyday but unique incident that details date, time, place, and experience—see Simons (2009 , p. 60).

Such naturalistic observations are also useful in contexts where we cannot understand what is going on through interviewing alone—in cultures with which we are less familiar or where key actors may not share our language or have difficulty expressing it. Careful description in these situations can help identify key issues, discover the norms and values that exist in the culture, and, if sufficiently detailed, allow others to cross corroborate what significance we draw from these observations. This last point is very important to avoid the danger in observation of ascribing motivations to people and meanings to transactions.

Finally, naturalistic observations are very important in highly politicized environments, often the case in commissioned evaluation case study, where individuals in interview may try to elude the “truth” or press on you that their view is the “right” view of the situation. In these contexts, naturalistic observations not only enable you to document interactions as you perceive them, but they also provide a cross-check on the veracity of information obtained in interviews.

Document analysis

Analysis of documents, as already intimated, is useful for establishing what historical antecedents might exist to provide a springboard for contemporaneous data gathering. In most cases, existing documents are also extremely pertinent for understanding the policy context.

In a national policy case study I conducted on a major curriculum change, the importance of preexisting documentation was brought home to me sharply when certain documentation initially proved elusive to obtain. It was difficult to believe that it did not exist, as the evolution of the innovation involved several parties who had not worked together before. There was bound, I thought, to be minuted meetings sharing progress and documentation of the “new” curriculum. In the absence of some crucial documents, I began to piece together the story through interviewing. Only there were gaps, and certain issues did not make sense.

It was only when I presented two versions of what I discerned had transpired in the development of this initiative in an interim report eighteen months into the study that things started to change. Subsequent to the meeting at which the report was presented, the “missing” documents started to appear. Suddenly found. What lay behind the “missing documents,” something I suspected from what certain individuals did and did not say in interview, was a major difference of view about how the innovation evolved, who was key in the process, and whose voice was more important in the context. Political differences, in other words, that some stakeholders were trying to keep from me. The emergence of the documents enabled me to finally produce an accurate and fair account.

This is an example of the importance of having access to all relevant documents relating to a program or policy in order to study it fairly. The other major way in which document analysis is useful in case study is for understanding the values, explicit and hidden, in policy and program documents and in the organization where the program or policy is implemented. Not to be ignored as documents are photographs, and these, too, can form the basis of a cultural and value analysis of an organization ( Prosser, 2000 ).

Creative artistic approaches

Increasingly, some case study researchers are employing creative approaches associated with the arts as a means of data gathering and analysis. Artistic approaches have often been used in representing findings, but less frequently in data gathering and interpretation ( Simons & McCormack, 2007 ). A major exception is the work of Richardson (1994) , who sees the very process of writing as an interpretative act, and of Cancienne and Snowber (2003) , who argue for movement as method.

The most familiar of these creative and artistic forms are written—narratives and short stories ( Clandinin & Connelly, 2000 ; Richardson, 1994 ; Sparkes, 2002 ), poems or poetic form ( Butler-Kisber, 2010 ; Duke, 2007 ; Richardson, 1997 ; Sparkes & Douglas, 2007 ), cameos of people, or vignettes of situations. These can be written by participants or by the researcher or developed in partnership. They can also be shared with participants to further interpret the data. But photographs also have a long history in qualitative research for presenting and constructing understanding ( Butler-Kisber, 2010 ; Collier, 1967 ; Prosser, 2000 ; Rugang, 2006 ; Walker, 1993 ).

Less common are other visual forms of gathering data, such as “draw and write” ( Sewell, 2011 ), artefacts, drawings, sketches, paintings, and collages, although all forms are now on the increase. For examples of the use of collage in data gathering, see Duke (2007) and Butler-Kisber (2010) , and for charcoal drawing, Elliott (2008) .

In qualitative inquiry broadly, these creative approaches are now quite common. And in the context of arts and health in particular (see, for example, Frank, 1997 ; Liamputtong & Rumbold, 2008 ; Spouse, 2000 ), we can see how artistic approaches illuminate in-depth understanding. However, in case study research to date, I think narrative forms have tended to be most prominent.

Finally, for capturing the quality and essence of peoples’ experience, nothing could be more revealing than a recording of their voices. Video diaries—self-evaluative portrayals by individuals of their perspectives, feelings, or experience of an event or situation—are a most potent way both of gaining understanding and communicating that to others. It is rather more difficult to gain access for observational videos, but they are useful for documentation and have the potential to engage participants and stakeholders in the interpretation.

Getting It All Together

Case study is so often associated with story or with a report of some event or program that it is easy to forget that much analysis and interpretation has gone on before we reach this point. In many case study reports, this process is hidden, leaving the reader with little evidence on which to assess the validity of the findings and having to trust the one who wrote the tale.

This section briefly outlines possibilities, first, for analyzing and interpreting data, and second, for how to communicate the findings to others. However it is useful to think of these together and indeed, at the start, because decisions about how you report may influence how you choose to make sense of the data. Your choice may also vary according to the context of the study—what is expected or acceptable—and your personal predilections, whether you prefer a more rational than intuitive mode of analysis, for example, or a formal or informal style of writing up that includes images, metaphor, narratives, or poetic forms.

Analyzing and Interpreting Data

When it comes to making sense of data, I make a distinction between analysis—a formal inductive process that seeks to explain—and interpretation, a more intuitive process that gains understanding and insight from a holistic grasp of data, although these may interact and overlap at different stages.

The process, whichever emphasis you choose, is one of reducing or transforming a large amount of data to themes that can encapsulate the overarching meaning in the data. This involves sorting, refining, and refocusing data until they make sense. It starts at the beginning with preliminary hunches, sometimes called “interpretative asides” or “working hypotheses,” later moving to themes, analytic propositions, or a theory of the case.

There are many ways to conduct this process. Two strategies often employed are concept mapping —a means of representing data visually to explore links between related concepts—and progressive focusing ( Parlett & Hamilton, 1976 ), the gradual reframing of initially identified issues into themes that are then further interpreted to generate findings. Each of these strategies tends to have three stages: initial sense making, identification of themes, and examination of patterns and relationships between them.

If taking a formal analytic approach to the task, the data would likely be broken down into segments or datasets (coded and categorized) and then reordered and explored for themes, patterns, and possible propositions. If adopting a more intuitive process, you might focus on identifying insights through metaphors and images, lateral thinking, or puzzling over paradoxes and ambiguities in the data, after first immersing yourself in the total dataset, reading and re-reading interview scripts, observations and field notes to get a sense of the whole. Trying out different forms of making sense through poetry, vignettes, cameos, narratives, collages, and drawing are further creative ways to interpret data, as are photographs taken in the case arranged to explain or tell the story of the case.

Reporting Case Study Research

Narrative structure and story.

As indicated in the introduction, telling a story is often associated with case study and some think this is what a case study is. In one sense, it is and, given that story is the natural way in which we learn ( Okri, 1997 ), it is a useful framework both for gathering data and for communicating case study findings. Not any story will do however. To count as research, it must be authentic, grounded in data, interpreted and analyzed to convey the meaning of the case.

There are several senses in which story is appropriate in qualitative case study: in capturing stories participants tell, in generating a narrative structure that makes sense of the case (i.e., the story you will tell), and in deciding how you communicate this narrative (i.e., in story form). If you choose a written story form (and advice here can be sought from Harrington (2003) and Caulley (2008) ), it needs to be clearly structured, well written, and contain only the detail that is necessary to give readers the vicarious experience of what it was like in the case. If the story is to be communicated in other ways, through, for example, audio or videotape, or computer or personal interaction, the same applies, substituting visual and interpersonal skill for written.

Matching forms of reporting to audience

The art of reporting is strongly connected to usability, so forms of reporting need to connect to the audiences we hope to inform: how they learn, what kind of evidence they value, and what kind of reporting maximizes the chances they will use the findings to promote policies and programs in the interests of beneficiaries. As Okri (1997) further reminds us, the writer only does half the work; the reader does the other (p. 41).

There may be other considerations as well: how open are commissioners to receiving stories of difficulties, as well as success stories? What might they need to hear beyond what is sought in the technical brief? And through what style of reporting would you try and persuade them? If conducting noncommissioned case study research, the scope for different forms of reporting is wider. In academia, for instance, many institutions these days accept creative and artistic forms of reporting when supported by supervisors and appreciated by examiners.

Styles of Reporting

The most obvious form of reporting is linear, often starting with a short executive summary and a brief description of focus and context, followed by methodology, the case study or thematic analysis, findings, and conclusions or implications. Conclusion-led reporting is similar in terms of its formality, but simply starts the other way around. From the conclusions drawn from the analyzed data, it works backward to tell the story through narrative, verbatim, and observational data of how these conclusions were reached. Both have a strong story line. The intent is analytic and explanatory.

Quite a different approach is to engage the reader in the experience and veracity of the case. Rather like constructing a portrait or editing a documentary film, this involves the sifting, constructing, re-ordering of frames, events and episodes to tell a coherent story primarily through interview excerpts, observations, vignettes, and critical incidents that depict what transpired in the case. Interpretation is indirect through the weaving of the data. The story can start at any point provided the underlying narrative structure is maintained to establish coherence ( House, 1980 , p. 116).

Different again, and from the other end of a continuum, is a highly interpretative account that may use similar ways of presenting data but weaves a story from the outset that is highly interpretative. Engaging metaphor, images, short stories, contradictions, paradoxes, and puzzles, it is invariably interesting to read and can be most persuasive. However, the evidence is less visible and therefore less open to alternative interpretations.

Even more persuasive is a case study that uses artistic forms to communicate the story of the case. Paintings, poetic form, drawings, photography, collage, and movement can all be adopted to report findings, whether the data was acquired using these forms or by other means. The arts-based inquiry movement ( Mullen & Finley, 2003 ) has contributed hugely to the validation and legitimation of artistic and creative ways of representing qualitative research findings. The journal Qualitative Inquiry contains many good examples, but see also Liamputtong & Rumbold (2008) . Such artistic forms of representation may not be for everyone or appropriate in some contexts, but they do have the power to engage an audience and the potential to facilitate use.

Generalization in Case Study Research

One of the potential limitations of case study often proposed is that it is impossible to generalize. This is not so. However, the way in which one generalizes from a case is different from that adopted in traditional forms of social science research that utilize large samples (randomly selected) and statistical procedures and which assume regularities in the social world that allow cause and effect to be determined. In this form of research inferences from data are stated as formal propositions that apply to all in the target population. See Donmoyer (1990) for an argument on the restricted nature of this form of generalization when considering single-case studies.

Making inferences from cases with a qualitative data set arises more from a process of interpretation in context, appealing to tacit and situated understanding for acceptance of their validity. Such inferences are possible where the context and experience of the case is richly described so the reader can recognize and connect with the events and experiences portrayed. There are two ways to examine how to reach these generalized understandings. One is to generalize from the case to other cases of a similar or dissimilar nature. The other is to see what we learn in-depth from the uniqueness of the single case itself.

Generalizing from the Single Case

A common approach to generalization and one most akin to a propositional form is cross-case generalization. In a collective or multi-site case study, each case is explored to see if issues that arise in one case also exist in other cases and what interconnecting themes there are between them. This kind of generalization has a degree of abstraction and potential for theorizing and is often welcomed by commissioners of research concerned that findings from the single case do not provide an adequate or “safe” basis for policy determination.

However, there are four additional ways to generalize from the single case, all of which draw more on tacit knowledge and recognition of context, although in different ways. In naturalistic generalization , first proposed by Stake (1978) , generalization is reached on the basis of recognition of similarities and differences to cases with which we are familiar. To enable such recognition, the case needs to feature rich description; people’s voices; and enough detail of time, place, and context to provide a vicarious experience to help readers discern what is similar and dissimilar to their own context ( Stake, 1978 ).

Situated generalization ( Simons, Kushner, Jones, & James, 2003 ) is close to the concept of naturalistic generalization in relying for its generality on retaining a connectedness with the context in which it first evolved. However, it has an extra dimension in a practice context. This notion of generalization was identified in an evaluation of a research project that engaged teachers in and with research. Here, in addition to the usual validity criteria to establish the warrant for the findings, the generalization was seen as dependable if trust existed between those who conducted the research (teachers, in this example) and those thinking about using it (other teachers). In other words, beyond the technical validity of the research, teachers considered using the findings in their own practice because they had confidence in those who generated them. This is a useful way to think about generalization if we wish research findings to improve professional practice.

The next two concepts of generalization— concept and process generalization —relate more to what you discover in making sense of the case. As you interpret and analyze, you begin to generate a theory of the case that makes sense of the whole. Concepts may be identified that make sense in the one case but have equal significance in other cases of a similar kind, even if the contexts are different.

It is the concept that generalizes, not the specific content or context. This may be similar to the process Donmoyer (2008) identifies of “intellectual generalization” (quoted by Butler-Kisber, 2010 , p. 15) to indicate the cognitive understanding one can gain from qualitative accounts even if settings are quite different.

The same is true for generalization of a process. It is possible to identify a significant process in one case (or several cases) that is transferable to other contexts, irrespective of the precise content and contexts of those other cases. An example here is the collaborative model for sustainable school self-evaluation I identified in researching school self-evaluation in a number of schools and countries ( Simons, 2002 ). Schools that successfully sustained school self-evaluation had an infrastructure that was collaborative at all stages of the evaluation process from design to conduct of the study, to analyzing the results and to reporting the findings. This ensured that the whole school was involved and that results were discussed and built into the ongoing development of school policies and practice. In other cases, different processes may be discovered that have applicability in a range of contexts. As with concept generalization, it is the process that generalizes not the substantive content or specific context.

Particularization

The forms of generalization discussed above are useful when we have to justify case study in a research or policy context. But the overarching justification for how we learn from case study is particularization —a rich portrayal of insights and understandings interpreted in the particular context. Several authors have made this point ( Stake, 1995 ; Flyvberg, 2006 ; Simons 2009 ). Stake puts it most sharply when he observes that “The real business of case study is particularization, not generalization” (p. 8), referring here to the main reason for studying the singular, which is to understand the uniqueness of the case itself.

My perspective (explored further in Simons, 1996 ; Simons, 2009 , p. 239; Simons & McCormack, 2007 ) is similar in that I believe the “real” strength of case study lies in the insights we gain from in-depth study of the particular. But I also argue for the universality of such insights—if we get it “right.” By which I mean that if we are able to capture and report the uniqueness, the essence, of the case in all its particularity and present this in a way we can all recognize, we will discover something of universal significance. This is something of a paradox. The more you learn in depth about the particularity of one person, situation, or context, the more likely you are to discover something universal. This process of reaching understanding has support both from the way in which many discoveries are made in science and in how we learn from artists, poets, and novelists, who reach us by communicating a recognizable truth about individuals, human relationships, and/or social contexts.

This concept of particularization is far from new, as the quotation from a preface to a book written in 1908 attests. Stephen Reynolds, the author of A Poor Man’s House , notes that the substance of the book was first recorded in a journal, kept for purposes of fiction, and in letters to one of his friends, but fiction proved an inappropriate medium. He felt that the life and the people were so much better than anything he could invent. The book therefore consists of the journal and letters drawn together to present a picture of a typical poor man’s house and life, much as we might draw together a range of data to present a case study. It is not the substance of the book that concerns us here but the methodological relevance to case study research. Reynolds notes that the conclusions expressed are tentative and possibly go beyond this man’s life, so he thought some explanation of the way he arrived at them was needed:

Educated people usually deal with the poor man’s life deductively; they reason from the general to the particular; and, starting with a theory, religious, philanthropic, political, or what not, they seek, and too easily find, among the millions of poor, specimens—very frequently abnormal—to illustrate their theories. With anything but human beings, that is an excellent method. Human beings, unfortunately, have individualities. They do what, theoretically, they ought not to do, and leave undone those things they ought to do. They are even said to possess souls—untrustworthy things beyond the reach of sociologists. The inductive method—reasoning from the particular to the general... should at least help to counterbalance the psychological superficiality of the deductive method. ( Reynolds, 1908 : preface) 1

Slightly overstated perhaps, but the point is well made. In our search for general laws, we not only lose sight of the uniqueness and humanity of individuals, but reduce them in the process, failing to present their experience in any “real” sense. What is astonishing about the quotation is that it was written over a century ago and yet many still argue today that you cannot generalize from the particular.

Going even further back, in 1798, Blake proclaimed that “To Generalize is to be an Idiot. To Particularize is the Alone Distinction of Merit.” In research, we may not wish to make such a strong distinction: these processes both have their uses in different kinds of research. But there is a major point here for the study of the particular that Wilson (2008) notes in commenting on Blake’s perception when he says: “Favouring the abstract over the concrete, one ‘sees all things only thro’ the narrow chinks of his cavern”’ (referring here to Blake’s The Marriage of Heaven and Hell [1793]; in Wilson, 2008 , p. 62). The danger Wilson is pointing to here is that abstraction relies heavily on what we know from our past understanding of things, and this may prevent us experiencing a concrete event directly or “apprehend[ing] a particular moment” ( Wilson, 2008 , p. 63).

Blake had a different mission, of course, than case researchers, and he was not himself free from abstractions, as Wilson points out, although he fought hard “to break through mental barriers to something unique and living” ( Wilson, 2008 , p. 65). It is this search for the “unique and living” and experiencing the “isness” of the particular that we should take from the Blake example to remind ourselves of the possibility of discovering something “new,” beyond our current understanding of the way things are.

Focusing on particularization does not diminish the usefulness of case study research for policy makers or practitioners. Grounded in recognizable experience, the potential is there to reach a range of audiences and to facilitate use of the findings. It may be more difficult for those who seek formal generalizations that seem to offer a safe basis for policy making to accept case study reports. However, particular stories often hold the key to why policies have or have not worked well in the past. It is not necessary to present long cases—a criticism frequently levelled—to demonstrate the story of the case. Such case stories can be most insightful for policy makers who, like many of us in everyday life, often draw inferences from a single instance or case, whatever the formal evidence presented. “I am reminded of the story of....”

The case for studying the particular to inform practice in professional contexts needs less persuasion because practitioners can recognize the content and context quite readily and make the inference to their own particular context ( Simons et al., 2003 ). In both sets of circumstances—policy and practice—it is more a question of whether the readers of our case research accept the validity of findings determined in this way, how they choose to learn, and our skill in telling the case study story.

Conclusion and Future Directions

In this chapter, I have presented an argument for case study research, making the case, in particular, for using qualitative methods to highlight what it is that qualitative case study research can bring to the study of social and educational programs. I outlined the various ways in which case study is commonly used before focusing directly on case study as a major mode of research inquiry, noting characteristics it shares with other qualitative methodologies, as well as itsdifference and the difficulties it is sometimes perceived to have. The chapter emphasizes the importance of thinking through what the case is, to be sure that the issues explored and the data generated do illuminate this case and not any other.

But there is still more to be done. In particular, I think we need to be more adventurous in how we craft and report the case. I suspect we may have been too cautious in the past in how we justified case study research, borrowing concepts from other disciplines and forms of educational research. More than 40 years on, it is time to take a greater risk—in demonstrating the intrinsic nature of case study and what it can offer to our understanding of human and social situations.

I have already drawn attention to the need to design the case, although this could be developed further to accentuate the uniqueness of the particular case. One way to do this is to feature individuals more in the design itself, not only to explore programs and policies through perspectives of key actors or groups and transactions between them, which to some extent happens already, but also to get them to characterize what makes the context unique. This is the reversal of many a design framework that starts with the logic of a program and takes forward the argument for personal evaluation ( Kushner, 2000 ), noted in the interlude on evaluation. Apart from this attention to design, there are three other issues I think we need to explore further: the warrant for creative methods in case study, more imaginative reporting; and how we learn from a study of the singular.

Warrant for More Creative Methods in Case Study Research

The promise that creative methods have for eliciting in-depth understanding and capturing the unusual, the idiosyncratic, the uniqueness of the case, was mentioned in the methods section. Yet, in case study research, particularly in program and policy contexts, we have few good examples of the use of artistic approaches for eliciting and interpreting data, although more, as acknowledged later, for presenting it. This may be because case study research is often conducted in academic or policy environments, where propositional ways of knowing are more valued.

Using creative and artistic forms in generating and interpreting case study data offers a form of evidence that acknowledges experiential understanding in illuminating the uniqueness of the case. The question is how to establish the warrant for this way of knowing and persuade others of its virtue. The answer is simple. By demonstrating the use of these methods in action, by arguing for a different form of validity that matches the intrinsic nature of the method, and, above all, by good examples.

Representing Findings to Engage Audiences in Learning

In evaluative and research policy contexts, where case study is often the main mode of inquiry or part of a broader study, case study reports often take a formal structure or sometimes, where the context is receptive, a portrayal or interpretative form. But, too often, the qualitative is an add-on to a story told by other means or reduced to issues in which the people who gave rise to the data are no longer seen. However, there are many ways to put them center stage.

Tell good stories and tell them well. Or, let key actors tell their own stories. Explore the different ways technology can help. Make video clips that demonstrate events in context, illustrate interactions between people, give voice to participants—show the reality of the program, in other words. Use graphics to summarize key issues and interactive, cartoon technology, as seen on some TED presentations, to summarize and visually show the complexity of the case. Video diaries were mentioned in the methods section: seeing individuals tell their tales directly is a powerful way of communicating, unhindered by “our” sense making. Tell photo stories. Let the photos convey the narrative, but make sure the structure of the narrative is evident to ensure coherence. These are just the beginnings. Those skilled in information technology could no doubt stretch our imagination further.

One problem and a further question concerns our audiences. Will they accept these modes of communication? Maybe not, in some contexts. However, there are three points I wish to leave you with. First, do not presume that they won’t. If people are fully present in the story and the complexity is not diminished, those reading, watching, or hearing about the case will get the message. If you are worried about how commissioners might respond, remember that they are no different from any other stakeholder or participant when it comes to how they learn from human experience. Witness the reference to Okri (1997) earlier about how we learn.

Second, when you detect that the context requires a more formal presentation of findings, respond according to expectation but also include elements of other forms of presentation. Nudge a little in the direction of creativity. Third, simply take a chance, that risk I spoke about earlier. Challenge the status quo. Find situations and contexts where you can fully represent the qualitative nature of the experience in the cases you study with creative forms of interpretation and representation. And let the audience decide.

Learning from a Study of the Singular

Finally, to return to the issue of “generalization” in case study that worries some audiences. I pointed out in the generalization section several ways in which it is possible to generalize from case study research, not in a formal propositional sense or from a case to a population, but by retaining a connection with the context in which the generalization first arose—that is, to realize in-depth understanding in context in different circumstances and situations. However, I also emphasized that, in many instances, it is particularization from which we learn. That is the point of the singular case study, and it is an art to perceive and craft the case in ways that we can.

Acknowledgments

Parts of this chapter build on ideas first explored in Simons, 2009 .

I am grateful to Bob Williams for pointing out the relevance of this quotation from Reynolds to remind us that “there is nothing new under the sun” and that we sometimes continue to engage endlessly in debates that have been well rehearsed before.

Adams, T. ( 2012 ) ‘ Olympics 2012: Team GB falters but London shines bright on opening day ’, Observer, 29.07.12.

Google Scholar

Google Preview

Bassey, M. ( 1999 ). Case study research in educational settings . Buckingham: Open University Press.

Bellah, R. N. , Madsen, R. , Sullivan, W. M. , Swidler, A. , & Tipton, S. M. ( 1985 ). Habits of the heart . London: Harper and Row.

Blake, W. (1798– 1809 ). Annotations to Sir Joshua Reynolds’s Discourses , pp. xvii–xcviii (c. 1798–1809) repr. In Complete Writings , ed. Geoffrey Keynes (1957). ‘Discourse II,’ annotations to Sir Joshua Reynolds, Discourses (c. 1808) .

Butler-Kisber, L. ( 2010 ). Qualitative inquiry: Thematic, narrative and arts-informed perspectives . London: Sage.

Cancienne, M. B. , & Snowber, C. N. ( 2003 ). Writing rhythm: Movement as method. Qualitative Inquiry , 9 (2), 237–253.

Caulley, D. N. ( 2008 ). Making qualitative research reports less boring: The techniques of writing creative nonfiction. Qualitative Inquiry , 14 (3) pp. 424–449.

Chadderton, C. , & Torrance, H. ( 2011 ). Case study. In B. Somekh & C. Lewin (Eds.), Theory and methods in social research . (2nd ed. pp 53–60). London and Thousand Oaks, CA: Sage.

Clandinin, D. J. & Connelly, F. M. ( 2000 ) Narrative inquiry: Experience and story in qualitative research. Ist edn. SanFrancisco: Jossey Bass Publishers.

Collier, J., Jr. ( 1967 ). Visual anthropology: Photography as a research method . New York: Holt, Reinhart, & Winston.

Denzin, N. K. & Lincoln, Y. S. (Eds.) ( 1994 ) Handbook of Qualitative Research , London and Thousand Oaks, CA:Sage

Donmoyer, R. ( 1990 ). Generalization and the single case study. In E. W. Eisner & A. Peshkin (Eds.), Qualitative inquiry in education (pp. 175–200). New York: Teachers College Press.

Donmoyer, R. ( 2008 ). Generalizability. In L. M. Givens (Ed.), The Sage encyclopedia of qualitative inquiry (vol. 2, pp. 371–372). Thousand Oaks, CA: Sage.

Duke, S. (2007). A narrative case study evaluation of the role of the Nurse Consultant in palliative care. PhD thesis, University of Southampton, England.

Elliott, J. (2008). Dance mirrors: Embodying, actualizing and operationalizing a dance experience in a healthcare context. PhD thesis, University of Ulster, Belfast.

Frank. A. ( 1997 ). Enacting illness stories: When, what, why. In H. L. Nelson (Ed.), Stories and their limits (pp. 31–49). London: Routledge.

Flyvberg, B. ( 2006 ). Five misunderstandings about case-study research. Qualitative Inquiry , 12 (2), 219–245.

Gomm, R. , Hammersley, M. , & Foster, P. (Eds.). ( 2004 ). Case study method: Key issues, key texts . [First published in 2000]. London and Thousand Oaks, CA: Sage.

Greene, J. C. ( 2000 ). Understanding social programs through evaluation. In N. K. Denzin and Y. S. Lincoln (Eds.), The handbook of qualitative research (2nd ed., pp. 981–999). Thousand Oaks, CA: Sage.

Greene, J. C. ( 2007 ). Mixing methods in social inquiry . San Francisco: Jossey Bass.

Greenhalgh, T. , & Worrall, J. G. ( 1997 ). From EBM to CSM: The evolution of context-sensitive medicine. Journal of Evaluation in Clinical Practice , 3 (2), 105–108.

Harrington, W. ( 2003 ). What journalism can offer ethnography. Qualitative Inquiry . 9 (1), 90–114.

Heron, J. ( 1992 ). Feeling and personhood . Sage: London.

Heron, J. ( 1999 ). The complete facilitator’s handbook . London: Kogan Page.

House, E. R. ( 1980 ). Evaluating with validity . London, Beverly Hills, CA: Sage.

House, E. R. ( 1993 ). Professional evaluation: Social impact and political consequences . Newbury Park and London: Sage

Kushner, S. ( 2000 ). Personalizing evaluation . London and Thousand Oaks, CA: Sage.

Liamputtong, P. , & Rumbold, J. (Eds.). ( 2008 ). Knowing differently: Arts-based and collaborative research methods . New York: Nova Science Publishers.

MacDonald, B. ( 1976 ). Evaluation and the control of education. In D. Tawney (Ed.), Curriculum evaluation today: Trends and implications . Schools Council Research Studies (pp. 125– 136). London: Macmillan.

Matarasso, F. ( 2012 ). West Bromwich Operatic Society: fine art of musical theatre . West Bromwich, UK: Multistory.

Merriam, S. B. ( 1988 ). Case study research in education: A qualitative Approach . San Francisco: Jossey Bass.

Mullen, C. A. , & Finley, S. (Eds.). ( 2003 ). Arts-based approaches to qualitative inquiry [Special Issue]. Qualitative Inquiry , 9 (2), 165–329.

Okri, B. ( 1997 ). A way of being free . London: Phoenix.

Parlett, M. , & Hamilton, D. ( 1976 ). Evaluation as illumination: A new approach to the study of innovatory programmes. In G. Glass (Ed.), Evaluation studies review annual, I (pp. 140–157). [First published in 1972 as Occasional Paper 9, Centre for Research in the Educational Sciences, University of Edinburgh.] Beverly Hills: CA: Sage.

Platt, J. ( 2007 ). Case study. In W. Outhwaite & S. P. Turner (Eds.), The Sage handbook of social science methodology (pp. 100–118). London: Sage.

Prosser, J. ( 2000 ). The moral maze of image ethics. In H. Simons & R. Usher (Eds.), Situated ethics in educational research (pp. 116–132). London and New York: Routledge/Falmer.

Ragin, C. C. ( 1992 ). Cases of “What is a case?” In C. C. Ragin & H. S. Becker (Eds.), What is a case?: Exploring the foundations of social inquiry (pp. 1–17). Cambridge: Cambridge University Press.

Reynolds, S. S. (1908). A Poor Man’s House . The Project Guttenberg eBook, July 25, 2008 [eBook#26126]. Accessed February 26, 2013, http.//www.gutenberg.org

Richardson, L. ( 1994 ). Writing as a form of inquiry. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of Qualitative Research (pp. 516–529). London: Sage.

Richardson, L. ( 1997 ). Fields of play (Constructing an academic life) . New Brunswick, NJ: Rutgers University Press.

Rugang, L. (2006). Chinese culture in globalisation: A multi-modal case study on visual discourse. PhD thesis, University of Southampton, England.

Seale, C. ( 1999 ). The quality of qualitative research . London and Thousand Oaks, CA: Sage.

Sewell, K. ( 2011 ). Researching sensitive issues: A critical appraisal of “draw and write” as a data collection technique in eliciting children’s perceptions. International Journal of Research Methods in Education 34(2), pp.175–191.

Shaw, I. , & Gould, N. ( 2001 ). Qualitative research in social work: Context and method . London: Sage.

Silverman, D. ( 2000 ). Doing qualitative research: A practical handbook . London and Thousand Oaks. CA: Sage.

Silverman, D. (Ed.). ( 2004 ). Qualitative research: Theory, methods and practice (2nd ed.). London and Thousand Oaks, CA: Sage.

Simons, H. ( 1971 ). Innovation and the case study of schools. Cambridge Journal of Education , 3 , 118–123.

Simons, H. (Ed.). ( 1980 ). Towards a science of the singular: Essays about case study in educational research and evaluation . Occasional Papers No. 10. Norwich, UK: Centre for Applied Research, University of East Anglia.

Simons, H. ( 1987 ). Getting to know schools in a democracy: The politics and process of evaluation . Lewes, UK: Falmer Press.

Simons, H. ( 1996 ). The paradox of case study. Cambridge Journal of Education , 26 (2), 225–240.

Simons, H. ( 2000 ). Damned if you do, damned if you don’t: ethical and political dilemmas in evaluation. In H. Simons & R. Usher (Eds.) Situated ethics in educational research (pp.39– 55) London and New York: Routledge/Falmer.

Simons, H. ( 2002 ). School self-evaluation in a democracy. In D. Nevo (Ed.), School-based evaluation: An international perspective . Advances in Program Evaluation. London: Sage.

Simons, H. ( 2006 ). Ethics and evaluation. In I. F. Shaw , J. C. Greene , & M. M. Mark (Eds.), The international handbook of evaluation (pp. 243–265). London and Thousand Oaks, CA Sage.

Simons, H. ( 2009 ). Case study research in practice . London: Sage.

Simons, H. (2010). Democratic evaluation: Theory and practice. Paper prepared for Virtual Evaluation Conference, University of the Witwatersrand, Johannesburg, South Africa, May, 2010.

Simons, H. , Kushner, S. , Jones, K. , & James, D. ( 2003 ). From evidence-based practice to practice-based evidence: The idea of situated generalization. Research Papers in Education: Policy and Practice , 18 (4), 347–364.

Simons, H. , & McCormack, B. ( 2007 ). Integrating arts-based inquiry in evaluation methodology. Qualitative Inquiry , 13 (2) 292–311.

Simons, H. , & Usher, R. (Eds.). ( 2000 ). Situated ethics in educational research . London and New York: Routledge/Falmer.

Smith, L. M. , & Pohland, P. A. ( 1974 ). Education, technology, and the rural highlands. In R. H. P. Kraft ., L. M. Smith ., P. A. Pohland ., C. J. Brauner , & C. Gjerde (Eds.), Four evaluation examples: Anthropological, economic, narrative and portrayal (pp. 5–54), AERA Monograph Series on Curriculum Evaluation 7. Chicago: Rand McNally.

Sparkes, A. ( 2002 ). Telling tales in sport and physical activity: A qualitative journey . Champaign, IL: Human Kinetics Press.

Sparkes, A. C. , & Douglas, K. ( 2007 ). Making the case for poetic representations: An example in action. The Sport Psychologist , 21(2) , 170–190.

Spouse, J. ( 2000 ). Talking pictures: Investigating personal knowledge though illuminating artwork. Nursing Times Research Journal , 5 (4), 253–261.

Stake, R. E. ( 1978 ) The case study method in social inquiry. Educational Researcher , 7(2), 5–9.

Stake, R. E. ( 1995 ). The art of case study research . Thousand Oaks, CA and London: Sage.

Stake, R. E. ( 2010 ). Qualitative research: Studying how things work . New York & London: Guildford Press.

Stenhouse, L. ( 1978 ). Case study and case records: Towards a contemporary history of education. British Educational Research Journal , 4 (2), 21–39.

Thomas, G. ( 2011 b)). A typology for the case study in social science following a review of definition, discourse and structure. Qualitative Inquiry , 17 (6) , 511–521.

Thomas, G. ( 2011 a). How to do your case study: A guide for students and researchers . London: Sage.

Walker, R. ( 1993 ). Finding a silent voice for the researcher: Using photographs in evaluation and research. In M. Schratz (Ed.), Qualitative voices in educational research (pp. 72–92). Lewes, UK: Falmer Press.

Wilson, E. G. ( 2008 ). Against happiness . New York: Sarah Crichton Books.

Yin, R. K. ( 2004 ). Case study research: Design and methods . Thousand Oaks, CA and London: Sage.

Zucker, D. M. ( 2001 ). Using case study methodology in nursing research. Qualitative Report , 6 (2) June.

About Oxford Academic
Publish journals with us
University press partners
What we publish
New features
Open access
Institutional account management
Rights and permissions
Get help with access
Accessibility
Advertising
Media enquiries
Oxford University Press
Oxford Languages
University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

Copyright © 2024 Oxford University Press
Cookie settings
Cookie policy
Privacy policy
Legal notice

This Feature Is Available To Subscribers Only

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Organizing Your Social Sciences Research Assignments

Annotated Bibliography
Analyzing a Scholarly Journal Article
Group Presentations
Dealing with Nervousness
Using Visual Aids
Grading Someone Else's Paper
Types of Structured Group Activities
Group Project Survival Skills
Leading a Class Discussion
Multiple Book Review Essay
Reviewing Collected Works
Writing a Case Analysis Paper
Writing a Case Study
About Informed Consent
Writing Field Notes
Writing a Policy Memo
Writing a Reflective Paper
Writing a Research Proposal
Generative AI and Writing
Acknowledgments

A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity. A case study research paper usually examines a single subject of analysis, but case study papers can also be designed as a comparative investigation that shows relationships between two or more subjects. The methods used to study a case can rest within a quantitative, qualitative, or mixed-method investigative paradigm.

Case Studies. Writing@CSU. Colorado State University; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010 ; “What is a Case Study?” In Swanborn, Peter G. Case Study Research: What, Why and How? London: SAGE, 2010.

How to Approach Writing a Case Study Research Paper

General information about how to choose a topic to investigate can be found under the " Choosing a Research Problem " tab in the Organizing Your Social Sciences Research Paper writing guide. Review this page because it may help you identify a subject of analysis that can be investigated using a case study design.

However, identifying a case to investigate involves more than choosing the research problem . A case study encompasses a problem contextualized around the application of in-depth analysis, interpretation, and discussion, often resulting in specific recommendations for action or for improving existing conditions. As Seawright and Gerring note, practical considerations such as time and access to information can influence case selection, but these issues should not be the sole factors used in describing the methodological justification for identifying a particular case to study. Given this, selecting a case includes considering the following:

The case represents an unusual or atypical example of a research problem that requires more in-depth analysis? Cases often represent a topic that rests on the fringes of prior investigations because the case may provide new ways of understanding the research problem. For example, if the research problem is to identify strategies to improve policies that support girl's access to secondary education in predominantly Muslim nations, you could consider using Azerbaijan as a case study rather than selecting a more obvious nation in the Middle East. Doing so may reveal important new insights into recommending how governments in other predominantly Muslim nations can formulate policies that support improved access to education for girls.
The case provides important insight or illuminate a previously hidden problem? In-depth analysis of a case can be based on the hypothesis that the case study will reveal trends or issues that have not been exposed in prior research or will reveal new and important implications for practice. For example, anecdotal evidence may suggest drug use among homeless veterans is related to their patterns of travel throughout the day. Assuming prior studies have not looked at individual travel choices as a way to study access to illicit drug use, a case study that observes a homeless veteran could reveal how issues of personal mobility choices facilitate regular access to illicit drugs. Note that it is important to conduct a thorough literature review to ensure that your assumption about the need to reveal new insights or previously hidden problems is valid and evidence-based.
The case challenges and offers a counter-point to prevailing assumptions? Over time, research on any given topic can fall into a trap of developing assumptions based on outdated studies that are still applied to new or changing conditions or the idea that something should simply be accepted as "common sense," even though the issue has not been thoroughly tested in current practice. A case study analysis may offer an opportunity to gather evidence that challenges prevailing assumptions about a research problem and provide a new set of recommendations applied to practice that have not been tested previously. For example, perhaps there has been a long practice among scholars to apply a particular theory in explaining the relationship between two subjects of analysis. Your case could challenge this assumption by applying an innovative theoretical framework [perhaps borrowed from another discipline] to explore whether this approach offers new ways of understanding the research problem. Taking a contrarian stance is one of the most important ways that new knowledge and understanding develops from existing literature.
The case provides an opportunity to pursue action leading to the resolution of a problem? Another way to think about choosing a case to study is to consider how the results from investigating a particular case may result in findings that reveal ways in which to resolve an existing or emerging problem. For example, studying the case of an unforeseen incident, such as a fatal accident at a railroad crossing, can reveal hidden issues that could be applied to preventative measures that contribute to reducing the chance of accidents in the future. In this example, a case study investigating the accident could lead to a better understanding of where to strategically locate additional signals at other railroad crossings so as to better warn drivers of an approaching train, particularly when visibility is hindered by heavy rain, fog, or at night.
The case offers a new direction in future research? A case study can be used as a tool for an exploratory investigation that highlights the need for further research about the problem. A case can be used when there are few studies that help predict an outcome or that establish a clear understanding about how best to proceed in addressing a problem. For example, after conducting a thorough literature review [very important!], you discover that little research exists showing the ways in which women contribute to promoting water conservation in rural communities of east central Africa. A case study of how women contribute to saving water in a rural village of Uganda can lay the foundation for understanding the need for more thorough research that documents how women in their roles as cooks and family caregivers think about water as a valuable resource within their community. This example of a case study could also point to the need for scholars to build new theoretical frameworks around the topic [e.g., applying feminist theories of work and family to the issue of water conservation].

Eisenhardt, Kathleen M. “Building Theories from Case Study Research.” Academy of Management Review 14 (October 1989): 532-550; Emmel, Nick. Sampling and Choosing Cases in Qualitative Research: A Realist Approach . Thousand Oaks, CA: SAGE Publications, 2013; Gerring, John. “What Is a Case Study and What Is It Good for?” American Political Science Review 98 (May 2004): 341-354; Mills, Albert J. , Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Seawright, Jason and John Gerring. "Case Selection Techniques in Case Study Research." Political Research Quarterly 61 (June 2008): 294-308.

Structure and Writing Style

The purpose of a paper in the social sciences designed around a case study is to thoroughly investigate a subject of analysis in order to reveal a new understanding about the research problem and, in so doing, contributing new knowledge to what is already known from previous studies. In applied social sciences disciplines [e.g., education, social work, public administration, etc.], case studies may also be used to reveal best practices, highlight key programs, or investigate interesting aspects of professional work.

In general, the structure of a case study research paper is not all that different from a standard college-level research paper. However, there are subtle differences you should be aware of. Here are the key elements to organizing and writing a case study research paper.

I. Introduction

As with any research paper, your introduction should serve as a roadmap for your readers to ascertain the scope and purpose of your study . The introduction to a case study research paper, however, should not only describe the research problem and its significance, but you should also succinctly describe why the case is being used and how it relates to addressing the problem. The two elements should be linked. With this in mind, a good introduction answers these four questions:

What is being studied? Describe the research problem and describe the subject of analysis [the case] you have chosen to address the problem. Explain how they are linked and what elements of the case will help to expand knowledge and understanding about the problem.
Why is this topic important to investigate? Describe the significance of the research problem and state why a case study design and the subject of analysis that the paper is designed around is appropriate in addressing the problem.
What did we know about this topic before I did this study? Provide background that helps lead the reader into the more in-depth literature review to follow. If applicable, summarize prior case study research applied to the research problem and why it fails to adequately address the problem. Describe why your case will be useful. If no prior case studies have been used to address the research problem, explain why you have selected this subject of analysis.
How will this study advance new knowledge or new ways of understanding? Explain why your case study will be suitable in helping to expand knowledge and understanding about the research problem.

Each of these questions should be addressed in no more than a few paragraphs. Exceptions to this can be when you are addressing a complex research problem or subject of analysis that requires more in-depth background information.

II. Literature Review

The literature review for a case study research paper is generally structured the same as it is for any college-level research paper. The difference, however, is that the literature review is focused on providing background information and enabling historical interpretation of the subject of analysis in relation to the research problem the case is intended to address . This includes synthesizing studies that help to:

Place relevant works in the context of their contribution to understanding the case study being investigated . This would involve summarizing studies that have used a similar subject of analysis to investigate the research problem. If there is literature using the same or a very similar case to study, you need to explain why duplicating past research is important [e.g., conditions have changed; prior studies were conducted long ago, etc.].
Describe the relationship each work has to the others under consideration that informs the reader why this case is applicable . Your literature review should include a description of any works that support using the case to investigate the research problem and the underlying research questions.
Identify new ways to interpret prior research using the case study . If applicable, review any research that has examined the research problem using a different research design. Explain how your use of a case study design may reveal new knowledge or a new perspective or that can redirect research in an important new direction.
Resolve conflicts amongst seemingly contradictory previous studies . This refers to synthesizing any literature that points to unresolved issues of concern about the research problem and describing how the subject of analysis that forms the case study can help resolve these existing contradictions.
Point the way in fulfilling a need for additional research . Your review should examine any literature that lays a foundation for understanding why your case study design and the subject of analysis around which you have designed your study may reveal a new way of approaching the research problem or offer a perspective that points to the need for additional research.
Expose any gaps that exist in the literature that the case study could help to fill . Summarize any literature that not only shows how your subject of analysis contributes to understanding the research problem, but how your case contributes to a new way of understanding the problem that prior research has failed to do.
Locate your own research within the context of existing literature [very important!] . Collectively, your literature review should always place your case study within the larger domain of prior research about the problem. The overarching purpose of reviewing pertinent literature in a case study paper is to demonstrate that you have thoroughly identified and synthesized prior studies in relation to explaining the relevance of the case in addressing the research problem.

III. Method

In this section, you explain why you selected a particular case [i.e., subject of analysis] and the strategy you used to identify and ultimately decide that your case was appropriate in addressing the research problem. The way you describe the methods used varies depending on the type of subject of analysis that constitutes your case study.

If your subject of analysis is an incident or event . In the social and behavioral sciences, the event or incident that represents the case to be studied is usually bounded by time and place, with a clear beginning and end and with an identifiable location or position relative to its surroundings. The subject of analysis can be a rare or critical event or it can focus on a typical or regular event. The purpose of studying a rare event is to illuminate new ways of thinking about the broader research problem or to test a hypothesis. Critical incident case studies must describe the method by which you identified the event and explain the process by which you determined the validity of this case to inform broader perspectives about the research problem or to reveal new findings. However, the event does not have to be a rare or uniquely significant to support new thinking about the research problem or to challenge an existing hypothesis. For example, Walo, Bull, and Breen conducted a case study to identify and evaluate the direct and indirect economic benefits and costs of a local sports event in the City of Lismore, New South Wales, Australia. The purpose of their study was to provide new insights from measuring the impact of a typical local sports event that prior studies could not measure well because they focused on large "mega-events." Whether the event is rare or not, the methods section should include an explanation of the following characteristics of the event: a) when did it take place; b) what were the underlying circumstances leading to the event; and, c) what were the consequences of the event in relation to the research problem.

If your subject of analysis is a person. Explain why you selected this particular individual to be studied and describe what experiences they have had that provide an opportunity to advance new understandings about the research problem. Mention any background about this person which might help the reader understand the significance of their experiences that make them worthy of study. This includes describing the relationships this person has had with other people, institutions, and/or events that support using them as the subject for a case study research paper. It is particularly important to differentiate the person as the subject of analysis from others and to succinctly explain how the person relates to examining the research problem [e.g., why is one politician in a particular local election used to show an increase in voter turnout from any other candidate running in the election]. Note that these issues apply to a specific group of people used as a case study unit of analysis [e.g., a classroom of students].

If your subject of analysis is a place. In general, a case study that investigates a place suggests a subject of analysis that is unique or special in some way and that this uniqueness can be used to build new understanding or knowledge about the research problem. A case study of a place must not only describe its various attributes relevant to the research problem [e.g., physical, social, historical, cultural, economic, political], but you must state the method by which you determined that this place will illuminate new understandings about the research problem. It is also important to articulate why a particular place as the case for study is being used if similar places also exist [i.e., if you are studying patterns of homeless encampments of veterans in open spaces, explain why you are studying Echo Park in Los Angeles rather than Griffith Park?]. If applicable, describe what type of human activity involving this place makes it a good choice to study [e.g., prior research suggests Echo Park has more homeless veterans].

If your subject of analysis is a phenomenon. A phenomenon refers to a fact, occurrence, or circumstance that can be studied or observed but with the cause or explanation to be in question. In this sense, a phenomenon that forms your subject of analysis can encompass anything that can be observed or presumed to exist but is not fully understood. In the social and behavioral sciences, the case usually focuses on human interaction within a complex physical, social, economic, cultural, or political system. For example, the phenomenon could be the observation that many vehicles used by ISIS fighters are small trucks with English language advertisements on them. The research problem could be that ISIS fighters are difficult to combat because they are highly mobile. The research questions could be how and by what means are these vehicles used by ISIS being supplied to the militants and how might supply lines to these vehicles be cut off? How might knowing the suppliers of these trucks reveal larger networks of collaborators and financial support? A case study of a phenomenon most often encompasses an in-depth analysis of a cause and effect that is grounded in an interactive relationship between people and their environment in some way.

NOTE: The choice of the case or set of cases to study cannot appear random. Evidence that supports the method by which you identified and chose your subject of analysis should clearly support investigation of the research problem and linked to key findings from your literature review. Be sure to cite any studies that helped you determine that the case you chose was appropriate for examining the problem.

IV. Discussion

The main elements of your discussion section are generally the same as any research paper, but centered around interpreting and drawing conclusions about the key findings from your analysis of the case study. Note that a general social sciences research paper may contain a separate section to report findings. However, in a paper designed around a case study, it is common to combine a description of the results with the discussion about their implications. The objectives of your discussion section should include the following:

Reiterate the Research Problem/State the Major Findings Briefly reiterate the research problem you are investigating and explain why the subject of analysis around which you designed the case study were used. You should then describe the findings revealed from your study of the case using direct, declarative, and succinct proclamation of the study results. Highlight any findings that were unexpected or especially profound.

Explain the Meaning of the Findings and Why They are Important Systematically explain the meaning of your case study findings and why you believe they are important. Begin this part of the section by repeating what you consider to be your most important or surprising finding first, then systematically review each finding. Be sure to thoroughly extrapolate what your analysis of the case can tell the reader about situations or conditions beyond the actual case that was studied while, at the same time, being careful not to misconstrue or conflate a finding that undermines the external validity of your conclusions.

Relate the Findings to Similar Studies No study in the social sciences is so novel or possesses such a restricted focus that it has absolutely no relation to previously published research. The discussion section should relate your case study results to those found in other studies, particularly if questions raised from prior studies served as the motivation for choosing your subject of analysis. This is important because comparing and contrasting the findings of other studies helps support the overall importance of your results and it highlights how and in what ways your case study design and the subject of analysis differs from prior research about the topic.

Consider Alternative Explanations of the Findings Remember that the purpose of social science research is to discover and not to prove. When writing the discussion section, you should carefully consider all possible explanations revealed by the case study results, rather than just those that fit your hypothesis or prior assumptions and biases. Be alert to what the in-depth analysis of the case may reveal about the research problem, including offering a contrarian perspective to what scholars have stated in prior research if that is how the findings can be interpreted from your case.

Acknowledge the Study's Limitations You can state the study's limitations in the conclusion section of your paper but describing the limitations of your subject of analysis in the discussion section provides an opportunity to identify the limitations and explain why they are not significant. This part of the discussion section should also note any unanswered questions or issues your case study could not address. More detailed information about how to document any limitations to your research can be found here .

Suggest Areas for Further Research Although your case study may offer important insights about the research problem, there are likely additional questions related to the problem that remain unanswered or findings that unexpectedly revealed themselves as a result of your in-depth analysis of the case. Be sure that the recommendations for further research are linked to the research problem and that you explain why your recommendations are valid in other contexts and based on the original assumptions of your study.

V. Conclusion

As with any research paper, you should summarize your conclusion in clear, simple language; emphasize how the findings from your case study differs from or supports prior research and why. Do not simply reiterate the discussion section. Provide a synthesis of key findings presented in the paper to show how these converge to address the research problem. If you haven't already done so in the discussion section, be sure to document the limitations of your case study and any need for further research.

The function of your paper's conclusion is to: 1) reiterate the main argument supported by the findings from your case study; 2) state clearly the context, background, and necessity of pursuing the research problem using a case study design in relation to an issue, controversy, or a gap found from reviewing the literature; and, 3) provide a place to persuasively and succinctly restate the significance of your research problem, given that the reader has now been presented with in-depth information about the topic.

Consider the following points to help ensure your conclusion is appropriate:

If the argument or purpose of your paper is complex, you may need to summarize these points for your reader.
If prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the conclusion of your paper to describe your main points and explain their significance.
Move from a detailed to a general level of consideration of the case study's findings that returns the topic to the context provided by the introduction or within a new context that emerges from your case study findings.

Note that, depending on the discipline you are writing in or the preferences of your professor, the concluding paragraph may contain your final reflections on the evidence presented as it applies to practice or on the essay's central research problem. However, the nature of being introspective about the subject of analysis you have investigated will depend on whether you are explicitly asked to express your observations in this way.

Problems to Avoid

Overgeneralization One of the goals of a case study is to lay a foundation for understanding broader trends and issues applied to similar circumstances. However, be careful when drawing conclusions from your case study. They must be evidence-based and grounded in the results of the study; otherwise, it is merely speculation. Looking at a prior example, it would be incorrect to state that a factor in improving girls access to education in Azerbaijan and the policy implications this may have for improving access in other Muslim nations is due to girls access to social media if there is no documentary evidence from your case study to indicate this. There may be anecdotal evidence that retention rates were better for girls who were engaged with social media, but this observation would only point to the need for further research and would not be a definitive finding if this was not a part of your original research agenda.

Failure to Document Limitations No case is going to reveal all that needs to be understood about a research problem. Therefore, just as you have to clearly state the limitations of a general research study , you must describe the specific limitations inherent in the subject of analysis. For example, the case of studying how women conceptualize the need for water conservation in a village in Uganda could have limited application in other cultural contexts or in areas where fresh water from rivers or lakes is plentiful and, therefore, conservation is understood more in terms of managing access rather than preserving access to a scarce resource.

Failure to Extrapolate All Possible Implications Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings. If you do not, your reader may question the validity of your analysis, particularly if you failed to document an obvious outcome from your case study research. For example, in the case of studying the accident at the railroad crossing to evaluate where and what types of warning signals should be located, you failed to take into consideration speed limit signage as well as warning signals. When designing your case study, be sure you have thoroughly addressed all aspects of the problem and do not leave gaps in your analysis that leave the reader questioning the results.

Case Studies. Writing@CSU. Colorado State University; Gerring, John. Case Study Research: Principles and Practices . New York: Cambridge University Press, 2007; Merriam, Sharan B. Qualitative Research and Case Study Applications in Education . Rev. ed. San Francisco, CA: Jossey-Bass, 1998; Miller, Lisa L. “The Use of Case Studies in Law and Social Science Research.” Annual Review of Law and Social Science 14 (2018): TBD; Mills, Albert J., Gabrielle Durepos, and Eiden Wiebe, editors. Encyclopedia of Case Study Research . Thousand Oaks, CA: SAGE Publications, 2010; Putney, LeAnn Grogan. "Case Study." In Encyclopedia of Research Design , Neil J. Salkind, editor. (Thousand Oaks, CA: SAGE Publications, 2010), pp. 116-120; Simons, Helen. Case Study Research in Practice . London: SAGE Publications, 2009; Kratochwill, Thomas R. and Joel R. Levin, editors. Single-Case Research Design and Analysis: New Development for Psychology and Education . Hilldsale, NJ: Lawrence Erlbaum Associates, 1992; Swanborn, Peter G. Case Study Research: What, Why and How? London : SAGE, 2010; Yin, Robert K. Case Study Research: Design and Methods . 6th edition. Los Angeles, CA, SAGE Publications, 2014; Walo, Maree, Adrian Bull, and Helen Breen. “Achieving Economic Benefits at Local Events: A Case Study of a Local Sports Event.” Festival Management and Event Tourism 4 (1996): 95-106.

Writing Tip

At Least Five Misconceptions about Case Study Research

Social science case studies are often perceived as limited in their ability to create new knowledge because they are not randomly selected and findings cannot be generalized to larger populations. Flyvbjerg examines five misunderstandings about case study research and systematically "corrects" each one. To quote, these are:

Misunderstanding 1 : General, theoretical [context-independent] knowledge is more valuable than concrete, practical [context-dependent] knowledge. Misunderstanding 2 : One cannot generalize on the basis of an individual case; therefore, the case study cannot contribute to scientific development. Misunderstanding 3 : The case study is most useful for generating hypotheses; that is, in the first stage of a total research process, whereas other methods are more suitable for hypotheses testing and theory building. Misunderstanding 4 : The case study contains a bias toward verification, that is, a tendency to confirm the researcher’s preconceived notions. Misunderstanding 5 : It is often difficult to summarize and develop general propositions and theories on the basis of specific case studies [p. 221].

While writing your paper, think introspectively about how you addressed these misconceptions because to do so can help you strengthen the validity and reliability of your research by clarifying issues of case selection, the testing and challenging of existing assumptions, the interpretation of key findings, and the summation of case outcomes. Think of a case study research paper as a complete, in-depth narrative about the specific properties and key characteristics of your subject of analysis applied to the research problem.

Flyvbjerg, Bent. “Five Misunderstandings About Case-Study Research.” Qualitative Inquiry 12 (April 2006): 219-245.

<< Previous: Writing a Case Analysis Paper
Next: Writing a Field Report >>
Last Updated: Mar 6, 2024 1:00 PM
URL: https://libguides.usc.edu/writingguide/assignments

Bipolar Disorder
Therapy Center
When To See a Therapist
Types of Therapy
Best Online Therapy
Best Couples Therapy
Best Family Therapy
Managing Stress
Sleep and Dreaming
Understanding Emotions
Self-Improvement
Healthy Relationships
Student Resources
Personality Types
Guided Meditations
Verywell Mind Insights
2023 Verywell Mind 25
Mental Health in the Classroom
Editorial Process
Meet Our Review Board
Crisis Support

What Is a Case Study?

Weighing the pros and cons of this method of research

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Cara Lustik is a fact-checker and copywriter.

Verywell / Colleen Tighe

Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
Gives researchers the chance to collect information on why one strategy might be chosen over another
Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

It cannot necessarily be generalized to the larger population
Cannot demonstrate cause and effect
It may not be scientifically rigorous
It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
Explanatory case studies : These are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

Archival records : Census records, survey records, and name lists are examples of archival records.
Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research.

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
Read examples of case studies to gain an idea about the style and format.
Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal. The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Research Writing and Analysis

NVivo Group and Study Sessions
SPSS This link opens in a new window
Statistical Analysis Group sessions
Using Qualtrics
Dissertation and Data Analysis Group Sessions
Defense Schedule - Commons Calendar This link opens in a new window
Research Process Flow Chart
Research Alignment This link opens in a new window
Step 1: Seek Out Evidence
Step 2: Explain
Step 3: The Big Picture
Step 4: Own It
Step 5: Illustrate
Annotated Bibliography
Literature Review This link opens in a new window
Systematic Reviews & Meta-Analyses
How to Synthesize and Analyze
Synthesis and Analysis Practice
Synthesis and Analysis Group Sessions
Problem Statement
Purpose Statement
Quantitative Research Questions
Qualitative Research Questions
Trustworthiness of Qualitative Data
Analysis and Coding Example- Qualitative Data
Thematic Data Analysis in Qualitative Design
Dissertation to Journal Article This link opens in a new window
International Journal of Online Graduate Education (IJOGE) This link opens in a new window
Journal of Research in Innovative Teaching & Learning (JRIT&L) This link opens in a new window

Writing a Case Study

What is a case study?

A Map of the world with hands holding a pen.

A Case study is:

An in-depth research design that primarily uses a qualitative methodology but sometimes includes quantitative methodology.
Used to examine an identifiable problem confirmed through research.
Used to investigate an individual, group of people, organization, or event.
Used to mostly answer "how" and "why" questions.

What are the different types of case studies?

Note: These are the primary case studies. As you continue to research and learn

about case studies you will begin to find a robust list of different types.

Who are your case study participants?

What is triangulation ?

Validity and credibility are an essential part of the case study. Therefore, the researcher should include triangulation to ensure trustworthiness while accurately reflecting what the researcher seeks to investigate.

How to write a Case Study?

When developing a case study, there are different ways you could present the information, but remember to include the five parts for your case study.

Man holding his hand out to show five fingers.

Was this resource helpful?

<< Previous: Thematic Data Analysis in Qualitative Design
Next: Journal Article Reporting Standards (JARS) >>
Last Updated: Apr 12, 2024 11:40 AM
URL: https://resources.nu.edu/researchtools

Essay Assignment Writing Tips for Students of MBA, Masters, PhD Level

Text for Mobile

181+ Latest Case Study Topics for Students to Think About

An overview of case study.

Case studies have been widely used in business teaching for a long time. But nowadays, researchers regard them as a good research methodology. This can help them explore the problem they could not address with their traditional methodologies.

Latest Case Study Topics for Students to Think About

By using the case study method, you can get a better understanding of your own subject matter. 3 topics are fundamental in the method- the case study nature, the role of theory, and the difference between the research and teaching cases.

After recognizing these 3 fundamentals, 3 major features of the qualitative methodology are considered. These are – how qualitative research differs from the quantitative research study.

You can see from the discussion that the case study method has a major scholarly merit to the quantitative research, opening up new paths for the researchers. This paper concludes with references to the case method as well as qualitative research.

Need Help with Assignments and Case Study Writing?

Casestudyhelp.com is the right place that can help you.

How to Find Good Case Study Topics?

Choose something that you are really interested in
Narrow down your main idea into specific points
Explore similar research ideas on the given topic
Identify the problem as well as solutions on your given topic

Case Study Topics on Various Academic Subjects

Psychology case study topics.

Dyslexia and Cognitive Neuroscience
Intelligence vs creativity
Relation of Landscape Paintings with my art
Relation between Intelligence, Logic and Creativity
Reflective essay on pointing analysis
Essay on “Legacy of Andy Warhol”
Essay on storytelling
ADHD treatment
Critical Analyses on Creativity vs. Intelligence
Creativity in problem-solving

Case Study Topics in Education

Impact of online education
Online vs. offline classes
Modern education
Education for special kids
Benefits of pursuing higher education
Pros and cons of studying abroad
Should school education be made free?
Adult education
Degree vs diploma
Public vs. private schools

Sociology Case Study Topics

Ethnicity race nationality
Youth culture
Gender and sexuality
Social moments
Communities’ cult clan
Social inequalities
Consumerism
Women’s empowerment in the society
Cast creed cult

Case Study Topics in Nursing

PPD (OB / MENTAL HEALTH)
Renal Failure
Head Injury
New Patient Care
Pediatric Abdominal Pain

Media Case Study Topics

Impact of online social media on everyday life
Effect of social media on children
The present role of social media in local and global communication
Role of media in entertainment
Media role in banning
Media role in news
Pros and cons of social media
The global influence of social media
Ho to make the best use of social media
Media role in global marketing

Biology Case Study Topics

Coronaviridae – evolution, causes, and symptoms
Immortality in the animal world
Ebola – evolution, causes, and symptoms
Plant pathology
Rare genetic disorders
Organ transplantation
Human memory
Human hormones
Basic principles of cloning
Is obesity hereditary?

Criminal Justice Case Study Topics

Why is it important in perinatal terms?
Is the research topic on criminal justice good enough to study?
Can a written assignment be converted into a speech?
Does a criminal justice research paper have global importance?
What are some counter-opinions?
Does the topic meet all grading rubric points?
Can it be reviewed? Coo person essay and its analysis paper?
What additional information can be included?
Is any other serious research paper available?
Practical application of criminal justice research paper

Marketing Project Case Study Topics

SWOT analysis
Boston matrix
PESTEL analysis
Local vs. global marketing
Market positioning
Advertisement
Most benefit analysis
Market intermediaries
4 P’s of marketing

Learn Everything About 5 Keys To Craft A Killer Marketing Mix Case Study Examples

Information Technology Case Study Topics

Ecology vs. Biodiversity Conservation
Challenges of software development in modern times
Energy vs. Environment
Ethical vs. unethical hacking
Evolution of SDLC (Software Development Life Cycle)
Semantic methods in debugging
Python programming language limitations
Modern usage of drones
Explanation of WordPress
Safety of data analysis
Pros and cons of Information Technology (IT) advancement

Environmental Science Case Study Topics

Climate change
Urban ecology
Fire ecology
Global warming
Renewable energy
Remote sensing and geo ecosystem
Bioremediation
Conservation Biology
Environmental justice

Management Case Study Topics

4 Ps of marketing
Market survey
Local and global marketing
Media Marketing
Benefits of online marketing
Advertising

Social Media Marketing Case Study Topics

Use of social media in global marketing
Pros and cons of social media marketing
Speed of online marketing
Use of multimedia marketing
Use of picks and videos for marketing
Web designing and development in marketing
Marketing ethics
Influence of marketing
Importance of marketing management
Market forecasting

MBA Case Study Topic Ideas

Importance of financial management
Significance of human resource (HR) management
Application of systems managing
Significance of operations management
How to reach management goals
How to thrive in high business competition
What is 360 degrees of human resource management?
What is HR AUDITING?
Marketing logistics
What is Mosley’s Hierarchy of Needs Model?

Human Rights Case Studies

KFAR ADUMIM – KHAN AL-AHMAR
SHILOH – QARYUT AND JALUD
SUSYA – KHIRBET SUSIYA

Nursing Case Study Subjects

Pediatric Nursing
Elderly nursing
Typhoid case
Natal and pre-natal case study
Diabetes patient case study
Heart patient case study
Degenerative diseases
Chronic diseases
Terminal Illness Case Study
Kidney diseases

Business Case Study Topics

Business and politics
Business Marketing
How to run a successful business
Business Finance
Business ethics
Corporate social responsibility (CSR)
Business and economics
Business competition
Brand loyalty
Business law

Law Case Study Topics

Civil law sections
Criminal law sections
Human rights law
Change of law codes
International law
Domestic violence
Equality in the eyes of law
Unbiased law
National law and order

Applied Physics Case Study Topics

Advancements in semiconductor technology an in-depth examination
Safety Analysis of high-energy colliders
Propagation of light in electric devices
Quantum physics in computing systems
Application of artificial intelligence (AI)
Application of physics in biological sciences and genetic engineering
Nuclear reactors
Space researches

Analysis Comes First

System analysis is the very first step in software development, while system design is the second step in the software development process. The ultimate goal of system analysis is identifying and understanding the user needs and business procedures the system needs to support.

This blog clearly shows that writing a good case study takes work. It would help if you always had a good case study writing service provider online, and Caestudyhelp.com is the top choice for you in this regard.

Why Casestudyhelp.com?

We are always the number one case study writing service provider online
24/7 hours of support are available via our website
Our team provides hundred per cent original and flawless writing services
All assignment submissions are done in a timely
Only customized services are provided by our experts
All our students are very happy and satisfied with our services

Thus, please register with us soon.

Author Bio:

Hi, I am Lyana Jones, the author of this blog. I am a well-experienced academic writer. We’ll help make your writing shine.

Pls. Contact us anytime, tell us about your topic, and get a 100% plagiarism-free paper with impeccable grammar and formatting.

How To Write A Convincing Case Study In 7 Easy Steps?

How to write a case study assignment for b-students, a complete guide to writing an effective case study, how to write an effective case study paper, how to write a case study report sample.

Hertz CEO Kathryn Marinello with CFO Jamere Jackson and other members of the executive team in 2017

Top 40 Most Popular Case Studies of 2021

Two cases about Hertz claimed top spots in 2021's Top 40 Most Popular Case Studies

Two cases on the uses of debt and equity at Hertz claimed top spots in the CRDT’s (Case Research and Development Team) 2021 top 40 review of cases.

Hertz (A) took the top spot. The case details the financial structure of the rental car company through the end of 2019. Hertz (B), which ranked third in CRDT’s list, describes the company’s struggles during the early part of the COVID pandemic and its eventual need to enter Chapter 11 bankruptcy.

The success of the Hertz cases was unprecedented for the top 40 list. Usually, cases take a number of years to gain popularity, but the Hertz cases claimed top spots in their first year of release. Hertz (A) also became the first ‘cooked’ case to top the annual review, as all of the other winners had been web-based ‘raw’ cases.

Besides introducing students to the complicated financing required to maintain an enormous fleet of cars, the Hertz cases also expanded the diversity of case protagonists. Kathyrn Marinello was the CEO of Hertz during this period and the CFO, Jamere Jackson is black.

Sandwiched between the two Hertz cases, Coffee 2016, a perennial best seller, finished second. “Glory, Glory, Man United!” a case about an English football team’s IPO made a surprise move to number four. Cases on search fund boards, the future of malls, Norway’s Sovereign Wealth fund, Prodigy Finance, the Mayo Clinic, and Cadbury rounded out the top ten.

Other year-end data for 2021 showed:

Online “raw” case usage remained steady as compared to 2020 with over 35K users from 170 countries and all 50 U.S. states interacting with 196 cases.
Fifty four percent of raw case users came from outside the U.S..
The Yale School of Management (SOM) case study directory pages received over 160K page views from 177 countries with approximately a third originating in India followed by the U.S. and the Philippines.
Twenty-six of the cases in the list are raw cases.
A third of the cases feature a woman protagonist.
Orders for Yale SOM case studies increased by almost 50% compared to 2020.
The top 40 cases were supervised by 19 different Yale SOM faculty members, several supervising multiple cases.

CRDT compiled the Top 40 list by combining data from its case store, Google Analytics, and other measures of interest and adoption.

All of this year’s Top 40 cases are available for purchase from the Yale Management Media store .

And the Top 40 cases studies of 2021 are:

1. Hertz Global Holdings (A): Uses of Debt and Equity

2. Coffee 2016

3. Hertz Global Holdings (B): Uses of Debt and Equity 2020

4. Glory, Glory Man United!

5. Search Fund Company Boards: How CEOs Can Build Boards to Help Them Thrive

6. The Future of Malls: Was Decline Inevitable?

7. Strategy for Norway's Pension Fund Global

8. Prodigy Finance

9. Design at Mayo

10. Cadbury

11. City Hospital Emergency Room

13. Volkswagen

14. Marina Bay Sands

15. Shake Shack IPO

16. Mastercard

17. Netflix

18. Ant Financial

19. AXA: Creating the New CR Metrics

20. IBM Corporate Service Corps

21. Business Leadership in South Africa's 1994 Reforms

22. Alternative Meat Industry

23. Children's Premier

24. Khalil Tawil and Umi (A)

25. Palm Oil 2016

26. Teach For All: Designing a Global Network

27. What's Next? Search Fund Entrepreneurs Reflect on Life After Exit

28. Searching for a Search Fund Structure: A Student Takes a Tour of Various Options

30. Project Sammaan

31. Commonfund ESG

32. Polaroid

33. Connecticut Green Bank 2018: After the Raid

34. FieldFresh Foods

35. The Alibaba Group

36. 360 State Street: Real Options

37. Herman Miller

38. AgBiome

39. Nathan Cummings Foundation

40. Toyota 2010

All You Wanted to Know About How to Write a Case Study

What do you study in your college? If you are a psychology, sociology, or anthropology student, we bet you might be familiar with what a case study is. This research method is used to study a certain person, group, or situation. In this guide from our dissertation writing service , you will learn how to write a case study professionally, from researching to citing sources properly. Also, we will explore different types of case studies and show you examples — so that you won’t have any other questions left.

What Is a Case Study?

A case study is a subcategory of research design which investigates problems and offers solutions. Case studies can range from academic research studies to corporate promotional tools trying to sell an idea—their scope is quite vast.

What Is the Difference Between a Research Paper and a Case Study?

While research papers turn the reader’s attention to a certain problem, case studies go even further. Case study guidelines require students to pay attention to details, examining issues closely and in-depth using different research methods. For example, case studies may be used to examine court cases if you study Law, or a patient's health history if you study Medicine. Case studies are also used in Marketing, which are thorough, empirically supported analysis of a good or service's performance. Well-designed case studies can be valuable for prospective customers as they can identify and solve the potential customers pain point.

Case studies involve a lot of storytelling – they usually examine particular cases for a person or a group of people. This method of research is very helpful, as it is very practical and can give a lot of hands-on information. Most commonly, the length of the case study is about 500-900 words, which is much less than the length of an average research paper.

The structure of a case study is very similar to storytelling. It has a protagonist or main character, which in your case is actually a problem you are trying to solve. You can use the system of 3 Acts to make it a compelling story. It should have an introduction, rising action, a climax where transformation occurs, falling action, and a solution.

Here is a rough formula for you to use in your case study:

Problem (Act I): > Solution (Act II) > Result (Act III) > Conclusion.

Types of Case Studies

The purpose of a case study is to provide detailed reports on an event, an institution, a place, future customers, or pretty much anything. There are a few common types of case study, but the type depends on the topic. The following are the most common domains where case studies are needed:

Historical case studies are great to learn from. Historical events have a multitude of source info offering different perspectives. There are always modern parallels where these perspectives can be applied, compared, and thoroughly analyzed.
Problem-oriented case studies are usually used for solving problems. These are often assigned as theoretical situations where you need to immerse yourself in the situation to examine it. Imagine you’re working for a startup and you’ve just noticed a significant flaw in your product’s design. Before taking it to the senior manager, you want to do a comprehensive study on the issue and provide solutions. On a greater scale, problem-oriented case studies are a vital part of relevant socio-economic discussions.
Cumulative case studies collect information and offer comparisons. In business, case studies are often used to tell people about the value of a product.
Critical case studies explore the causes and effects of a certain case.
Illustrative case studies describe certain events, investigating outcomes and lessons learned.

Need a compelling case study? EssayPro has got you covered. Our experts are ready to provide you with detailed, insightful case studies that capture the essence of real-world scenarios. Elevate your academic work with our professional assistance.

Case Study Format

The case study format is typically made up of eight parts:

Executive Summary. Explain what you will examine in the case study. Write an overview of the field you’re researching. Make a thesis statement and sum up the results of your observation in a maximum of 2 sentences.
Background. Provide background information and the most relevant facts. Isolate the issues.
Case Evaluation. Isolate the sections of the study you want to focus on. In it, explain why something is working or is not working.
Proposed Solutions. Offer realistic ways to solve what isn’t working or how to improve its current condition. Explain why these solutions work by offering testable evidence.
Conclusion. Summarize the main points from the case evaluations and proposed solutions. 6. Recommendations. Talk about the strategy that you should choose. Explain why this choice is the most appropriate.
Implementation. Explain how to put the specific strategies into action.
References. Provide all the citations.

How to Write a Case Study

Let's discover how to write a case study.

Setting Up the Research

When writing a case study, remember that research should always come first. Reading many different sources and analyzing other points of view will help you come up with more creative solutions. You can also conduct an actual interview to thoroughly investigate the customer story that you'll need for your case study. Including all of the necessary research, writing a case study may take some time. The research process involves doing the following:

Define your objective. Explain the reason why you’re presenting your subject. Figure out where you will feature your case study; whether it is written, on video, shown as an infographic, streamed as a podcast, etc.
Determine who will be the right candidate for your case study. Get permission, quotes, and other features that will make your case study effective. Get in touch with your candidate to see if they approve of being part of your work. Study that candidate’s situation and note down what caused it.
Identify which various consequences could result from the situation. Follow these guidelines on how to start a case study: surf the net to find some general information you might find useful.
Make a list of credible sources and examine them. Seek out important facts and highlight problems. Always write down your ideas and make sure to brainstorm.
Focus on several key issues – why they exist, and how they impact your research subject. Think of several unique solutions. Draw from class discussions, readings, and personal experience. When writing a case study, focus on the best solution and explore it in depth. After having all your research in place, writing a case study will be easy. You may first want to check the rubric and criteria of your assignment for the correct case study structure.

Read Also: ' WHAT IS A CREDIBLE SOURCES ?'

Although your instructor might be looking at slightly different criteria, every case study rubric essentially has the same standards. Your professor will want you to exhibit 8 different outcomes:

Correctly identify the concepts, theories, and practices in the discipline.
Identify the relevant theories and principles associated with the particular study.
Evaluate legal and ethical principles and apply them to your decision-making.
Recognize the global importance and contribution of your case.
Construct a coherent summary and explanation of the study.
Demonstrate analytical and critical-thinking skills.
Explain the interrelationships between the environment and nature.
Integrate theory and practice of the discipline within the analysis.

Need Case Study DONE FAST?

Pick a topic, tell us your requirements and get your paper on time.

Case Study Outline

Let's look at the structure of an outline based on the issue of the alcoholic addiction of 30 people.

Introduction

Statement of the issue: Alcoholism is a disease rather than a weakness of character.
Presentation of the problem: Alcoholism is affecting more than 14 million people in the USA, which makes it the third most common mental illness there.
Explanation of the terms: In the past, alcoholism was commonly referred to as alcohol dependence or alcohol addiction. Alcoholism is now the more severe stage of this addiction in the disorder spectrum.
Hypotheses: Drinking in excess can lead to the use of other drugs.
Importance of your story: How the information you present can help people with their addictions.
Background of the story: Include an explanation of why you chose this topic.
Presentation of analysis and data: Describe the criteria for choosing 30 candidates, the structure of the interview, and the outcomes.
Strong argument 1: ex. X% of candidates dealing with anxiety and depression...
Strong argument 2: ex. X amount of people started drinking by their mid-teens.
Strong argument 3: ex. X% of respondents’ parents had issues with alcohol.
Concluding statement: I have researched if alcoholism is a disease and found out that…
Recommendations: Ways and actions for preventing alcohol use.

Writing a Case Study Draft

After you’ve done your case study research and written the outline, it’s time to focus on the draft. In a draft, you have to develop and write your case study by using: the data which you collected throughout the research, interviews, and the analysis processes that were undertaken. Follow these rules for the draft:

Your draft should contain at least 4 sections: an introduction; a body where you should include background information, an explanation of why you decided to do this case study, and a presentation of your main findings; a conclusion where you present data; and references.
In the introduction, you should set the pace very clearly. You can even raise a question or quote someone you interviewed in the research phase. It must provide adequate background information on the topic. The background may include analyses of previous studies on your topic. Include the aim of your case here as well. Think of it as a thesis statement. The aim must describe the purpose of your work—presenting the issues that you want to tackle. Include background information, such as photos or videos you used when doing the research.
Describe your unique research process, whether it was through interviews, observations, academic journals, etc. The next point includes providing the results of your research. Tell the audience what you found out. Why is this important, and what could be learned from it? Discuss the real implications of the problem and its significance in the world.
Include quotes and data (such as findings, percentages, and awards). This will add a personal touch and better credibility to the case you present. Explain what results you find during your interviews in regards to the problem and how it developed. Also, write about solutions which have already been proposed by other people who have already written about this case.
At the end of your case study, you should offer possible solutions, but don’t worry about solving them yourself.

Use Data to Illustrate Key Points in Your Case Study

Even though your case study is a story, it should be based on evidence. Use as much data as possible to illustrate your point. Without the right data, your case study may appear weak and the readers may not be able to relate to your issue as much as they should. Let's see the examples from essay writing service :

‍ With data: Alcoholism is affecting more than 14 million people in the USA, which makes it the third most common mental illness there. Without data: A lot of people suffer from alcoholism in the United States.

Try to include as many credible sources as possible. You may have terms or sources that could be hard for other cultures to understand. If this is the case, you should include them in the appendix or Notes for the Instructor or Professor.

Finalizing the Draft: Checklist

After you finish drafting your case study, polish it up by answering these ‘ask yourself’ questions and think about how to end your case study:

Check that you follow the correct case study format, also in regards to text formatting.
Check that your work is consistent with its referencing and citation style.
Micro-editing — check for grammar and spelling issues.
Macro-editing — does ‘the big picture’ come across to the reader? Is there enough raw data, such as real-life examples or personal experiences? Have you made your data collection process completely transparent? Does your analysis provide a clear conclusion, allowing for further research and practice?

Problems to avoid:

Overgeneralization – Do not go into further research that deviates from the main problem.
Failure to Document Limitations – Just as you have to clearly state the limitations of a general research study, you must describe the specific limitations inherent in the subject of analysis.
Failure to Extrapolate All Possible Implications – Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings.

How to Create a Title Page and Cite a Case Study

Let's see how to create an awesome title page.

Your title page depends on the prescribed citation format. The title page should include:

A title that attracts some attention and describes your study
The title should have the words “case study” in it
The title should range between 5-9 words in length
Your name and contact information
Your finished paper should be only 500 to 1,500 words in length.With this type of assignment, write effectively and avoid fluff

Here is a template for the APA and MLA format title page:

There are some cases when you need to cite someone else's study in your own one – therefore, you need to master how to cite a case study. A case study is like a research paper when it comes to citations. You can cite it like you cite a book, depending on what style you need.

Citation Example in MLA ‍ Hill, Linda, Tarun Khanna, and Emily A. Stecker. HCL Technologies. Boston: Harvard Business Publishing, 2008. Print.

Citation Example in APA ‍ Hill, L., Khanna, T., & Stecker, E. A. (2008). HCL Technologies. Boston: Harvard Business Publishing.

Citation Example in Chicago Hill, Linda, Tarun Khanna, and Emily A. Stecker. HCL Technologies.

Case Study Examples

To give you an idea of a professional case study example, we gathered and linked some below.

Eastman Kodak Case Study

Case Study Example: Audi Trains Mexican Autoworkers in Germany

To conclude, a case study is one of the best methods of getting an overview of what happened to a person, a group, or a situation in practice. It allows you to have an in-depth glance at the real-life problems that businesses, healthcare industry, criminal justice, etc. may face. This insight helps us look at such situations in a different light. This is because we see scenarios that we otherwise would not, without necessarily being there. If you need custom essays , try our research paper writing services .

Get Help Form Qualified Writers

Crafting a case study is not easy. You might want to write one of high quality, but you don’t have the time or expertise. If you’re having trouble with your case study, help with essay request - we'll help. EssayPro writers have read and written countless case studies and are experts in endless disciplines. Request essay writing, editing, or proofreading assistance from our custom case study writing service , and all of your worries will be gone.

Don't Know Where to Start?

Crafting a case study is not easy. You might want to write one of high quality, but you don’t have the time or expertise. Request ' write my case study ' assistance from our service.

What Is A Case Study?

How to cite a case study in apa, how to write a case study, related articles.

How to Write a Summary of a Book with an Example

AI Content Shield
AI KW Research
AI Assistant
SEO Optimizer
AI KW Clustering
Customer reviews
The NLO Revolution
Press Center
Help Center
Content Resources
Facebook Group

List of Current Topics to Write a Case Study

Table of Contents

Writing a case study can be an exciting and challenging task, especially when selecting the right topic. As a student or academic writer, you want to choose a subject that captures your interest. It must also provide valuable insights into a specific area of research. And staying abreast of current topics to write a case study is the key to producing compelling and impactful work. This article provides a list of topic ideas on various subjects to get you started on the best topic for your paper.

What Is a Case Study?

A case study is an in-depth exploration of a particular issue, problem, or phenomenon . It looks at the issue from multiple angles and often involves collecting data from various sources to build up evidence for making conclusions. The primary purpose of a case study is to gain an understanding of a complex system or entity. This is done by breaking it down into its components and analyzing them individually. In most cases, the analysis may be conducted with interviews, surveys, experiments, field observations, document reviews, and other qualitative or quantitative methods. Case studies are invaluable tools that allow researchers to analyze various factors involved in their topic of interest while utilizing real-world examples that make the findings more tangible.

person holding ballpoint pen writing on notebook

Effective Current Topics to Write a Case Study

Choosing a good topic for your case study is crucial to ensure the quality and reliability of your research results. We have categorized some current topics to write a case study effectively.

Information Technology Case Study Topics

Examining WordPress’ strengths and weaknesses
Exploring the efficacy of semantic methods in debugging
Analyzing ethical hackers and their implications
Assessing data analysis safety for medical usage
Analyzing the restrictions of Python programming
Should one become a hacker to deter cyberattacks?

Education Case Study Topics

Innovative Teaching Methods in European Middle Schools.
Is Summer Camp Education Worth Its Hefty Cost?
Which Pedagogical Methods Are Proven Ineffective?
The Impact of School Self-Defense Courses on Students.
Innovative Approaches to Foreign Language Acquisition.
Developing Financial Acumen among Middle Schoolers.

Environmental Science Case Study Topics

The effect of climate change on world agriculture production.
The role of politics in fighting Global Warming.
Identifying how college students can contribute to environmental conservation efforts.
Harnessing Green Technologies during pandemic crises.
The advantages and disadvantages of ecological tourism.
Examining the feasibility of conserving endangered species in modern times.

Psychology Case Study Topics

Disparities in educational attainment among different age groups.
Effectiveness of staff appreciation programs for improving motivation levels.
Benefits of using meditation and mindfulness practices for managing stress.
Emotional and psychological ramifications of family separations.
Psychiatric difficulties of child abuse survivors in maturity.
Mental health effects of social media overload.

Marketing Case Study Topics

Cultural and regional differences in marketing strategies.
Impact of corporate branding tactics on customer loyalty.
Distinctive features of Steve Jobs’ marketing style.
The role of creative design in modern-day advertising.
The impact of social media on brand development.
Impact of celebrity endorsements on brand image.

Human Rights Case Study Topics

Prevalent Misconceptions regarding the Black Lives Matter Movement.
Human Rights Activists and their Ethical Values: South Africa.
Upholding Minor Children’s Basic Human Rights.
Uncovering the Ethical Implications of Free Expression.
Contrasting US & Canadian Human Rights Controversies.
Exploring the Debate: Should Kids Vote/Participate in Politics?

Social Media Marketing Case Study Topics

Risks associated with online advertising.
The detrimental effects of an excessive online presence.
Issues confronting influencers on social media platforms.
Is Social Media Advertising the next great advance in modern sales tactics?
Grounds for TikTok’s rapid rise to stardom.
Examining potential pitfalls for young users on social media networks.

Business Case Study Topics

The detrimental effects of consumerism on the U.S. economy.
Personnel management challenges at Amazon outlets.
Exploring Australia’s investment-driven industrial environment.
Apple’s pricing tactics for maximizing returns.
The correlation between production excellence and innovative strategic thinking among CEOs.
Methods for successful market expansion across Asian countries.

Applied Physics Case Study Topics

How astrophysics instruction augments school learning.
Quantum Information Science and data transfer techniques.
The psychological ramifications of radiation therapy.
Green energy systems in domestic settings.
Evaluating potential hazards in studying Microfluidics.
The effects of weightlessness on the vital activity of the body.

The topics for writing a case study are vast and varied. You should choose a topic carefully to ensure it is relevant to your audience. You should also ensure that you have enough knowledge on the subject to do it justice. We have provided a list of current topics as inspiration to help you start writing your next case study.

List of Current Topics to Write a Case Study

Abir Ghenaiet

Abir is a data analyst and researcher. Among her interests are artificial intelligence, machine learning, and natural language processing. As a humanitarian and educator, she actively supports women in tech and promotes diversity.

Explore All Write A Case Study Articles

How to write a leadership case study (sample) .

Writing a case study isn’t as straightforward as writing essays. But it has proven to be an effective way of…

Write A Case Study

Top 5 Online Expert Case Study Writing Services

It’s a few hours to your deadline — and your case study college assignment is still a mystery to you.…

Examples Of Business Case Study In Research

A business case study can prevent an imminent mistake in business. How? It’s an effective teaching technique that teaches students…

How to Write a Multiple Case Study Effectively

Have you ever been assigned to write a multiple case study but don’t know where to begin? Are you intimidated…

How to Write a Case Study Presentation: 6 Key Steps

Case studies are an essential element of the business world. Understanding how to write a case study presentation will give…

How to Write a Case Study for Your Portfolio

Are you ready to showcase your design skills and move your career to the next level? Crafting a compelling case…

Browse All Articles
Newsletter Sign-Up

18 Mar 2024
Research & Ideas

When It Comes to Climate Regulation, Energy Companies Take a More Nuanced View

Many assume that major oil and gas companies adamantly oppose climate-friendly regulation, but that's not true. A study of 30 years of corporate advocacy by Jonas Meckling finds that energy companies have backed clean-energy efforts when it aligns with their business interests.

12 Mar 2024

How Used Products Can Unlock New Markets: Lessons from Apple's Refurbished iPhones

The idea of reselling old smartphones might have seemed risky for a company known for high-end devices, but refurbished products have become a major profit stream for Apple and an environmental victory. George Serafeim examines Apple's circular model in a case study, and offers insights for other industries.

27 Feb 2024
Cold Call Podcast

How Could Harvard Decarbonize Its Supply Chain?

Harvard University aims to be fossil-fuel neutral by 2026 and totally free of fossil fuels by 2050. As part of this goal, the university is trying to decarbonize its supply chain and considers replacing cement with a low-carbon substitute called Pozzotive®, made with post-consumer recycled glass. A successful pilot project could jump start Harvard’s initiative to reduce embodied carbon emissions, but it first needs credible information about the magnitude and validity of potential carbon reductions. Harvard Business School professor emeritus Robert Kaplan and assistant professor Shirley Lu discuss the flow of emissions along the supply chain of Harvard University’s construction projects, the different methods of measuring carbon emissions, including the E-liability approach, and the opportunity to leverage blockchain technology to facilitate the flow of comparable and reliable emissions information in the case, “Harvard University and Urban Mining Industries: Decarbonizing the Supply Chain.”

30 Jan 2024

Can Second-Generation Ethanol Production Help Decarbonize the World?

Raízen, a bioenergy company headquartered in São Paulo, is Brazil’s leader in sugar and ethanol production and the world’s leading ethanol trader. Since its creation in 2011, the company had primarily produced first-generation ethanol (E1G) from sugarcane, a crop that can also be used to produce sugar. In 2015, Raízen also started to produce second-generation ethanol (E2G), a biofuel derived from residual and waste materials, such as cane bagasse and straw – which don’t compete with food production. The company’s growth strategy focused on developing and boosting a low carbon portfolio that focused on E2G, based on the belief that Raízen—and Brazil—could help the world decarbonize and profit from the energy transition. Paula Kovarsky, Raízen’s chief strategy and sustainability officer, was confident the company could become a global green energy champion. But after the board’s approval for the first round of E2G investments, she faced a complex challenge: how to expand the market for second-generation ethanol and other sugar-cane waste biofuels, in order to ensure Raízen’s long-term growth? Harvard Business School professor Gunnar Trumbull and Kovarsky discuss the company’s strategy for bringing second-generation ethanol to the world in the case, “Raízen: Helping to Decarbonize the World?”

29 Jan 2024

Do Disasters Rally Support for Climate Action? It's Complicated.

Reactions to devastating wildfires in the Amazon show the contrasting realities for people living in areas vulnerable to climate change. Research by Paula Rettl illustrates the political ramifications that arise as people weigh the economic tradeoffs of natural disasters.

17 Jan 2024

Are Companies Getting Away with 'Cheap Talk' on Climate Goals?

Many companies set emissions targets with great fanfare—and never meet them, says research by Shirley Lu and colleagues. But what if investors held businesses accountable for achieving their climate plans?

09 Jan 2024

Could Clean Hydrogen Become Affordable at Scale by 2030?

The cost to produce hydrogen could approach the $1-per-kilogram target set by US regulators by 2030, helping this cleaner energy source compete with fossil fuels, says research by Gunther Glenk and colleagues. But planned global investments in hydrogen production would need to come to fruition to reach full potential.

02 Jan 2024

Should Businesses Take a Stand on Societal Issues?

Should businesses take a stand for or against particular societal issues? And how should leaders determine when and how to engage on these sensitive matters? Harvard Business School Senior Lecturer Hubert Joly, who led the electronics retailer Best Buy for almost a decade, discusses examples of corporate leaders who had to determine whether and how to engage with humanitarian crises, geopolitical conflict, racial justice, climate change, and more in the case, “Deciding When to Engage on Societal Issues.”

10 Trends to Watch in 2024

Employees may seek new approaches to balance, even as leaders consider whether to bring more teams back to offices or make hybrid work even more flexible. These are just a few trends that Harvard Business School faculty members will be following during a year when staffing, climate, and inclusion will likely remain top of mind.

19 Sep 2023

What Chandrayaan-3 Says About India's Entrepreneurial Approach to Space

India reached an unexplored part of the moon despite its limited R&D funding compared with NASA and SpaceX. Tarun Khanna discusses the significance of the landing, and the country's advancements in data and digital technology.

12 Sep 2023
What Do You Think?

Who Gets the Loudest Voice in DEI Decisions?

Business leaders are wrestling with how to manage their organizations' commitment to diversity, equity, and inclusion. If you were a CEO, which constituency would you consider most: your employees, customers, or investors? asks James Heskett. Open for comment; 0 Comments.

26 Jul 2023

STEM Needs More Women. Recruiters Often Keep Them Out

Tech companies and programs turn to recruiters to find top-notch candidates, but gender bias can creep in long before women even apply, according to research by Jacqueline Ng Lane and colleagues. She highlights several tactics to make the process more equitable.

18 Jul 2023

Will Global Demand for Oil Peak This Decade?

The International Energy Agency expects the world's oil demand to start to ebb in the coming years. However, Joseph Lassiter and Lauren Cohen say the outlook will likely be more complex, especially as poor and fast-growing regions seek energy sources for their economies.

28 Apr 2023

Sweden’s Northvolt Electric Battery Maker: A Startup with a Mission

In Stockholm, Sweden an upstart battery maker, Northvolt, is trying to recreate the value chain for European car manufacturers making the switch to EVs. With two founders from Tesla and two experienced financiers at the helm, the company seems bound for success. But can they partner with government, scale fast enough, and truly be part of the climate solution? Harvard Business School professor George Serafeim discusses what it takes to scale a business—the right people, in the right place, at the right time—with the aim of providing a climate solution in the case, “Northvolt, Building Batteries to Fight Climate Change.” As part of a new first-year MBA course at Harvard Business School, this case examines the central question: what is the social purpose of the firm?

18 Apr 2023

What Happens When Banks Ditch Coal: The Impact Is 'More Than Anyone Thought'

Bank divestment policies that target coal reduced carbon dioxide emissions, says research by Boris Vallée and Daniel Green. Could the finance industry do even more to confront climate change?

11 Apr 2023

A Rose by Any Other Name: Supply Chains and Carbon Emissions in the Flower Industry

Headquartered in Kitengela, Kenya, Sian Flowers exports roses to Europe. Because cut flowers have a limited shelf life and consumers want them to retain their appearance for as long as possible, Sian and its distributors used international air cargo to transport them to Amsterdam, where they were sold at auction and trucked to markets across Europe. But when the Covid-19 pandemic caused huge increases in shipping costs, Sian launched experiments to ship roses by ocean using refrigerated containers. The company reduced its costs and cut its carbon emissions, but is a flower that travels halfway around the world truly a “low-carbon rose”? Harvard Business School professors Willy Shih and Mike Toffel debate these questions and more in their case, “Sian Flowers: Fresher by Sea?”

28 Mar 2023

BMW’s Decarbonization Strategy: Sustainable for the Environment and the Bottom Line

In mid-2022, automakers, consumers, regulators, and investors were focusing on the transition from internal combustion engine (ICE) vehicles to electric vehicles (EV). While this would reduce tail-pipe emissions, it ignored the fact that the production of EVs—and especially their batteries—increases emissions in the supply chain. Many automakers were announcing deadlines by which they would stop selling ICE vehicles altogether, buoyed by investment analysts and favorable press. But BMW decided to focus on lifecycle emissions and pursued a flexible powertrain strategy by offering vehicles with several options: gasoline and diesel-fueled ICE, plug-in hybrid electric vehicles, and battery electric vehicles. That approach received a frostier reception in the stock market. Assistant Professor Shirley Lu discusses how BMW plans to convince stakeholders that its strategy is good for both the environment and the company’s financial performance in the case, “Driving Decarbonization at BMW.”

23 Mar 2023

As Climate Fears Mount, More Investors Turn to 'ESG' Funds Despite Few Rules

Regulations and ratings remain murky, but that's not deterring climate-conscious investors from paying more for funds with an ESG label. Research by Mark Egan and Malcolm Baker sizes up the premium these funds command. Is it time for more standards in impact investing?

13 Jan 2023

Are Companies Actually Greener—or Are They All Talk?

More companies than ever use ESG reports to showcase their social consciousness. But are these disclosures meaningful or just marketing? Research by Ethan Rouen delves into the murky world of voluntary reporting and offers advice for investors.

09 Nov 2022
In Practice

COP27: What Can Business Leaders Do to Fight Climate Change Now?

The US government plans to spend $370 billion to cut greenhouse gases and expand renewable energy—its biggest investment yet. In the wake of COP27, we asked Harvard Business School faculty members how executives could seize this moment.

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Healthcare-related research topics and ideas

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

Allopathic medicine
Alternative /complementary medicine
Veterinary medicine
Physical therapy/ rehab
Optometry and ophthalmology
Pharmacy and pharmacology
Public health
Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

The effectiveness of telemedicine in remote elderly patient care
The impact of stress on the immune system of cancer patients
The effects of a plant-based diet on chronic diseases such as diabetes
The use of AI in early cancer diagnosis and treatment
The role of the gut microbiome in mental health conditions such as depression and anxiety
The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
The benefits and drawbacks of electronic health records in a developing country
The effects of environmental pollution on breast milk quality
The use of personalized medicine in treating genetic disorders
The impact of social determinants of health on chronic diseases in Asia
The role of high-intensity interval training in improving cardiovascular health
The efficacy of using probiotics for gut health in pregnant women
The impact of poor sleep on the treatment of chronic illnesses
The role of inflammation in the development of chronic diseases such as lupus
The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

The benefits of herbal medicine in treating young asthma patients
The use of acupuncture in treating infertility in women over 40 years of age
The effectiveness of homoeopathy in treating mental health disorders: A systematic review
The role of aromatherapy in reducing stress and anxiety post-surgery
The impact of mindfulness meditation on reducing high blood pressure
The use of chiropractic therapy in treating back pain of pregnant women
The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
The impact of yoga on physical and mental health in adolescents
The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
The role of Reiki in promoting healing and relaxation post birth
The effectiveness of naturopathy in treating skin conditions such as eczema
The use of deep tissue massage therapy in reducing chronic pain in amputees
The impact of tai chi on the treatment of anxiety and depression
The benefits of reflexology in treating stress, anxiety and chronic fatigue
The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

The impact of sugar consumption on the oral health of infants
The use of digital dentistry in improving patient care: A systematic review
The efficacy of orthodontic treatments in correcting bite problems in adults
The role of dental hygiene in preventing gum disease in patients with dental bridges
The impact of smoking on oral health and tobacco cessation support from UK dentists
The benefits of dental implants in restoring missing teeth in adolescents
The use of lasers in dental procedures such as root canals
The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
The role of fluoride in promoting remineralization and slowing down demineralization
The impact of stress-induced reflux on oral health
The benefits of dental crowns in restoring damaged teeth in elderly patients
The use of sedation dentistry in managing dental anxiety in children
The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
The role of orthodontic appliances in improving well-being
The impact of periodontal disease on overall health and chronic illnesses

Free Webinar: How To Find A Dissertation Research Topic

Tops & Ideas: Veterinary Medicine

The impact of nutrition on broiler chicken production
The role of vaccines in disease prevention in horses
The importance of parasite control in animal health in piggeries
The impact of animal behaviour on welfare in the dairy industry
The effects of environmental pollution on the health of cattle
The role of veterinary technology such as MRI in animal care
The importance of pain management in post-surgery health outcomes
The impact of genetics on animal health and disease in layer chickens
The effectiveness of alternative therapies in veterinary medicine: A systematic review
The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
The impact of climate change on animal health and infectious diseases in animals
The importance of animal welfare in veterinary medicine and sustainable agriculture
The effects of the human-animal bond on canine health
The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
The impact of telerehabilitation on patient outcomes in Germany
The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
A comparison of manual therapy and yoga exercise therapy in the management of low back pain
The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
The impact of mindfulness-based interventions in physical therapy in adolescents
The effects of resistance training on individuals with Parkinson’s disease
The role of hydrotherapy in the management of fibromyalgia
The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
The use of virtual reality in physical rehabilitation of sports injuries
The effects of electrical stimulation on muscle function and strength in athletes
The role of physical therapy in the management of stroke recovery: A systematic review
The impact of pilates on mental health in individuals with depression
The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

The impact of screen time on the vision and ocular health of children under the age of 5
The effects of blue light exposure from digital devices on ocular health
The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
The use of telemedicine in optometry and ophthalmology in the UK
The impact of myopia control interventions on African American children’s vision
The use of contact lenses in the management of dry eye syndrome: different treatment options
The effects of visual rehabilitation in individuals with traumatic brain injury
The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
The impact of environmental air pollution on ocular health
The effectiveness of orthokeratology in myopia control compared to contact lenses
The role of dietary supplements, such as omega-3 fatty acids, in ocular health
The effects of ultraviolet radiation exposure from tanning beds on ocular health
The impact of computer vision syndrome on long-term visual function
The use of novel diagnostic tools in optometry and ophthalmology in developing countries
The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

The impact of medication adherence on patient outcomes in cystic fibrosis
The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
The effects of pharmacogenomics on drug response and toxicity in cancer patients
The role of pharmacists in the management of chronic pain in primary care
The impact of drug-drug interactions on patient mental health outcomes
The use of telepharmacy in healthcare: Present status and future potential
The effects of herbal and dietary supplements on drug efficacy and toxicity
The role of pharmacists in the management of type 1 diabetes
The impact of medication errors on patient outcomes and satisfaction
The use of technology in medication management in the USA
The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
Leveraging the role of pharmacists in preventing and managing opioid use disorder
The impact of the opioid epidemic on public health in a developing country
The use of biosimilars in the management of the skin condition psoriasis
The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

The impact of the built environment and urbanisation on physical activity and obesity
The effects of food insecurity on health outcomes in Zimbabwe
The role of community-based participatory research in addressing health disparities
The impact of social determinants of health, such as racism, on population health
The effects of heat waves on public health
The role of telehealth in addressing healthcare access and equity in South America
The impact of gun violence on public health in South Africa
The effects of chlorofluorocarbons air pollution on respiratory health
The role of public health interventions in reducing health disparities in the USA
The impact of the United States Affordable Care Act on access to healthcare and health outcomes
The effects of water insecurity on health outcomes in the Middle East
The role of community health workers in addressing healthcare access and equity in low-income countries
The impact of mass incarceration on public health and behavioural health of a community
The effects of floods on public health and healthcare systems
The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

Research Topic Kickstarter - Need Help Finding A Research Topic?

You Might Also Like:

Topic Kickstarter: Research topics in education

15 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Print Friendly

Work & Careers
Life & Arts
Currently reading: Business school teaching case study: can green hydrogen’s potential be realised?
Business school teaching case study: how electric vehicles pose tricky trade dilemmas
Business school teaching case study: is private equity responsible for child labour violations?

Business school teaching case study: can green hydrogen’s potential be realised?

Close-up of a green and white sign featuring the chemical symbol for hydrogen, ‘H2’

Business school teaching case study: can green hydrogen’s potential be realised? on x (opens in a new window)
Business school teaching case study: can green hydrogen’s potential be realised? on facebook (opens in a new window)
Business school teaching case study: can green hydrogen’s potential be realised? on linkedin (opens in a new window)
Business school teaching case study: can green hydrogen’s potential be realised? on whatsapp (opens in a new window)

Jennifer Howard-Grenville and Ujjwal Pandey

Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

Hydrogen is often hyped as the “Swiss army knife” of the energy transition because of its potential versatility in decarbonising fossil fuel-intensive energy production and industries. Making use of that versatility, however, will require hydrogen producers and distributors to cut costs, manage technology risks, and obtain support from policymakers.

To cut carbon dioxide emissions, hydrogen production must shift from its current reliance on fossil fuels. The most common method yields “grey hydrogen”, made from natural gas but without emissions capture. “Blue hydrogen,” which is also made from natural gas but with the associated carbon emissions captured and stored, is favourable.

But “green hydrogen” uses renewable energy sources, including wind and solar, to split water into hydrogen and oxygen via electrolysis. And, because there are no carbon emissions during production or combustion, green hydrogen can help to decarbonise energy generation as well as industry sectors — such as steel, chemicals and transport — that rely heavily on fossil fuels.

Ultimately, though, the promise of green hydrogen will hinge on how businesses and policymakers weigh several questions, trade-offs, and potential long-term consequences. We know from previous innovations that progress can be far from straightforward.

Wind power, for example, is a mature renewable energy technology and a key enabler in green hydrogen production, but it suffers vulnerabilities on several fronts. Even Denmark’s Ørsted — the world’s largest developer of offshore wind power and a beacon for renewable energy — recently said it was struggling to deliver new offshore wind projects profitably in the UK.

Generally, the challenge arises from interdependencies between macroeconomic conditions — such as energy costs and interest rates — and business decision-making around investments. In the case of Ørsted, it said the escalating costs of turbines, labour, and financing have exceeded the inflation-linked fixed price for electricity set by regulators.

Business leaders will also need to steer through uncertainties — such as market demand, technological risks, regulatory ambiguity, and investment risks — as they seek to incorporate green hydrogen.

Test yourself

This is the third in a series of monthly business school-style teaching case studies devoted to responsible-business dilemmas faced by organisations. Read the piece and FT articles suggested at the end before considering the questions raised.

About the authors: Jennifer Howard-Grenville is Diageo professor of organisation studies at Cambridge Judge Business School; Ujjwal Pandey is an MBA candidate at Cambridge Judge and a former consultant at McKinsey.

The series forms part of a wide-ranging collection of FT ‘instant teaching case studies ’ that explore business challenges.

Two factors could help business leaders gain more clarity.

The first factor will be where, and how quickly, costs fall and enable the necessary increase to large-scale production. For instance, the cost of the electrolysers needed to split water into hydrogen and oxygen remains high because levels of production are too low. These costs and slow progress in expanding the availability and affordability of renewable energy sources have made green hydrogen much more expensive than grey hydrogen, so far — currently, two to three times the cost.

The FT’s Lex column calculated last year that a net zero energy system would create global demand for hydrogen of 500mn tonnes, annually, by 2050 — which would require an investment of $20tn. However, only $29bn had been committed by potential investors, Lex noted, despite some 1,000 new projects being announced globally and estimated to require total investment of $320bn.

A worker in a cleanroom suit inspects a large flexible solar panel in a high-tech manufacturing setting, with the panel’s reflection visible on a shiny surface below

Solar power faced similar challenges a decade ago. Thanks to low-cost manufacturing in China and supportive government policies, the sector has grown and is, within a very few years , expected to surpass gas-fired power plant installed capacity, globally. Green hydrogen requires a similar concerted effort. With the right policies and technological improvements, the cost of green hydrogen could fall below the cost of grey hydrogen in the next decade, enabling widespread adoption of the former.

Countries around the world are introducing new and varied incentives to address this gap between the expected demand and supply of green hydrogen. In Canada, for instance, Belgium’s Tree Energy Solutions plans to build a $4bn plant in Quebec, to produce synthetic natural gas from green hydrogen and captured carbon, attracted partly by a C$17.7bn ($12.8bn) tax credit and the availability of hydropower.

Such moves sound like good news for champions of green hydrogen, but companies still need to manage the short-term risks from potential policy and energy price swings. The US Inflation Reduction Act, which offers tax credits of up to $3 per kilogramme for producing low-carbon hydrogen, has already brought in limits , and may not survive a change of government.

Against such a backdrop, how should companies such as Hystar — a Norwegian maker of electrolysers already looking to expand capacity from 50 megawatts to 4 gigawatts a year in Europe — decide where and when to open a North American production facility?

The second factor that will shape hydrogen’s future is how and where it is adopted across different industries. Will it be central to the energy sector, where it can be used to produce synthetic fuels, or to help store the energy generated by intermittent renewables, such as wind and solar? Or will it find its best use in hard-to-abate sectors — so-called because cutting their fossil fuel use, and their CO₂ emissions, is difficult — such as aviation and steelmaking?

Steel producers are already seeking to pivot to hydrogen, both as an energy source and to replace the use of coal in reducing iron ore. In a bold development in Sweden, H2 Green Steel says it plans to decarbonise by incorporating hydrogen in both these ways, targeting 2.5mn tonnes of green steel production annually .

Meanwhile, the global aviation industry is exploring the use of hydrogen to replace petroleum-based aviation fuels and in fuel cell technologies that transform hydrogen into electricity. In January 2023, for instance, Anglo-US start-up ZeroAvia conducted a successful test flight of a hydrogen fuel cell-powered aircraft.

A propeller-driven aircraft with the inscription ‘ZEROAVIA’ is seen ascending above a grassy airfield with buildings and trees in the background

The path to widespread adoption, and the transformation required for hydrogen’s range of potential applications, will rely heavily on who invests, where and how. Backers have to be willing to pay a higher initial price to secure and build a green hydrogen supply in the early phases of their investment.

It will also depend on how other technologies evolve. No industry is looking only to green hydrogen to achieve their decarbonisation aims. Other, more mature technologies — such as battery storage for renewable energy — may instead dominate, leaving green hydrogen to fulfil niche applications that can bear high costs.

As with any transition, there will be unintended consequences. Natural resources (sun, wind, hydropower) and other assets (storage, distribution, shipping) that support the green hydrogen economy are unevenly distributed around the globe. There will be new exporters — countries with abundant renewables in the form of sun, wind or hydropower, such as Australia or some African countries — and new importers, such as Germany, with existing industry that relies on hydrogen but has relatively low levels of renewable energy sourced domestically.

How will the associated social and environmental costs be borne, and how will the economic and development benefits be shared? Tackling climate change through decarbonisation is urgent and essential, but there are also trade-offs and long-term consequences to the choices made today.

Questions for discussion

Lex in depth: the staggering cost of a green hydrogen economy

How Germany’s steelmakers plan to go green

Hydrogen-electric aircraft start-up secures UK Infrastructure Bank backing

Aviation start-ups test potential of green hydrogen

Consider these questions:

Are the trajectories for cost/scale-up of other renewable energy technologies (eg solar, wind) applicable to green hydrogen? Are there features of the current economic, policy, and business landscape that point to certain directions for green hydrogen’s development and application?

Take the perspective of someone from a key industry that is part of, or will be affected by, the development of green hydrogen. How should you think about the technology and business opportunities and risks in the near term, and longer term? How might you retain flexibility while still participating in these key shifts?

Solving one problem often creates or obscures new ones. For example, many technologies that decarbonise (such as electric vehicles) have other impacts (such as heavy reliance on certain minerals and materials). How should those participating in the emerging green hydrogen economy anticipate, and address, potential environmental and social impacts? Can we learn from energy transitions of the past?

Climate Capital

Where climate change meets business, markets and politics. Explore the FT’s coverage here .

Are you curious about the FT’s environmental sustainability commitments? Find out more about our science-based targets here

Promoted Content

Explore the series.

A Smart EQ Fortwo electric vehicle charges at a Belib’ station alongside a locked bicycle in Paris, France

Follow the topics in this article

Carbon footprint Add to myFT
Climate change Add to myFT
Renewable energy Add to myFT
Environment Add to myFT
Business school Add to myFT

International Edition

Teaching & Learning

Education Excellence
Professional development
Case studies
Teaching toolkits
MicroCPD-UCL
Assessment resources
Student partnership
Generative AI Hub
Community Engaged Learning
UCL Student Success

Teaching difficult and sensitive topics in higher education: some starting points

Helen Knowler, Associate Professor (Teaching), the Eugenics Legacy Education Project, offers thoughtful advice on how to help your students constructively tackle difficult or sensitive topics.

12 April 2024

MediaCentral Widget Placeholder https://mediacentral.ucl.ac.uk/Player/Cd00GDie

Watch the video on MediaCentral . Download the transcript [docx] .

What are difficult and/or sensitive topics?

Defining and agreeing what constitutes a difficult and/or sensitive topic can be hard to agree on because what is ‘difficult’ for some, is not for others. A key aspect for success in the classroom is dependent on some careful thinking and planning as well as challenging some ‘taken for granted’ aspects of our practices. Generally, difficult topics are characterised by engagement with curriculum content that can make learners feel discomfort, where disagreement becomes a feature of the classroom space, perhaps in ways it was not in previous modules or sessions. So, talking to colleagues about the ways you define and understand ‘difficulty’ can be a really valuable first step in understanding how best to teach these areas.

Why do we need to think about this?

Higher education classrooms are diverse and dynamic and, while this can bring many benefits for learners, it can pose tensions and dilemmas for educators introducing difficult topics within a short space of time (such as one module session). We cannot always do justice to the complexity of the topic. Conversely, working with colleagues to introduce or revise teaching to incorporate direct engagement with difficult topics can be creative and drive innovation – because we need to think about issues such as inclusive learning, culturally relevant teaching, authentic assessment and preparing students to work in institutions where difficult topics and conversations may be the norm. Teaching difficult topics offers enormous potential to teach critical thinking skills, using evidence and reasoning to agree on productive solutions and to think about wider concepts around social justice and equity.

What can we do?

There are three key strategies important when thinking about and planning for teaching topics that could be described as difficult or sensitive.

Prepare your students

Firstly, it is helpful to think about the ways that students encounter potentially difficult or sensitive topics across a module or a programme. It is useful to think about the timing of the introduction of difficult content from the perspective of students. The research shows that introducing content too early or too late restricts opportunities to prepare students to learn about difficult content and for us to ensure we have laid the groundwork in terms of skills and understanding.

For example, we might want to teach students to understand the legacy of eugenics at UCL and ask them to present their research on the topic. If this topic is introduced in a way that leaves students unprepared to do the task, to understand the rationale behind including this work, and not understanding why this is relevant to learning outcomes, we are more likely to encounter a lack of engagement or strong emotions related to wanting to question the inclusion of such content.

Explain your approach

Linked to mapping, offering and explicit educational rationale and justification is critical. In my experience, when colleagues offer a short overview of their teaching approach, explain the inclusion of content and their choices for learning strategies, students understand the decision-making around the inclusion of difficult content, and can see the connections between teaching philosophies and practical approaches.

This doesn’t have to be a huge piece of work – I have seen examples of this done well as part of module introductions on Moodle or as part of introductory sessions with students where tutors have explored, with students, the use of approaches and their intended aims. This is important if we want our sessions to be productive and engaging for students and it also enables us to work with students before difficult topics appear.

Alignment pedagogies

The final tool that I see used by educators relates to alignment. Reflecting on times when I have seen things ‘go wrong’ in teaching session, I have worked with colleagues to explore and identify places in their work where there is a small misalignment in their teaching. This is usually almost imperceptible, but its impact can be significant for students.

For example, we might be wanting to teach an area that is sensitive, and our goal is to support students to understand many perspectives and to think about empathy, and develop their critical thinking skills. So, these are lofty aims for one session and when we add a pedagogic approach that is not quite aligned, we might find that students do not engage. So here, we’d want to think about reducing the content and aims of the session, and choosing a pedagogic approach that offers students time and space to think about the complexity. We would want the students to understand and experience that the goal is NOT to decide for or against, or offer simplistic solutions to complex issues.

Find out more

Access a range of resources relating to the Eugenics Legacy Education project , including recordings of many of our sessions.

More MicroCPD-UCL

Funnelback feed: https://cms-feed.ucl.ac.uk/s/search.json?collection=drupal-teaching-lear... Double click the feed URL above to edit

See us on facebook
See us on twitter
See us on youtube
See us on linkedin
See us on instagram

Two key brain systems are central to psychosis, Stanford Medicine-led study finds

When the brain has trouble filtering incoming information and predicting what’s likely to happen, psychosis can result, Stanford Medicine-led research shows.

April 11, 2024 - By Erin Digitale

People with psychosis have trouble filtering relevant information (mesh funnel) and predicting rewarding events (broken crystal ball), creating a complex inner world. Emily Moskal

Inside the brains of people with psychosis, two key systems are malfunctioning: a “filter” that directs attention toward important external events and internal thoughts, and a “predictor” composed of pathways that anticipate rewards.

Dysfunction of these systems makes it difficult to know what’s real, manifesting as hallucinations and delusions.

The findings come from a Stanford Medicine-led study , published April 11 in Molecular Psychiatry , that used brain scan data from children, teens and young adults with psychosis. The results confirm an existing theory of how breaks with reality occur.

“This work provides a good model for understanding the development and progression of schizophrenia, which is a challenging problem,” said lead author Kaustubh Supekar , PhD, clinical associate professor of psychiatry and behavioral sciences.

The findings, observed in individuals with a rare genetic disease called 22q11.2 deletion syndrome who experience psychosis as well as in those with psychosis of unknown origin, advance scientists’ understanding of the underlying brain mechanisms and theoretical frameworks related to psychosis.

During psychosis, patients experience hallucinations, such as hearing voices, and hold delusional beliefs, such as thinking that people who are not real exist. Psychosis can occur on its own and isa hallmark of certain serious mental illnesses, including bipolar disorder and schizophrenia. Schizophrenia is also characterized by social withdrawal, disorganized thinking and speech, and a reduction in energy and motivation.

It is challenging to study how schizophrenia begins in the brain. The condition usually emerges in teens or young adults, most of whom soon begin taking antipsychotic medications to ease their symptoms. When researchers analyze brain scans from people with established schizophrenia, they cannot distinguish the effects of the disease from the effects of the medications. They also do not know how schizophrenia changes the brain as the disease progresses.

To get an early view of the disease process, the Stanford Medicine team studied young people aged 6 to 39 with 22q11.2 deletion syndrome, a genetic condition with a 30% risk for psychosis, schizophrenia or both.

Kaustubh Supekar

Brain function in 22q11.2 patients who have psychosis is similar to that in people with psychosis of unknown origin, they found. And these brain patterns matched what the researchers had previously theorized was generating psychosis symptoms.

“The brain patterns we identified support our theoretical models of how cognitive control systems malfunction in psychosis,” said senior study author Vinod Menon , PhD, the Rachael L. and Walter F. Nichols, MD, Professor; a professor of psychiatry and behavioral sciences; and director of the Stanford Cognitive and Systems Neuroscience Laboratory .

Thoughts that are not linked to reality can capture the brain’s cognitive control networks, he said. “This process derails the normal functioning of cognitive control, allowing intrusive thoughts to dominate, culminating in symptoms we recognize as psychosis.”

Cerebral sorting

Normally, the brain’s cognitive filtering system — aka the salience network — works behind the scenes to selectively direct our attention to important internal thoughts and external events. With its help, we can dismiss irrational thoughts and unimportant events and focus on what’s real and meaningful to us, such as paying attention to traffic so we avoid a collision.

The ventral striatum, a small brain region, and associated brain pathways driven by dopamine, play an important role in predicting what will be rewarding or important.

For the study, the researchers assembled as much functional MRI brain-scan data as possible from young people with 22q11.2 deletion syndrome, totaling 101 individuals scanned at three different universities. (The study also included brain scans from several comparison groups without 22q11.2 deletion syndrome: 120 people with early idiopathic psychosis, 101 people with autism, 123 with attention deficit/hyperactivity disorder and 411 healthy controls.)

The genetic condition, characterized by deletion of part of the 22nd chromosome, affects 1 in every 2,000 to 4,000 people. In addition to the 30% risk of schizophrenia or psychosis, people with the syndrome can also have autism or attention deficit hyperactivity disorder, which is why these conditions were included in the comparison groups.

The researchers used a type of machine learning algorithm called a spatiotemporal deep neural network to characterize patterns of brain function in all patients with 22q11.2 deletion syndrome compared with healthy subjects. With a cohort of patients whose brains were scanned at the University of California, Los Angeles, they developed an algorithmic model that distinguished brain scans from people with 22q11.2 deletion syndrome versus those without it. The model predicted the syndrome with greater than 94% accuracy. They validated the model in additional groups of people with or without the genetic syndrome who had received brain scans at UC Davis and Pontificia Universidad Católica de Chile, showing that in these independent groups, the model sorted brain scans with 84% to 90% accuracy.

The researchers then used the model to investigate which brain features play the biggest role in psychosis. Prior studies of psychosis had not given consistent results, likely because their sample sizes were too small.

Vinod Menon

Comparing brain scans from 22q11.2 deletion syndrome patients who had and did not have psychosis, the researchers showed that the brain areas contributing most to psychosis are the anterior insula (a key part of the salience network or “filter”) and the ventral striatum (the “reward predictor”); this was true for different cohorts of patients.

In comparing the brain features of people with 22q11.2 deletion syndrome and psychosis against people with psychosis of unknown origin, the model found significant overlap, indicating that these brain features are characteristic of psychosis in general.

A second mathematical model, trained to distinguish all subjects with 22q11.2 deletion syndrome and psychosis from those who have the genetic syndrome but without psychosis, selected brain scans from people with idiopathic psychosis with 77.5% accuracy, again supporting the idea that the brain’s filtering and predicting centers are key to psychosis.

Furthermore, this model was specific to psychosis: It could not classify people with idiopathic autism or ADHD.

“It was quite exciting to trace our steps back to our initial question — ‘What are the dysfunctional brain systems in schizophrenia?’ — and to discover similar patterns in this context,” Menon said. “At the neural level, the characteristics differentiating individuals with psychosis in 22q11.2 deletion syndrome are mirroring the pathways we’ve pinpointed in schizophrenia. This parallel reinforces our understanding of psychosis as a condition with identifiable and consistent brain signatures.” However, these brain signatures were not seen in people with the genetic syndrome but no psychosis, holding clues to future directions for research, he added.

Applications for treatment or prevention

In addition to supporting the scientists’ theory about how psychosis occurs, the findings have implications for understanding the condition — and possibly preventing it.

“One of my goals is to prevent or delay development of schizophrenia,” Supekar said. The fact that the new findings are consistent with the team’s prior research on which brain centers contribute most to schizophrenia in adults suggests there may be a way to prevent it, he said. “In schizophrenia, by the time of diagnosis, a lot of damage has already occurred in the brain, and it can be very difficult to change the course of the disease.”

“What we saw is that, early on, functional interactions among brain regions within the same brain systems are abnormal,” he added. “The abnormalities do not start when you are in your 20s; they are evident even when you are 7 or 8.”

Our discoveries underscore the importance of approaching people with psychosis with compassion.

The researchers plan to use existing treatments, such as transcranial magnetic stimulation or focused ultrasound, targeted at these brain centers in young people at risk of psychosis, such as those with 22q11.2 deletion syndrome or with two parents who have schizophrenia, to see if they prevent or delay the onset of the condition or lessen symptoms once they appear.

The results also suggest that using functional MRI to monitor brain activity at the key centers could help scientists investigate how existing antipsychotic medications are working.

Although it’s still puzzling why someone becomes untethered from reality — given how risky it seems for one’s well-being — the “how” is now understandable, Supekar said. “From a mechanistic point of view, it makes sense,” he said.

“Our discoveries underscore the importance of approaching people with psychosis with compassion,” Menon said, adding that his team hopes their work not only advances scientific understanding but also inspires a cultural shift toward empathy and support for those experiencing psychosis.

“I recently had the privilege of engaging with individuals from our department’s early psychosis treatment group,” he said. “Their message was a clear and powerful: ‘We share more similarities than differences. Like anyone, we experience our own highs and lows.’ Their words were a heartfelt appeal for greater empathy and understanding toward those living with this condition. It was a call to view psychosis through a lens of empathy and solidarity.”

Researchers contributed to the study from UCLA, Clinica Alemana Universidad del Desarrollo, Pontificia Universidad Católica de Chile, the University of Oxford and UC Davis.

The study was funded by the Stanford Maternal and Child Health Research Institute’s Uytengsu-Hamilton 22q11 Neuropsychiatry Research Program, FONDEYCT (the National Fund for Scientific and Technological Development of the government of Chile), ANID-Chile (the Chilean National Agency for Research and Development) and the U.S. National Institutes of Health (grants AG072114, MH121069, MH085953 and MH101779).

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

Artificial intelligence

Exploring ways AI is applied to health care

SUGGESTED TOPICS
The Magazine
Newsletters
Managing Yourself
Managing Teams
Work-life Balance
The Big Idea
Data & Visuals
Reading Lists
Case Selections
HBR Learning
Topic Feeds
Account Settings
Email Preferences

Case Study: How Aggressively Should a Bank Pursue AI?

Thomas H. Davenport
George Westerman

A Malaysia-based CEO weighs the risks and potential benefits of turning a traditional bank into an AI-first institution.

Siti Rahman, the CEO of Malaysia-based NVF Bank, faces a pivotal decision. Her head of AI innovation, a recent recruit from Google, has a bold plan. It requires a substantial investment but aims to transform the traditional bank into an AI-first institution, substantially reducing head count and the number of branches. The bank’s CFO worries they are chasing the next hype cycle and cautions against valuing efficiency above all else. Siti must weigh the bank’s mixed history with AI, the resistance to losing the human touch in banking services, and the risks of falling behind in technology against the need for a prudent, incremental approach to innovation.

Two experts offer advice: Noemie Ellezam-Danielo, the chief digital and AI strategy at Société Générale, and Sastry Durvasula, the chief information and client services officer at TIAA.

Siti Rahman, the CEO of Malaysia-headquartered NVF Bank, hurried through the corridors of the university’s computer engineering department. She had directed her driver to the wrong building—thinking of her usual talent-recruitment appearances in the finance department—and now she was running late. As she approached the room, she could hear her head of AI innovation, Michael Lim, who had joined NVF from Google 18 months earlier, breaking the ice with the students. “You know, NVF used to stand for Never Very Fast,” he said to a few giggles. “But the bank is crawling into the 21st century.”

Thomas H. Davenport is the President’s Distinguished Professor of Information Technology and Management at Babson College, a visiting scholar at the MIT Initiative on the Digital Economy, and a senior adviser to Deloitte’s AI practice. He is a coauthor of All-in on AI: How Smart Companies Win Big with Artificial Intelligence (Harvard Business Review Press, 2023).
George Westerman is a senior lecturer at MIT Sloan School of Management and a coauthor of Leading Digital (HBR Press, 2014).

Partner Center

Research article
Open access
Published: 15 April 2024

What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography

Trisha Greenhalgh ORCID: orcid.org/0000-0003-2369-8088 1 ,
Julie L. Darbyshire 1 ,
Cassie Lee 2 ,
Emma Ladds 1 &
Jenny Ceolta-Smith 3

BMC Medicine volume 22 , Article number: 159 ( 2024 ) Cite this article

1073 Accesses

59 Altmetric

Metrics details

Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards to reduce a so-called “postcode lottery” of care. The original aim of this study—to examine the nature of quality in long covid care and reduce unwarranted variation in services—evolved to focus on examining the reasons why standardizing care was so challenging in this condition.

In 2021–2023, we ran a quality improvement collaborative across 10 UK sites. The dataset reported here was mostly but not entirely qualitative. It included data on the origins and current context of each clinic, interviews with staff and patients, and ethnographic observations at 13 clinics (50 consultations) and 45 multidisciplinary team (MDT) meetings (244 patient cases). Data collection and analysis were informed by relevant lenses from clinical care (e.g. evidence-based guidelines), improvement science (e.g. quality improvement cycles) and philosophy of knowledge.

Participating clinics made progress towards standardizing assessment and management in some topics; some variation remained but this could usually be explained. Clinics had different histories and path dependencies, occupied a different place in their healthcare ecosystem and served a varied caseload including a high proportion of patients with comorbidities. A key mechanism for achieving high-quality long covid care was when local MDTs deliberated on unusual, complex or challenging cases for which evidence-based guidelines provided no easy answers. In such cases, collective learning occurred through idiographic (case-based) reasoning , in which practitioners build lessons from the particular to the general. This contrasts with the nomothetic reasoning implicit in evidence-based guidelines, in which reasoning is assumed to go from the general (e.g. findings of clinical trials) to the particular (management of individual patients).

Not all variation in long covid services is unwarranted. Largely because long covid’s manifestations are so varied and comorbidities common, generic “evidence-based” standards require much individual adaptation. In this complex condition, quality improvement resources may be productively spent supporting MDTs to optimise their case-based learning through interdisciplinary discussion. Quality assessment of a long covid service should include review of a sample of individual cases to assess how guidelines have been interpreted and personalized to meet patients’ unique needs.

Study registration

NCT05057260, ISRCTN15022307.

Peer Review reports

The term “long covid” [ 1 ] means prolonged symptoms following SARS-CoV-2 infection not explained by an alternative diagnosis [ 2 ]. It embraces the US term “post-covid conditions” (symptoms beyond 4 weeks) [ 3 ], the UK terms “ongoing symptomatic covid-19” (symptoms lasting 4–12 weeks) and “post covid-19 syndrome” (symptoms beyond 12 weeks) [ 4 ] and the World Health Organization’s “post covid-19 condition” (symptoms occurring beyond 3 months and persisting for at least 2 months) [ 5 ]. Long covid thus defined is extremely common. In UK, for example, 1.8 million of a population of 67 million met the criteria for long covid in early 2023 and 41% of these had been unwell for more than 2 years [ 6 ].

Long covid is characterized by a constellation of symptoms which may include breathlessness, fatigue, muscle and joint pain, chest pain, memory loss and impaired concentration (“brain fog”), sleep disturbance, depression, anxiety, palpitations, dizziness, gastrointestinal problems such as diarrhea, skin rashes and allergy to food or drugs [ 2 ]. These lead to difficulties with essential daily activities such as washing and dressing, impaired exercise tolerance and ability to work, and reduced quality of life [ 2 , 7 , 8 ]. Symptoms typically cluster (e.g. in different patients, long covid may be dominated by fatigue, by breathlessness or by palpitations and dizziness) [ 9 , 10 ]. Long covid may follow a fairly constant course or a relapsing and remitting one, perhaps with specific triggers [ 11 ]. Overlaps between fatigue-dominant subtypes of long covid, myalgic encephalomyelitis and chronic fatigue syndrome have been hypothesized [ 12 ] but at the time of writing remain unproven.

Long covid has been a contested condition from the outset. Whilst long-term sequelae following other coronavirus (SARS and MERS) infections were already well-documented [ 13 ], SARS-CoV-2 was originally thought to cause a short-lived respiratory illness from which the patient either died or recovered [ 14 ]. Some clinicians dismissed protracted or relapsing symptoms as due to anxiety or deconditioning, especially if the patient had not had laboratory-confirmed covid-19. People with long covid got together in online groups and shared accounts of their symptoms and experiences of such “gaslighting” in their healthcare encounters [ 15 , 16 ]. Some groups conducted surveys on their members, documenting the wide range of symptoms listed in the previous paragraph and showing that whilst long covid is more commonly a sequel to severe acute covid-19, it can (rarely) follow a mild or even asymptomatic acute infection [ 17 ].

Early publications on long covid depicted a post-pneumonia syndrome which primarily affected patients who had been hospitalized (and sometimes ventilated) [ 18 , 19 ]. Later, covid-19 was recognized to be a multi-organ inflammatory condition (the pneumonia, for example, was reclassified as pneumonitis ) and its long-term sequelae attributed to a combination of viral persistence, dysregulated immune response (including auto-immunity), endothelial dysfunction and immuno-thrombosis, leading to damage to the lining of small blood vessels and (thence) interference with transfer of oxygen and nutrients to vital organs [ 20 , 21 , 22 , 23 , 24 ]. But most such studies were highly specialized, laboratory-based and written primarily for an audience of fellow laboratory researchers. Despite demonstrating mean differences in a number of metabolic variables, they failed to identify a reliable biomarker that could be used routinely in the clinic to rule a diagnosis of long covid in or out. Whilst the evidence base from laboratory studies grew rapidly, it had little influence on clinical management—partly because most long covid clinics had been set up with impressive speed by front-line clinical teams to address an immediate crisis, with little or no input from immunologists, virologists or metabolic specialists [ 25 ].

Studies of the patient experience revealed wide geographical variation in whether any long covid services were provided and (if they were) which patients were eligible for these and what tests and treatments were available [ 26 ]. An interim UK clinical guideline for long covid had been produced at speed and published in December 2020 [ 27 ], but it was uncertain about diagnostic criteria, investigations, treatments and prognosis. Early policy recommendations for long covid services in England, based on wide consultation across UK, had proposed a tiered service with “tier 1” being supported self-management, “tier 2” generalist assessment and management in primary care, “tier 3” specialist rehabilitation or respiratory follow-up with oversight from a consultant physician and “tier 4” tertiary care for patients with complications or complex needs [ 28 ]. In 2021, ring-fenced funding was allocated to establish 90 multidisciplinary long covid clinics in England [ 29 ]; some clinics were also set up with local funding in Scotland and Wales. These clinics varied widely in eligibility criteria, referral pathways, staffing mix (some had no doctors at all) and investigations and treatments offered. A further policy document on improving long covid services was published in 2022 [ 30 ]; it recommended that specialist long covid clinics should continue, though the long-term funding of these services remains uncertain [ 31 ]. To build the evidence base for delivering long covid services, major programs of publicly funded research were commenced in both UK [ 32 ] and USA [ 33 ].

In short, at the time this study began (late 2021), there appeared to be much scope for a program of quality improvement which would capture fast-emerging research findings, establish evidence-based standards and ensure these were rapidly disseminated and consistently adopted across both specialist long covid services and in primary care.

Quality improvement collaboratives

The quality improvement movement in healthcare was born in the early 1980s when clinicians and policymakers US and UK [ 34 , 35 , 36 , 37 ] began to draw on insights from outside the sector [ 38 , 39 , 40 ]. Adapting a total quality management approach that had previously transformed the Japanese car industry, they sought to improve efficiency, reduce waste, shift to treating the upstream causes of problems (hence preventing disease) and help all services approach the standards of excellence achieved by the best. They developed an approach based on (a) understanding healthcare as a complex system (especially its key interdependencies and workflows), (b) analysing and addressing variation within the system, (c) learning continuously from real-world data and (d) developing leaders who could motivate people and help them change structures and processes [ 41 , 42 , 43 , 44 ].

Quality improvement collaboratives (originally termed “breakthrough collaboratives” [ 45 ]), in which representatives from different healthcare organizations come together to address a common problem, identify best practice, set goals, share data and initiate and evaluate improvement efforts [ 46 ], are one model used to deliver system-wide quality improvement. It is widely assumed that these collaboratives work because—and to the extent that—they identify, interpret and implement high-quality evidence (e.g. from randomized controlled trials).

Research on why quality improvement collaboratives succeed or fail has produced the following list of critical success factors: taking a whole-system approach, selecting a topic and goal that fits with organizations’ priorities, fostering a culture of quality improvement (e.g. that quality is everyone’s job), engagement of everyone (including the multidisciplinary clinical team, managers, patients and families) in the improvement effort, clearly defining people’s roles and contribution, engaging people in preliminary groundwork, providing organizational-level support (e.g. chief executive endorsement, protected staff time, training and support for teams, resources, quality-focused human resource practices, external facilitation if needed), training in specific quality improvement techniques (e.g. plan-do-study-act cycle), attending to the human dimension (including cultivating trust and working to ensure shared vision and buy-in), continuously generating reliable data on both processes (e.g. current practice) and outcomes (clinical, satisfaction) and a “learning system” infrastructure in which knowledge that is generated feeds into individual, team and organizational learning [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].

The quality improvement collaborative approach has delivered many successes but it has been criticized at a theoretical level for over-simplifying the social science of human motivation and behaviour and for adopting a somewhat mechanical approach to the study of complex systems [ 55 , 56 ]. Adaptations of the original quality improvement methodology (e.g. from Sweden [ 57 , 58 ]) have placed greater emphasis on human values and meaning-making, on the grounds that reducing the complexities of a system-wide quality improvement effort to a set of abstract and generic “success factors” will miss unique aspects of the case such as historical path dependencies, personalities, framing and meaning-making and micropolitics [ 59 ].

Perhaps this explains why, when the abovementioned factors are met, a quality improvement collaborative’s success is more likely but is not guaranteed, as a systematic review demonstrated [ 60 ]. Some well-designed and well-resourced collaboratives addressing clear knowledge gaps produced few or no sustained changes in key outcome measures [ 49 , 53 , 60 , 61 , 62 ]. To identify why this might be, a detailed understanding of a service’s history, current challenges and contextual constraints is needed. This explains our decision, part-way through the study reported here, to collect rich contextual data on participating sites so as to better explain success or failure of our own collaborative.

Warranted and unwarranted variation in clinical practice

A generation ago, Wennberg described most variation in clinical practice as “unwarranted” (which he defined as variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences) [ 63 ]. Others coined the term “postcode lottery” to depict how such variation allegedly impacted on health outcomes [ 64 ]. Wennberg and colleagues’ Atlas of Variation , introduced in 1999 [ 65 ], and its UK equivalent, introduced in 2010 [ 66 ], described wide regional differences in the rates of procedures from arthroscopy to hysterectomy, and were used to prompt services to identify and address examples of under-treatment, mis-treatment and over-treatment. Numerous similar initiatives, mostly based on hospital activity statistics, have been introduced around the world [ 66 , 67 , 68 , 69 ]. Sutherland and Levesque’s proposed framework for analysing variation, for example, has three domains: capacity (broadly, whether sufficient resources are allocated at organizational level and whether individuals have the time and headspace to get involved), evidence (the extent to which evidence-based guidelines exist and are followed), and agency (e.g. whether clinicians are engaged with the issue and the effect of patient choice) [ 70 ].

Whilst it is clearly a good idea to identify unwarranted variation in practice, it is also important to acknowledge that variation can be warranted . The very act of measuring and describing variation carries great rhetorical power, since revealing geographical variation in any chosen metric effectively frames this as a problem with a conceptually simple solution (reducing variation) that will appeal to both politicians and the public [ 71 ]. The temptation to expose variation (e.g. via visualizations such as maps) and address it in mechanistic ways should be resisted until we have fully understood the reasons why it exists, which may include perverse incentives, insufficient opportunities to discuss cases with colleagues, weak or absent feedback on practice, unclear decision processes, contested definitions of appropriate care and professional challenges to guidelines [ 72 ].

Research question, aims and objectives

Research question.

What is quality in long covid care and how can it best be achieved?

To identify best practice and reduce unwarranted variation in UK long covid services.

To explain aspects of variation in long covid services that are or may be warranted.

Our original objectives were to:

Establish a quality improvement collaborative for 10 long covid clinics across UK.

Use quality improvement methods in collaboration with patients and clinic staff to prioritize aspects of care to improve. For each priority topic, identify best (evidence-informed) clinical practice, measure performance in each clinic, compare performance with a best practice benchmark and improve performance.

Produce organizational case studies of participating long covid clinics to explain their origins, evolution, leadership, ethos, population served, patient pathways and place in the wider healthcare ecosystem.

Examine these case studies to explain variation in practice, especially in topics where the quality improvement cycle proves difficult to follow or has limited impact.

The LOCOMOTION study

LOCOMOTION (LOng COvid Multidisciplinary consortium Optimising Treatments and services across the NHS) was a 30-month multi-site case study of 10 long covid clinics (8 in England, 1 in Wales and 1 in Scotland), beginning in 2021, which sought to optimise long covid care. Each clinic offered multidisciplinary care to patients referred from primary or secondary care (and, in some cases, self-referred), and held regular multidisciplinary team (MDT) meetings, mostly online via Microsoft Teams, to discuss cases. A study protocol for LOCOMOTION, with details of ethical approvals, management, governance and patient involvement has been published [ 25 ]. The three main work packages addressed quality improvement, technology-supported patient self-management and phenotyping and symptom clustering. This paper reports on the first work package, focusing mainly on qualitative findings.

Setting up the quality improvement collaborative

We broadly followed standard methodology for “breakthrough” quality improvement collaboratives [ 44 , 45 ], with two exceptions. First, because of geographical distance, continuing pandemic precautions and developments in videoconferencing technology, meetings were held online. Second, unlike in the original breakthrough model, patients were included in the collaborative, reflecting the cultural change towards patient partnerships since the model was originally proposed 40 years ago.

Each site appointed a clinical research fellow (doctor, nurse or allied health professional) funded partly by the LOCOMOTION study and partly with clinical sessions; some were existing staff who were backfilled to take on a research role whilst others were new appointments. The quality improvement meetings were held approximately every 8 weeks on Microsoft Teams and lasted about 2 h; there was an agenda and a chair, and meetings were recorded with consent. The clinical research fellow from each clinic attended, sometimes joined by the clinical lead for that site. In the initial meeting, the group proposed and prioritized topics before merging their consensus with the list of priority topics generated separately by patients (there was much overlap but also some differences).

In subsequent meetings, participants attempted to reach consensus on how to define, measure and achieve quality for each priority topic in turn, implement this approach in their own clinic and monitor its impact. Clinical leads prepared illustrative clinical cases and summaries of the research evidence, which they presented using Microsoft Powerpoint; the group then worked towards consensus on the implications for practice through general discussion. Clinical research fellows assisted with literature searches, collected baseline data from their own clinic, prepared and presented anonymized case examples, and contributed to collaborative goal-setting for improvement. Progress on each topic was reviewed at a later meeting after an agreed interval.

An additional element of this work package was semi-structured interviews with 29 patients, recruited from 9 of the 10 participating sites, about their clinic experiences with a view to feeding into service improvement (in the other site, no patient volunteered).

Our patient advisory group initially met separately from the quality improvement collaborative. They designed a short survey of current practice and sent it to each clinic; the results of this informed a prioritization exercise for topics where they considered change was needed. The patient-generated list was tabled at the quality improvement collaborative discussions, but patients were understandably keen to join these discussions directly. After about 9 months, some patient advisory group members joined the regular collaborative meetings. This dynamic was not without its tensions, since sharing performance data requires trust and there were some concerns about confidentiality when real patient cases were discussed with other patients present.

How evidence-informed quality targets were set

At the time the study began, there were no published large-scale randomized controlled trials of any interventions for long covid. We therefore followed a model used successfully in other quality improvement efforts where research evidence was limited or absent or it did not translate unambiguously into models for current services. In such circumstances, the best evidence may be custom and practice in the best-performing units. The quality improvement effort becomes oriented to what one group of researchers called “potentially better practices”—that is, practices that are “developed through analysis of the processes of care, literature review, and site visits” (page 14) [ 73 ]. The idea was that facilitated discussion among clinical teams, drawing on published research where available but also incorporating clinical experience, established practice and systematic analysis of performance data across participating clinics would surface these “potentially better practices”—an approach which, though not formally tested in controlled trials, appears to be associated with improved outcomes [ 46 , 73 ].

Adding an ethnographic component

Following limited progress made on some topics that had been designated high priority, we interviewed all 10 clinical research fellows (either individually or, in two cases, with a senior clinician present) and 18 other clinic staff (five individually plus two groups of 5 and 8), along with additional informal discussions, to explore the challenges of implementing the changes that had been agreed. These interviews were not audiotaped but detailed notes were made and typed up immediately afterwards. It became evident that some aspects of what the collaborative had deemed “evidence-informed” care were contested by front-line clinic staff, perceived as irrelevant to the service they were delivering, or considered impossible to implement. To unpack these issues further, the research protocol was amended to include an ethnographic component.

TG and EL (academic general practitioners) and JLD (a qualitative researcher with a PhD in the patient experience) attended a total of 45 MDT meetings in participating clinics (mostly online or hybrid). Staff were informed in advance that there would be an observer present; nobody objected. We noted brief demographic and clinical details of cases discussed (but no identifying data), dilemmas and uncertainties on which discussions focused, and how different staff members contributed.

TG made 13 in-person visits to participating long covid clinics. Staff were notified in advance; all were happy to be observed. Visits lasted between 5 and 8 h (54 h in total). We observed support staff booking patients in and processing requests and referrals, and shadowed different clinical staff in turn as they saw patients. Patients were informed of our presence and its purpose beforehand and given the opportunity to decline (three of 53 patients approached did). We discussed aspects of each case with the clinician after the patient left. When invited, we took breaks with staff and used these as an opportunity to ask them informally what it was like working in the clinic.

Ethnographic observation, analysis and reporting was geared to generating a rich interpretive account of the clinical, operational and interpersonal features of each clinic—what Van Maanen calls an “impressionist tales” [ 74 ]. Our work was also guided by the principles set out by Golden-Biddle and Locke, namely authenticity (spending time in the field and basing interpretations on these direct observations), plausibility (creating a plausible account through rich persuasive description) and criticality (e.g. reflexively examining our own assumptions) [ 75 ]. Our collection and analysis of qualitative data was informed by our own professional backgrounds (two general practitioners, one physical therapist, two non-clinicians).

In both MDTs and clinics, we took contemporaneous notes by hand and typed these up immediately afterwards.

Data management and analysis

Typed interview notes and field notes from clinics were collated in a set of Word documents, one for each clinic attended. They were analysed thematically [ 76 ] with attention to the literature on quality improvement and variation (see “ Background ”). Interim summaries were prepared on each clinic, setting out the narrative of how it had been established, its ethos and leadership, setting and staffing, population served and key links with other parts of the local healthcare ecosystem.

Minutes and field notes from the quality improvement collaborative meetings were summarized topic by topic, including initial data collected by the researchers-in-residence, improvement actions taken (or attempted) in that clinic, and any follow-up data shared. Progress or lack of it was interpreted in relation to the contextual case summary for that clinic.

Patient cases seen in clinic, and those discussed by MDTs, were summarized as brief case narratives in Word documents. Using the constant comparative method [ 77 ], we produced an initial synthesis of the clinical picture and principles of management based on the first 10 patient cases seen, and refined this as each additional case was added. Demographic and brief clinical and social details were also logged on Excel spreadsheets. When writing up clinical cases, we used the technique of composite case construction (in which we drew on several actual cases to generate a fictitious one, thereby protecting anonymity whilst preserving key empirical findings [ 78 ]); any names reported in this paper are pseudonyms.

Member checking

A summary was prepared for each clinic, including a narrative of the clinic’s own history and a summary of key quality issues raised across the ten clinics. These summaries included examples from real cases in our dataset. These were shared with the clinical research fellow and a senior clinician from the clinic, and amended in response to feedback. We also shared these summaries with representatives from the patient advisory group.

Overview of dataset

This study generated three complementary datasets. First, the video recordings, minutes, and field notes of 12 quality improvement collaborative meetings, along with the evidence summaries prepared for these meetings and clinic summaries (e.g. descriptions of current practice, audits) submitted by the clinical research fellows. This dataset illustrated wide variation in practice, and (in many topics) gaps or ambiguities in the evidence base.

Second, interviews with staff ( n = 30) and patients ( n = 29) from the clinics, along with ethnographic field notes (approximately 100 pages) from 13 in-person clinic visits (54 h), including notes on 50 patient consultations (40 face-to-face, 6 telephone, 4 video). This dataset illustrated the heterogeneity among the ten participating clinics.

Third, field notes (approximately 100 pages), including discussions on 244 clinical cases from the 45 MDT meetings (49 h) that we observed. This dataset revealed further similarities and contrasts among clinics in how patients were managed. In particular, it illustrated how, for the complex patients whose cases were presented at these meetings, teams made sense of, and planned for, each case through multidisciplinary dialogue. This dialogue typically began with one staff member presenting a detailed clinical history along with a narrative of how it had affected the patient’s life and what was at stake for them (e.g. job loss), after which professionals from various backgrounds (nursing, physical therapy, occupational therapy, psychology, dietetics, and different medical specialties) joined in a discussion about what to do.

The ten participating sites are summarized in Table 1 .

In the next two sections, we explore two issues—difficulty defining best practice and the heterogeneous nature of the clinics—that were key to explaining why quality, when pursued in a 10-site collaborative, proved elusive. We then briefly summarize patients’ accounts of their experience in the clinics and give three illustrative examples of the elusiveness of quality improvement using selected topics that were prioritized in our collaborative: outcome measures, investigation of palpitations and management of fatigue. In the final section of the results, we describe how MDT deliberations proved crucial for local quality improvement. Further detail on clinical priority topics will be presented in a separate paper.

“Best practice” in long covid: uncertainty and conflict

The study period (September 2021 to December 2023) corresponded with an exponential increase in published research on long covid. Despite this, the quality improvement collaborative found few unambiguous recommendations for practice. This gap between what the research literature offered and what clinical practice needed was partly ontological (relating what long covid is ). One major bone of contention between patients and clinicians (also evident in discussions with our patient advisory group), for example, was how far (and in whom) clinicians should look for and attempt to treat the various metabolic abnormalities that had been documented in laboratory research studies. The literature on this topic was extensive but conflicting [ 20 , 21 , 22 , 23 , 24 , 79 , 80 , 81 , 82 ]; it was heavy on biological detail but light on clinical application.

Patients were often aware of particular studies that appeared to offer plausible molecular or cellular explanations for symptom clusters along with a drug (often repurposed and off-label) whose mechanism of action appeared to be a good fit with the metabolic chain of causation. In one clinic, for example, we were shown an email exchange between a patient (not medically qualified) and a consultant, in which the patient asked them to reconsider their decision not to prescribe low-dose naltrexone, an opioid receptor antagonist with anti-inflammatory properties. The request included a copy of a peer-reviewed academic paper describing a small, uncontrolled pre-post study (i.e. a weak study design) in which this drug appeared to improve symptoms and functional performance in patients with long covid, as well as a mechanistic argument explaining why the patient felt this drug was a plausible choice in their own case.

This patient’s clinician, in common with most clinicians delivering front-line long covid services, considered that the evidence for such mechanism-based therapies was weak. Clinicians generally felt that this evidence, whilst promising, did not yet support routine measurement of clotting factors, antibodies, immune cells or other biomarkers or the prescription of mechanism-based therapies such as antivirals, anti-inflammatories or anticoagulants. Low-dose naltroxone, for example, is currently being tested in at least one randomized controlled trial (see National Clinical Trials Registry NCT05430152), which had not reported at the time of our observations.

Another challenge to defining best practice was the oft-repeated phrase that long covid is a “diagnosis by exclusion”, but the high prevalence of comorbidities meant that the “pure” long covid patient untainted by other potential explanations for their symptoms was a textbook ideal. In one MDT, for example, we observed a discussion about a patient who had had both swab-positive covid-19 and erythema migrans (a sign of Lyme disease) in the weeks before developing fatigue, yet local diagnostic criteria for each condition required the other to be excluded.

The logic of management in most participating clinics was pragmatic: prompt multidisciplinary assessment and treatment with an emphasis on obtaining a detailed clinical history (including premorbid health status), excluding serious complications (“red flags”), managing specific symptom clusters (for example, physical therapy for breathing pattern disorder), treating comorbidities (for example, anaemia, diabetes or menopause) and supporting whole-person rehabilitation [ 7 , 83 ]. The evidentiary questions raised in MDT discussions (which did not include patients) addressed the practicalities of the rehabilitation model (for example, whether cognitive therapy for neurocognitive complications is as effective when delivered online as it is when delivered in-person) rather than the molecular or cellular mechanisms of disease. For example, the question of whether patients with neurocognitive impairment should be tested for micro-clots or treated with anticoagulants never came up in the MDTs we observed, though we did visit a tertiary referral clinic (the tier 4 clinic in site H), whose lead clinician had a research interest in inflammatory coagulopathies and offered such tests to selected patients.

Because long covid typically produces dozens of symptoms that tend to be uniquely patterned in each patient, the uncertainties on which MDT discussions turned were rarely about general evidence of the kind that might be found in a guideline (e.g. how should fatigue be managed?). Rather they concerned particular case-based clinical decisions (e.g. how should this patient’s fatigue be managed, given the specifics of this case?). An example from our field notes illustrates this:

Physical therapist presents the case of a 39-year-old woman who works as a cleaner on an overnight ferry. Has had long covid for 2 years. Main symptoms are shortness of breath and possible anxiety attacks, especially when at work. She has had a course of physical therapy to teach diaphragmatic breathing but has found that focusing on her breathing makes her more anxious. Patient has to do a lot of bending in her job (e.g. cleaning toilets and under seats), which makes her dizzy, but Active Stand Test was normal. She also has very mild tricuspid incompetence [someone reads out a cardiology report—not hemodynamically significant].

Rehabilitation guidelines (e.g. WHO) recommend phased return to work (e.g. with reduced hours) and frequent breaks. “Tricky!” says someone. The job is intense and busy, and the patient can’t afford not to work. Discussion on whether all her symptoms can be attributed to tension and anxiety. Physical therapist who runs the breathing group says, “No, it’s long covid”, and describes severe initial covid-19 episode and results of serial chest X-rays which showed gradual clearing of ground glass shadows. Team discussion centers on how to negotiate reduced working hours in this particular job, given the overnight ferry shifts. --MDT discussion, Site D

This example raises important considerations about the nature of clinical knowledge in long covid. We return to it in the final section of the “ Results ” and in the “ Discussion ”.

Long covid clinics: a heterogeneous context for quality improvement

Most participating clinics had been established in mid-2020 to follow up patients who had been hospitalized (and perhaps ventilated) for severe acute covid-19. As mass vaccination reduced the severity of acute covid-19 for most people, the patient population in all clinics progressively shifted to include fewer “post-ICU [intensive care unit]” patients (in whom respiratory symptoms almost always dominated), and more people referred by their general practitioners or other secondary care specialties who had not been hospitalized for their acute covid-19 infection, and in whom fatigue, brain fog and palpitations were often the most troubling symptoms. Despite these similarities, the ten clinics had very different histories, geographical and material settings, staffing structures, patient pathways and case mix, as Table 1 illustrates. Below, we give more detail on three example sites.

Site C was established as a generalist “assessment-only” service by a general practitioner with an interest in infectious diseases. It is led jointly by that general practitioner and an occupational therapist, assisted by a wide range of other professionals including speech and language therapy, dietetics, clinical psychology and community-based physical therapy and occupational therapy. It has close links with a chronic fatigue service and a pain clinic that have been running in the locality for over 20 years. The clinic, which is entirely virtual (staff consult either from home or from a small side office in the community trust building), is physically located in a low-rise building on the industrial outskirts of a large town, sharing office space with various community-based health and social care services. Following a 1-h telephone consultation by one of the clinical leads, each patient is discussed at the MDT and then either discharged back to their general practitioner with a detailed management plan or referred on to one of the specialist services. This arrangement evolved to address a particular problem in this locality—that many patients with long covid were being referred by their general practitioner to multiple specialties (e.g. respiratory, neurology, fatigue), leading to a fragmented patient experience, unnecessary specialist assessments and wasteful duplication. The generalist assessment by telephone is oriented to documenting what is often a complex illness narrative (including pre-existing physical and mental comorbidities) and working with the patient to prioritize which symptoms or problems to pursue in which order.

Site E, in a well-regarded inner-city teaching hospital, had been set up in 2020 by a respiratory physician. Its initial ethos and rationale had been “respiratory follow-up”, with strong emphasis on monitoring lung damage via repeated imaging and lung function tests and in ensuring that patients received specialist physical therapy to “re-learn” efficient breathing techniques. Over time, this site has tried to accommodate a more multi-system assessment, with the introduction of a consultant-led infectious disease clinic for patients without a dominant respiratory component, reflecting the shift towards a more fatigue-predominant case mix. At the time of our fieldwork, each patient was seen in turn by a physician, psychologist, occupational therapist and respiratory physical therapist (half an hour each) before all four staff reconvened in a face-to-face MDT meeting to form a plan for each patient. But whilst a wide range of patients with diverse symptoms were discussed at these meetings, there remained a strong focus on respiratory pathology (e.g. tracking improvements in lung function and ensuring that coexisting asthma was optimally controlled).

Site F, one of the first long covid clinics in UK, was set up by a rehabilitation consultant who had been drafted to work on the ICU during the first wave of covid-19 in early 2020. He had a longstanding research interest in whole-patient rehabilitation, especially the assessment and management of chronic fatigue and pain. From the outset, clinic F was more oriented to rehabilitation, including vocational rehabilitation to help patients return to work. There was less emphasis on monitoring lung function or pursuing respiratory comorbidities. At the time of our fieldwork, clinic F offered both a community-based service (“tier 2”) led by an occupational therapist, supported by a respiratory physical therapist and psychologist, and a hospital-based service (“tier 3”) led by the rehabilitation consultant, supported by a wider MDT. Staff in both tiers emphasized that each patient needs a full physical and mental assessment and help to set and work towards achievable goals, whilst staying within safe limits so as to avoid post-exertional symptom exacerbation. Because of the research interest of the lead physician, clinic F adapted well to the growing numbers of patients with fatigue and quickly set up research studies on this cohort [ 84 ].

Details of the other seven sites are shown in Table 1 . Broadly speaking, sites B, E, G and H aligned with the “respiratory follow-up” model and sites F and I aligned with the “rehabilitation” model. Sites A and J had a high-volume, multi-tiered service whose community tier aligned with the “holistic GP assessment” model (site C above) and which also offered a hospital-based, rehabilitation-focused tier. The small service in Scotland (site D) had evolved from an initial respiratory focus to become part of the infectious diseases (ME/CFS) service; Lyme disease (another infectious disease whose sequelae include chronic fatigue) was also prevalent in this region.

The patient experience

Whilst the 10 participating clinics were very diverse in staffing, ethos and patient flows, the 29 patient interviews described remarkably consistent clinic experiences. Almost all identified the biggest problem to be the extended wait of several months before they were seen and the limited awareness (when initially referred) of what long covid clinics could provide. Some talked of how they cried with relief when they finally received an appointment. When the quality improvement collaborative was initially established, waiting times and bottlenecks were patients’ the top priority for quality improvement, and this ranking was shared by clinic staff, who were very aware of how much delays and uncertainties in assessment and treatment compounded patients’ suffering. This issue resolved to a large extent over the study period in all clinics as the referral backlog cleared and the incidence of new cases of long covid fell [ 85 ]; it will be covered in more detail in a separate publication.

Most patients in our sample were satisfied with the care they received when they were finally seen in clinic, especially how they finally felt “heard” after a clinician took a full history. They were relieved to receive affirmation of their experience, a diagnosis of what was wrong and reassurance that they were believed. They were grateful for the input of different members of the multidisciplinary teams and commented on the attentiveness, compassion and skill of allied professionals in particular (“she was wonderful, she got me breathing again”—patient BIR145 talking about a physical therapist). One or two patient participants expressed confusion about who exactly they had seen and what advice they had been given, and some did not realize that a telephone assessment had been an actual clinical consultation. A minority expressed disappointment that an expected investigation had not been ordered (one commented that they had not had any blood tests at all). Several had assumed that the help and advice from the long covid clinic would continue to be offered until they were better and were disappointed that they had been discharged after completing the various courses on offer (since their clinic had been set up as an “assessment only” service).

In the next sections, we give examples of topics raised in the quality improvement collaborative and how they were addressed.

Example quality topic 1: Outcome measures

The first topic considered by the quality improvement collaborative was how (that is, using which measures and metrics) to assess and monitor patients with long covid. In the absence of a validated biomarker, various symptom scores and quality of life scales—both generic and disease-specific—were mooted. Site F had already developed and validated a patient-reported outcome measure (PROM), the C19-YRS (Covid-19 Yorkshire Rehabilitation Scale) and used it for both research and clinical purposes [ 86 ]. It was quickly agreed that, for the purposes of generating comparative research findings across the ten clinics, the C19-YRS should be used at all sites and completed by patients three-monthly. A commercial partner produced an electronic version of this instrument and an app for patient smartphones. The quality improvement collaborative also agreed that patients should be asked to complete the EUROQOL EQ5D, a widely used generic health-related quality of life scale [ 87 ], in order to facilitate comparisons between long covid and other chronic conditions.

In retrospect, the discussions which led to the unopposed adoption of these two measures as a “quality” initiative in clinical care were somewhat aspirational. A review of progress at a subsequent quality improvement meeting revealed considerable variation among clinics, with a wide variety of measures used in different clinics to different degrees. Reasons for this variation were multiple. First, although our patient advisory group were keen that we should gather as much data as possible on the patient experience of this new condition, many clinic patients found the long questionnaires exhausting to complete due to cognitive impairment and fatigue. In addition, whilst patients were keen to answer questions on symptoms that troubled them, many had limited patience to fill out repeated surveys on symptoms that did not trouble them (“it almost felt as if I’ve not got long covid because I didn’t feel like I fit the criteria as they were laying it out”—patient SAL001). Staff assisted patients in completing the measures when needed, but this was time-consuming (up to 45 min per instrument) and burdensome for both staff and patients. In clinics where a high proportion of patients required assistance, staff time was the rate-limiting factor for how many instruments got completed. For some patients, one short instrument was the most that could be asked of them, and the clinician made a judgement on which one would be in their best interests on the day.

The second reason for variation was that the clinical diagnosis and management of particular features, complications and comorbidities of long covid required more nuance than was provided by these relatively generic instruments, and the level of detail sought varied with the specialist interest of the clinic (and the clinician). The modified C19-YRS [ 88 ], for example, contained 19 items, of which one asked about sleep quality. But if a patient had sleep difficulties, many clinicians felt that these needed to be documented in more detail—for example using the 8-item Epworth Sleepiness Scale, originally developed for conditions such as narcolepsy and obstructive sleep apnea [ 89 ]. The “Epworth score” was essential currency for referrals to some but not all specialist sleep services. Similarly, the C19-YRS had three items relating to anxiety, depression and post-traumatic stress disorder, but in clinics where there was a strong focus on mental health (e.g. when there was a resident psychologist), patients were usually invited to complete more specific tools (e.g. the Patient Health Questionnaire 9 [ 90 ], a 9-item questionnaire originally designed to assess severity of depression).

The third reason for variation was custom and practice. Ethnographic visits revealed that paper copies of certain instruments were routinely stacked on clinicians’ desks in outpatient departments and also (in some cases) handed out by administrative staff in waiting areas so that patients could complete them before seeing the clinician. These familiar clinic artefacts tended to be short (one-page) instruments that had a long tradition of use in clinical practice. They were not always fit for purpose. For example, the Nijmegen questionnaire was developed in the 1980s to assess hyperventilation; it was validated against a longer, “gold standard” instrument for that condition [ 91 ]. It subsequently became popular in respiratory clinics to diagnose or exclude breathing pattern disorder (a condition in which the normal physiological pattern of breathing becomes replaced with less efficient, shallower breathing [ 92 ]), so much so that the researchers who developed the instrument published a paper to warn fellow researchers that it had not been validated for this purpose [ 93 ]. Whilst a validated 17-item instrument for breathing pattern disorder (the Self-Evaluation of Breathing Questionnaire [ 94 ]) does exist, it is not in widespread clinical use. Most clinics in LOCOMOTION used Nijmegen either on all patients (e.g. as part of a comprehensive initial assessment, especially if the service had begun as a respiratory follow-up clinic) or when breathing pattern disorder was suspected.

In sum, the use of outcome measures in long covid clinics was a compromise between standardization and contingency. On the one hand, all clinics accepted the need to use “validated” instruments consistently. On the other hand, there were sometimes good reasons why they deviated from agreed practice, including mismatch between the clinic’s priorities as a research site, its priorities as a clinical service, and the particular clinical needs of a patient; the clinic’s—and the clinician’s—specialist focus; and long-held traditions of using particular instruments with which staff and patients were familiar.

Example quality topic 2: Postural orthostatic tachycardia syndrome (POTS)

Palpitations (common in long covid) and postural orthostatic tachycardia syndrome (POTS, a disproportionate acceleration in heart rate on standing, the assumed cause of palpitations in many long covid patients) was the top priority for quality improvement identified by our patient advisory group. Reflecting discussions and evidence (of various kinds) shared in online patient communities, the group were confident that POTS is common in long covid patients and that many cases remain undetected (perhaps misdiagnosed as anxiety). Their request that all long covid patients should be “screened” for POTS prompted a search for, and synthesis of, evidence (which we published in the BMJ [ 95 ]). In sum, that evidence was sparse and contested, but, combined with standard practice in specialist clinics, broadly supported the judicious use of the NASA Lean Test [ 96 ]. This test involves repeated measurements of pulse and blood pressure with the patient first lying and then standing (with shoulders resting against a wall).

The patient advisory group’s request that the NASA Lean Test should be conducted on all patients met with mixed responses from the clinics. In site F, the lead physician had an interest in autonomic dysfunction in chronic fatigue and was keen; he had already published a paper on how to adapt the NASA Lean Test for self-assessment at home [ 97 ]. Several other sites were initially opposed. Staff at site E, for example, offered various arguments:

The test is time-consuming, labor-intensive, and takes up space in the clinic which has an opportunity cost in terms of other potential uses;

The test is unvalidated and potentially misleading (there is a high incidence of both false negative and false positive results);

There is no proven treatment for POTS, so there is no point in testing for it;

It is a specialist test for a specialist condition, so it should be done in a specialist clinic where its benefits and limitations are better understood;

Objective testing does not change clinical management since what we treat is the patient’s symptoms (e.g. by a pragmatic trial of lifestyle measures and medication);

People with symptoms suggestive of dysautonomia have already been “triaged out” of this clinic (that is, identified in the initial telephone consultation and referred directly to neurology or cardiology);

POTS is a manifestation of the systemic nature of long covid; it does not need specific treatment but will improve spontaneously as the patient goes through standard interventions such as active pacing, respiratory physical therapy and sleep hygiene;

Testing everyone, even when asymptomatic, runs counter to the ethos of rehabilitation, which is to “de-medicalize” patients so as to better orient them to their recovery journey.

When clinics were invited to implement the NASA Lean Test on a consecutive sample of patients to resolve a dispute about the incidence of POTS (from “we’ve only seen a handful of people with it since the clinic began” to “POTS is common and often missed”), all but one site agreed to participate. The tertiary POTS centre linked to site H was already running the NASA Lean Test as standard on all patients. Site C, which operated entirely virtually, passed the work to the referring general practitioner by making this test a precondition for seeing the patient; site D, which was largely virtual, sent instructions for patients to self-administer the test at home.

The NASA Lean Test study has been published separately [ 98 ]. In sum, of 277 consecutive patients tested across the eight clinics, 20 (7%) had a positive NASA Lean Test for POTS and a further 28 (10%) a borderline result. Six of 20 patients who met the criteria for POTS on testing had no prior history of orthostatic intolerance. The question of whether this test should be used to “screen” all patients was not answered definitively. But the experience of participating in the study persuaded some sceptics that postural changes in heart rate could be severe in some long covid patients, did not appear to be fully explained by their previously held theories (e.g. “functional”, anxiety, deconditioning), and had likely been missed in some patients. The outcome of this particular quality improvement cycle was thus not a wholescale change in practice (for which the evidence base was weak) but a more subtle increase in clinical awareness, a greater willingness to consider testing for POTS and a greater commitment to contribute to research into this contested condition.

More generally, the POTS audit prompted some clinicians to recognize the value of quality improvement in novel clinical areas. One physician who had initially commented that POTS was not seen in their clinic, for example, reflected:

“ Our clinic population is changing. […] Overall there’s far fewer post-ICU patients with ECMO [extra-corporeal membrane oxygenation] issues and far more long covid from the community, and this is the bit our clinic isn’t doing so well on. We’re doing great on breathing pattern disorder; neuro[logists] are helping us with the brain fogs; our fatigue and occupational advice is ok but some of the dysautonomia symptoms that are more prevalent in the people who were not hospitalized – that’s where we need to improve .” -Respiratory physician, site G (from field visit 6.6.23)

Example quality topic 3: Management of fatigue

Fatigue was the commonest symptom overall and a high priority among both patients and clinicians for quality improvement. It often coexisted with the cluster of neurocognitive symptoms known as brain fog, with both conditions relapsing and remitting in step. Clinicians were keen to systematize fatigue management using a familiar clinical framework oriented around documenting a full clinical history, identifying associated symptoms, excluding or exploring comorbidities and alternative explanations (e.g. poor sleep patterns, depression, menopause, deconditioning), assessing how fatigue affects physical and mental function, implementing a program of physical and cognitive therapy that was sensitive to the patient’s condition and confidence level, and monitoring progress using validated patient-reported outcome measures and symptom diaries.

The underpinning logic of this approach, which broadly reflected World Health Organization guidance [ 99 ], was that fatigue and linked cognitive impairment could be a manifestation of many—perhaps interacting—conditions but that a whole-patient (body and mind) rehabilitation program was the cornerstone of management in most cases. Discussion in the quality improvement collaborative focused on issues such as whether fatigue was so severe that it produced safety concerns (e.g. in a person’s job or with childcare), the pros and cons of particular online courses such as yoga, relaxation and mindfulness (many were viewed positively, though the evidence base was considered weak), and the extent to which respiratory physical therapy had a crossover impact on fatigue (systematic reviews suggested that it may do, but these reviews also cautioned that primary studies were sparse, methodologically flawed, and heterogeneous [ 100 , 101 ]). They also debated the strengths and limitations of different fatigue-specific outcome measures, each of which had been developed and validated in a different condition, with varying emphasis on cognitive fatigue, physical fatigue, effect on daily life, and motivation. These instruments included the Modified Fatigue Impact Scale; Fatigue Severity Scale [ 102 ]; Fatigue Assessment Scale; Functional Assessment Chronic Illness Therapy—Fatigue (FACIT-F) [ 103 ]; Work and Social Adjustment Scale [ 104 ]; Chalder Fatigue Scale [ 105 ]; Visual Analogue Scale—Fatigue [ 106 ]; and the EQ5D [ 87 ]. In one clinic (site F), three of these scales were used in combination for reasons discussed below.

Some clinicians advocated melatonin or nutritional supplements (such as vitamin D or folic acid) for fatigue on the grounds that many patients found them helpful and formal placebo-controlled trials were unlikely ever to be conducted. But neurostimulants used in other fatigue-predominant conditions (e.g. brain injury, stroke), which also lacked clinical trial evidence in long covid, were viewed as inappropriate in most patients because of lack of evidence of clear benefit and hypothetical risk of harm (e.g. adverse drug reactions, polypharmacy).

Whilst the patient advisory group were broadly supportive of a whole-patient rehabilitative approach to fatigue, their primary concern was fatiguability , especially post-exertional symptom exacerbation (PESE, also known as “crashes”). In these, the patient becomes profoundly fatigued some hours or days after physical or mental exertion, and this state can last for days or even weeks [ 107 ]. Patients viewed PESE as a “red flag” symptom which they felt clinicians often missed and sometimes caused. They wanted the quality improvement effort to focus on ensuring that all clinicians were aware of the risks of PESE and acted accordingly. A discussion among patients and clinicians at a quality improvement collaborative meeting raised a new research hypothesis—that reducing the number of repeated episodes of PESE may improve the natural history of long covid.

These tensions around fatigue management played out differently in different clinics. In site C (the GP-led virtual clinic run from a community hub), fatigue was viewed as one manifestation of a whole-patient condition. The lead general practitioner used the metaphor of untangling a skein of wool: “you have to find the end and then gently pull it”. The underlying problem in a fatigued patient, for example, might be an undiagnosed physical condition such as anaemia, disturbed sleep, or inadequate pacing. These required (respectively) the chronic fatigue service (comprising an occupational therapist and specialist psychologist and oriented mainly to teaching the techniques of goal-setting and pacing), a “tiredness” work-up (e.g. to exclude anaemia or menopause), investigation of poor sleep (which, not uncommonly, was due to obstructive sleep apnea), and exploration of mental health issues.

In site G (a hospital clinic which had evolved from a respiratory service), patients with fatigue went through a fatigue management program led by the occupational therapist with emphasis on pacing, energy conservation, avoidance of PESE and sleep hygiene. Those without ongoing respiratory symptoms were often discharged back to their general practitioner once they had completed this; there was no consultant follow-up of unresolved fatigue.

In site F (a rehabilitation clinic which had a longstanding interest in chronic fatigue even before the pandemic), active interdisciplinary management of fatigue was commenced at or near the patient’s first visit, on the grounds that the earlier this began, the more successful it would be. In this clinic, patients were offered a more intensive package: a similar occupational therapy-led fatigue course as those in site G, plus input from a dietician to advise on regular balanced meals and caffeine avoidance and a group-based facilitated peer support program which centred on fatigue management. The dietician spoke enthusiastically about how improving diet in longstanding long covid patients often improved fatigue (e.g. because they had often lost muscle mass and tended to snack on convenience food rather than make meals from scratch), though she agreed there was no evidence base from trials to support this approach.

Pursuing local quality improvement through MDTs

Whilst some long covid patients had “textbook” symptoms and clinical findings, many cases were unique and some were fiendishly complex. One clinician commented that, somewhat paradoxically, “easy cases” were often the post-ICU follow-ups who had resolving chest complications; they tended to do well with a course of respiratory physical therapy and a return-to-work program. Such cases were rarely brought to MDT meetings. “Difficult cases” were patients who had not been hospitalized for their acute illness but presented with a months- or years-long history of multiple symptoms with fatigue typically predominant. Each one was different, as the following example (some details of which have been fictionalized to protect anonymity) illustrates.

The MDT is discussing Mrs Fermah, a 65-year-old homemaker who had covid-19 a year ago. She has had multiple symptoms since, including fluctuating fatigue, brain fog, breathlessness, retrosternal chest pain of burning character, dry cough, croaky voice, intermittent rashes (sometimes on eating), lips going blue, ankle swelling, orthopnoea, dizziness with the room spinning which can be triggered by stress, low back pain, aches and pains in the arms and legs and pins and needles in the fingertips, loss of taste and smell, palpitations and dizziness (unclear if postural, but clear association with nausea), headaches on waking, and dry mouth. She is somewhat overweight (body mass index 29) and admits to low mood. Functionally, she is mostly confined to the house and can no longer manage the stairs so has begun to sleep downstairs. She has stumbled once or twice but not fallen. Her social life has ceased and she rarely has the energy to see her grandchildren. Her 70-year-old husband is retired and generally supportive, though he spends most evenings at his club. Comorbidities include glaucoma which is well controlled and overseen by an ophthalmologist, mild club foot (congenital) and stage 1 breast cancer 20 years ago. Various tests, including a chest X-ray, resting and exercise oximetry and a blood panel, were normal except for borderline vitamin D level. Her breathing questionnaire score suggests she does not have breathing pattern disorder. ECG showed first-degree atrioventricular block and left axis deviation. No clinician has witnessed the blue lips. Her current treatment is online group respiratory physical therapy; a home visit is being arranged to assess her climbing stairs. She has declined a psychologist assessment. The consultant asks the nurse who assessed her: “Did you get a feel if this is a POTS-type dizziness or an ENT-type?” She sighs. “Honestly it was hard to tell, bless her.”—Site A MDT

This patient’s debilitating symptoms and functional impairments could all be due to long covid, yet “evidence-based” guidance for how to manage her complex suffering does not exist and likely never will exist. The question of which (if any) additional blood or imaging tests to do, in what order of priority, and what interventions to offer the patient will not be definitively answered by consulting clinical trials involving hundreds of patients, since (even if these existed) the decision involves weighing this patient’s history and the multiple factors and uncertainties that are relevant in her case. The knowledge that will help the MDT provide quality care to Mrs Fermah is case-based knowledge—accumulated clinical experience and wisdom from managing and deliberating on multiple similar cases. We consider case-based knowledge further in the “ Discussion ”.

Summary of key findings

This study has shown that a quality improvement collaborative of UK long covid clinics made some progress towards standardizing assessment and management in some topics, but some variation remained. This could be explained in part by the fact that different clinics had different histories and path dependencies, occupied a different place in the local healthcare ecosystem, served different populations, were differently staffed, and had different clinical interests. Our patient advisory group and clinicians in the quality improvement collaborative broadly prioritized the same topics for improvement but interpreted them somewhat differently. “Quality” long covid care had multiple dimensions, relating to (among other things) service set-up and accessibility, clinical provision appropriate to the patient’s need (including options for referral to other services locally), the human qualities of clinical and support staff, how knowledge was distributed across (and accessible within) the system, and the accumulated collective wisdom of local MDTs in dealing with complex cases (including multiple kinds of specialist expertise as well as relational knowledge of what was at stake for the patient). Whilst both staff and patients were keen to contribute to the quality improvement effort, the burden of measurement was evident: multiple outcome measures, used repeatedly, were resource-intensive for staff and exhausting for patients.

Strengths and limitations of this study

To our knowledge, we are the first to report both a quality improvement collaborative and an in-depth qualitative study of clinical work in long covid. Key strengths of this work include the diverse sampling frame (with sites from three UK jurisdictions and serving widely differing geographies and demographics); the use of documents, interviews and reflexive interpretive ethnography to produce meaningful accounts of how clinics emerged and how they were currently organized; the use of philosophical concepts to analyse data on how MDTs produced quality care on a patient-by-patient basis; and the close involvement of patient co-researchers and coauthors during the research and writing up.

Limitations of the study include its exclusive UK focus (the external validity of findings to other healthcare systems is unknown); the self-selecting nature of participants in a quality improvement collaborative (our patient advisory group suggested that the MDTs observed in this study may have represented the higher end of a quality spectrum, hence would be more likely than other MDTs to adhere to guidelines); and the particular perspective brought by the researchers (two GPs, a physical therapist and one non-clinical person) in ethnographic observations. Hospital specialists or organizational scholars, for example, may have noticed different things or framed what they observed differently.

Explaining variation in long covid care

Sutherland and Levesque’s framework mentioned in the “ Background ” section does not explain much of the variation found in our study [ 70 ]. In terms of capacity, at the time of this study most participating clinics benefited from ring-fenced resources. In terms of evidence, guidelines existed and were not greatly contested, but as illustrated by the case of Mrs Fermah above, many patients were exceptions to the guideline because of complex symptomatology and relevant comorbidities. In terms of agency, clinicians in most clinics were passionately engaged with long covid (they were pioneers who had set up their local clinic and successfully bid for national ring-fenced resources) and were generally keen to support patient choice (though not if the patient requested tests which were unavailable or deemed not indicated).

Astma et al.’s list of factors that may explain variation in practice (see “ Background ”) includes several that may be relevant to long covid, especially that the definition of appropriate care in this condition remains somewhat contested. But lack of opportunity to discuss cases was not a problem in the clinics in our sample. On the contrary, MDT meetings in each locality gave clinicians multiple opportunities to discuss cases with colleagues and reflect collectively on whether and how to apply particular guidelines.

The key problem was not that clinicians disputed the guidelines for managing long covid or were unaware of them; it was that the guidelines were not self-interpreting . Rather, MDTs had to deliberate on the balance of benefits and harms in different aspects of individual cases. In patients whose symptoms suggested a possible diagnosis of POTS (or who suspected themselves of having POTS), for example, these deliberations were sometimes lengthy and nuanced. Should a test result that is not technically in the abnormal range but close to it be treated as diagnostic, given that symptoms point to this diagnosis? If not, should the patient be told that the test excludes POTS or that it is equivocal? If a cardiology opinion has stated firmly that the patient does not have POTS but the cardiologist is not known for their interest in this condition, should a second specialist opinion be sought? If the gold standard “tilt test” [ 108 ] for POTS (usually available only in tertiary centres) is not available locally, does this patient merit a costly out-of-locality referral? Should the patient’s request for a trial of off-label medication, reflecting discussions in an online support group, be honoured? These are the kinds of questions on which MDTs deliberated at length.

The fact that many cases required extensive deliberation does not necessarily justify variation in practice among clinics. But taking into account the clinics’ very different histories, set-up, and local referral pathways, the variation begins to make sense. A patient who is being assessed in a clinic that functions as a specialist chronic fatigue centre and attracts referrals which reflect this interest (e.g. site F in our sample) will receive different management advice from one that functions as a telephone-only generalist assessment centre and refers on to other specialties (site C in our sample). The wide variation in case mix, coupled with the fact that a different proportion of these cases were highly complex in each clinic (and in different ways), suggests that variation in practice may reflect appropriate rather than inappropriate care.

Our patient advisory group affirmed that many of the findings reported here resonated with their own experience, but they raised several concerns. These included questions about patient groups who may have been missed in our sample because they were rarely discussed in MDTs. The decision to take a case to MDT discussion is taken largely by a clinician, and there was evidence from online support groups that some patients’ requests for their case to be taken to an MDT had been declined (though not, to our knowledge, in the clinics participating in the LOCOMOTION study).

We began this study by asking “what is quality in long covid care?”. We initially assumed that this question referred to a generalizable evidence base, which we felt we could identify, and we believed that we could then determine whether long covid clinics were following the evidence base through conventional audits of structure, process, and outcome. In retrospect, these assumptions were somewhat naïve. On the basis of our findings, we suggest that a better (and more individualized) research question might be “to what extent does each patient with long covid receive evidence-based care appropriate to their needs?”. This question would require individual case review on a sample of cases, tracking each patient longitudinally including cross-referrals, and also interviewing the patient.

Nomothetic versus idiographic knowledge

In a series of lectures first delivered in the 1950s and recently republished [ 109 ], psychiatrist Dr Maurice O’Connor Drury drew on the later philosophy of his friend and mentor Ludwig Wittgenstein to challenge what he felt was a concerning trend: that the nomothetic (generalizable, abstract) knowledge from randomized controlled trials (RCTs) was coming to over-ride the idiographic (personal, situated) knowledge about particular patients. Based on Wittgenstein’s writings on the importance of the particular, Drury predicted—presciently—that if implemented uncritically, RCTs would result in worse, not better, care for patients, since it would go hand-in-hand with a downgrading of experience, intuition, subjective judgement, personal reflection, and collective deliberation.

Much conventional quality improvement methodology is built on an assumption that nomothetic knowledge (for example, findings from RCTs and systematic reviews) is a higher form of knowing than idiographic knowledge. But idiographic, case-based reasoning—despite its position at the very bottom of evidence-based medicine’s hierarchy of evidence [ 110 ]—is a legitimate and important element of medical practice. Bioethicist Kathryn Montgomery, drawing on Aristotle’s notion of praxis , considers clinical practice to be an example of case-based reasoning [ 111 ]. Medicine is governed not by hard and fast laws but by competing maxims or rules of thumb ; the essence of judgement is deciding which (if any) rule should be applied in a particular circumstance. Clinical judgement incorporates science (especially the results of well-conducted research) and makes use of available tools and technologies (including guidelines and decision-support algorithms that incorporate research findings). But rather than being determined solely by these elements, clinical judgement is guided both by the scientific evidence and by the practical and ethical question “what is it best to do, for this individual, given these circumstances?”.

In this study, we observed clinical management of, and MDT deliberations on, hundreds of clinical cases. In the more straightforward ones (for example, recovering pneumonitis), guideline-driven care was not difficult to implement and such cases were rarely brought to the MDT. But cases like Mrs Fermah (see last section of “ Results ”) required much discussion on which aspects of which guideline were in the patient’s best interests to bring into play at any particular stage in their illness journey.

Conclusions

One systematic review on quality improvement collaboratives concluded that “ [those] reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline” (page 226) [ 60 ]. The findings from this study suggest that to the extent that such collaboratives address clinical cases that are not straightforward, conventional quality improvement methods may be less useful and even counterproductive.

The question “what is quality in long covid care?” is partly a philosophical one. Our findings support an approach that recognizes and values idiographic knowledge —including establishing and protecting a safe and supportive space for deliberation on individual cases to occur and to value and draw upon the collective learning that occurs in these spaces. It is through such deliberation that evidence-based guidelines can be appropriately interpreted and applied to the unique needs and circumstances of individual patients. We suggest that Drury’s warning about the limitations of nomothetic knowledge should prompt a reassessment of policies that rely too heavily on such knowledge, resulting in one-size-fits-all protocols. We also cautiously hypothesize that the need to centre the quality improvement effort on idiographic rather than nomothetic knowledge is unlikely to be unique to long covid. Indeed, such an approach may be particularly important in any condition that is complex, unpredictable, variable in presentation and clinical course, and associated with comorbidities.

Availability of data and materials

Selected qualitative data (ensuring no identifiable information) will be made available to formal research teams on reasonable request to Professor Greenhalgh at the University of Oxford, on condition that they have research ethics approval and relevant expertise. The quantitative data on NASA Lean Test have been published in full in a separate paper [ 98 ].

Abbreviations

Chronic fatigue syndrome

Intensive care unit

Jenny Ceolta-Smith

Julie Darbyshire

LOng COvid Multidisciplinary consortium Optimising Treatments and services across the NHS

Multidisciplinary team

Myalgic encephalomyelitis

Middle East Respiratory Syndrome

National Aeronautics and Space Association

Occupational therapy/ist

Post-exertional symptom exacerbation

Postural orthostatic tachycardia syndrome

Speech and language therapy

Severe Acute Respiratory Syndrome

Trisha Greenhalgh

United Kingdom

United States

World Health Organization

Perego E, Callard F, Stras L, Melville-JÛhannesson B, Pope R, Alwan N. Why the Patient-Made Term “Long Covid” is needed. Wellcome Open Res. 2020;5:224.

Article Google Scholar

Greenhalgh T, Sivan M, Delaney B, Evans R, Milne R: Long covid—an update for primary care. bmj 2022;378:e072117.

Centers for Disease Control and Prevention (US): Long COVID or Post-COVID Conditions (updated 16th December 2022). Atlanta: CDC. Accessed 2nd June 2023 at https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html ; 2022.

National Institute for Health and Care Excellence (NICE) Scottish Intercollegiate Guidelines Network (SIGN) and Royal College of General Practitioners (RCGP): COVID-19 rapid guideline: managing the long-term effects of COVID-19, vol. Accessed 30th January 2022 at https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-the-longterm-effects-of-covid19-pdf-51035515742 . London: NICE; 2022.

Organization WH: Post Covid-19 Condition (updated 7th December 2022), vol. Accessed 2nd June 2023 at https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition#:~:text=It%20is%20defined%20as%20the,months%20with%20no%20other%20explanation . Geneva: WHO; 2022.

Office for National Statistics: Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 31st March 2023. London: ONS. Accessed 30th May 2023 at https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/alldatarelatingtoprevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk ; 2023.

Crook H, Raza S, Nowell J, Young M, Edison P: Long covid—mechanisms, risk factors, and management. bmj 2021;374.

Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, Pujol JC, Klaser K, Antonelli M, Canas LS. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626–31.

Article CAS PubMed PubMed Central Google Scholar

Reese JT, Blau H, Casiraghi E, Bergquist T, Loomba JJ, Callahan TJ, Laraway B, Antonescu C, Coleman B, Gargano M: Generalisable long COVID subtypes: findings from the NIH N3C and RECOVER programmes. EBioMedicine 2023;87.

Thaweethai T, Jolley SE, Karlson EW, Levitan EB, Levy B, McComsey GA, McCorkell L, Nadkarni GN, Parthasarathy S, Singh U. Development of a definition of postacute sequelae of SARS-CoV-2 infection. JAMA. 2023;329(22):1934–46.

Brown DA, O’Brien KK. Conceptualising Long COVID as an episodic health condition. BMJ Glob Health. 2021;6(9): e007004.

Article PubMed Google Scholar

Tate WP, Walker MO, Peppercorn K, Blair AL, Edgar CD. Towards a Better Understanding of the Complexities of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID. Int J Mol Sci. 2023;24(6):5124.

Ahmed H, Patel K, Greenwood DC, Halpin S, Lewthwaite P, Salawu A, Eyre L, Breen A, Connor RO, Jones A. Long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome coronavirus (MERS) outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis. J Rehabil Med. 2020;52(5):1–11.

Google Scholar

World Health Organisation: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance (13th March 2020). Geneva: WHO. Accessed 3rd January 2023 at https://t.co/JpNdP8LcV8?amp=1 ; 2020.

Rushforth A, Ladds E, Wieringa S, Taylor S, Husain L, Greenhalgh T: Long Covid – the illness narratives. Under review for Sociology of Health and Illness 2021.

Russell D, Spence NJ. Chase J-AD, Schwartz T, Tumminello CM, Bouldin E: Support amid uncertainty: Long COVID illness experiences and the role of online communities. SSM-Qual Res Health. 2022;2: 100177.

Article PubMed PubMed Central Google Scholar

Ziauddeen N, Gurdasani D, O’Hara ME, Hastie C, Roderick P, Yao G, Alwan NA. Characteristics and impact of Long Covid: Findings from an online survey. PLoS ONE. 2022;17(3): e0264331.

Evans RA, McAuley H, Harrison EM, Shikotra A, Singapuri A, Sereno M, Elneima O, Docherty AB, Lone NI, Leavy OC. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. Lancet Respir Med. 2021;9(11):1275–87.

Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post-COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung. 2021;199(2):113–9.

Altmann DM, Whettlock EM, Liu S, Arachchillage DJ, Boyton RJ: The immunology of long COVID. Nat Rev Immunol 2023:1–17.

Klein J, Wood J, Jaycox J, Dhodapkar RM, Lu P, Gehlhausen JR, Tabachnikova A, Greene K, Tabacof L, Malik AA et al : Distinguishing features of Long COVID identified through immune profiling. Nature 2023.

Chen B, Julg B, Mohandas S, Bradfute SB. Viral persistence, reactivation, and mechanisms of long COVID. Elife. 2023;12: e86015.

Wang C, Ramasamy A, Verduzco-Gutierrez M, Brode WM, Melamed E. Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants. Virol J. 2023;20(1):124.

Cervia-Hasler C, Brüningk SC, Hoch T, Fan B, Muzio G, Thompson RC, Ceglarek L, Meledin R, Westermann P, Emmenegger M et al Persistent complement dysregulation with signs of thromboinflammation in active Long Covid Science 2024;383(6680):eadg7942.

Sivan M, Greenhalgh T, Darbyshire JL, Mir G, O’Connor RJ, Dawes H, Greenwood D, O’Connor D, Horton M, Petrou S. LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK. BMJ Open. 2022;12(5): e063505.

Rushforth A, Ladds E, Wieringa S, Taylor S, Husain L, Greenhalgh T. Long covid–the illness narratives. Soc Sci Med. 2021;286: 114326.

National Institute for Health and Care Excellence: COVID-19 rapid guideline: managing the long-term effects of COVID-19, vol. Accessed 4th October 2023 at https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-the-longterm-effects-of-covid19-pdf-51035515742 . London: NICE 2020.

NHS England: Long COVID: the NHS plan for 2021/22. London: NHS England. Accessed 2nd August 2022 at https://www.england.nhs.uk/coronavirus/documents/long-covid-the-nhs-plan-for-2021-22/ ; 2021.

NHS England: NHS to offer ‘long covid’ sufferers help at specialist centres. London: NHS England. Accessed 10th October 2020 at https://www.england.nhs.uk/2020/10/nhs-to-offer-long-covid-help/ ; 2020 (7th October).

NHS England: The NHS plan for improving long COVID services, vol. Acessed 4th February 2024 at https://www.england.nhs.uk/publication/the-nhs-plan-for-improving-long-covid-services/ .London: Gov.uk; 2022.

NHS England: Commissioning guidance for post-COVID services for adults, children and young people, vol. Accessed 6th February 2024 at https://www.england.nhs.uk/long-read/commissioning-guidance-for-post-covid-services-for-adults-children-and-young-people/ . London: gov.uk; 2023.

National Institute for Health Research: Researching Long Covid: Adressing a new global health challenge, vol. Accessed 9.8.23 at https://evidence.nihr.ac.uk/collection/researching-long-covid-addressing-a-new-global-health-challenge/ . London: NIHR; 2022.

Subbaraman N. NIH will invest $1 billion to study long COVID. Nature. 2021;591(7850):356–356.

Article CAS PubMed Google Scholar

Donabedian A. The definition of quality and approaches to its assessment and monitoring. Ann Arbor: Michigan; 1980.

Laffel G, Blumenthal D. The case for using industrial quality management science in health care organizations. JAMA. 1989;262(20):2869–73.

Maxwell RJ. Quality assessment in health. BMJ. 1984;288(6428):1470.

Berwick DM, Godfrey BA, Roessner J. Curing health care: New strategies for quality improvement. The Journal for Healthcare Quality (JHQ). 1991;13(5):65–6.

Deming WE. Out of the Crisis. Cambridge, MA: MIT Press; 1986.

Argyris C: Increasing leadership effectiveness: New York: J. Wiley; 1976.

Juran JM: A history of managing for quality: The evolution, trends, and future directions of managing for quality: Asq Press; 1995.

Institute of Medicine (US): Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.

McNab D, McKay J, Shorrock S, Luty S, Bowie P. Development and application of ‘systems thinking’ principles for quality improvement. BMJ Open Qual. 2020;9(1): e000714.

Sampath B, Rakover J, Baldoza K, Mate K, Lenoci-Edwards J, Barker P. Whole-System Quality: A Unified Approach to Building Responsive, Resilient Health Care Systems. Boston: Institute for Healthcare Immprovement; 2021.

Batalden PB, Davidoff F: What is “quality improvement” and how can it transform healthcare? In . , vol. 16: BMJ Publishing Group Ltd; 2007: 2–3.

Baker G. Collaborating for improvement: the Institute for Healthcare Improvement’s breakthrough series. New Med. 1997;1:5–8.

Plsek PE. Collaborating across organizational boundaries to improve the quality of care. Am J Infect Control. 1997;25(2):85–95.

Ayers LR, Beyea SC, Godfrey MM, Harper DC, Nelson EC, Batalden PB. Quality improvement learning collaboratives. Qual Manage Healthcare. 2005;14(4):234–47.

Brandrud AS, Schreiner A, Hjortdahl P, Helljesen GS, Nyen B, Nelson EC. Three success factors for continual improvement in healthcare: an analysis of the reports of improvement team members. BMJ Qual Saf. 2011;20(3):251–9.

Dückers ML, Spreeuwenberg P, Wagner C, Groenewegen PP. Exploring the black box of quality improvement collaboratives: modelling relations between conditions, applied changes and outcomes. Implement Sci. 2009;4(1):1–12.

Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q. 2013;91(2):354–94.

Shortell SM, Marsteller JA, Lin M, Pearson ML, Wu S-Y, Mendel P, Cretin S, Rosen M: The role of perceived team effectiveness in improving chronic illness care. Medical Care 2004:1040–1048.

Wilson T, Berwick DM, Cleary PD. What do collaborative improvement projects do? Experience from seven countries. Joint Commission J Qual Safety. 2004;30:25–33.

Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ. 2008;336(7659):1491–4.

Hulscher ME, Schouten LM, Grol RP, Buchan H. Determinants of success of quality improvement collaboratives: what does the literature show? BMJ Qual Saf. 2013;22(1):19–31.

Dixon-Woods M, Bosk CL, Aveling EL, Goeschel CA, Pronovost PJ. Explaining Michigan: developing an ex post theory of a quality improvement program. Milbank Q. 2011;89(2):167–205.

Bate P, Mendel P, Robert G: Organizing for quality: the improvement journeys of leading hospitals in Europe and the United States: CRC Press; 2007.

Andersson-Gäre B, Neuhauser D. The health care quality journey of Jönköping County Council. Sweden Qual Manag Health Care. 2007;16(1):2–9.

Törnblom O, Stålne K, Kjellström S. Analyzing roles and leadership in organizations from cognitive complexity and meaning-making perspectives. Behav Dev. 2018;23(1):63.

Greenhalgh T, Russell J. Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles. PLoS Med. 2010;7(11): e1000360.

Wells S, Tamir O, Gray J, Naidoo D, Bekhit M, Goldmann D. Are quality improvement collaboratives effective? A systematic review. BMJ Qual Saf. 2018;27(3):226–40.

Landon BE, Wilson IB, McInnes K, Landrum MB, Hirschhorn L, Marsden PV, Gustafson D, Cleary PD. Effects of a quality improvement collaborative on the outcome of care of patients with HIV infection: the EQHIV study. Ann Intern Med. 2004;140(11):887–96.

Mittman BS. Creating the evidence base for quality improvement collaboratives. Ann Intern Med. 2004;140(11):897–901.

Wennberg JE. Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ. 2002;325(7370):961–4.

Bungay H. Cancer and health policy: the postcode lottery of care. Soc Policy Admin. 2005;39(1):35–48.

Wennberg JE, Cooper MM: The Quality of Medical Care in the United States: A Report on the Medicare Program: The Dartmouth Atlas of Health Care 1999: The Center for the Evaluative Clinical Sciences [Internet]. 1999.

DaSilva P, Gray JM. English lessons: can publishing an atlas of variation stimulate the discussion on appropriateness of care? Med J Aust. 2016;205(S10):S5–7.

Gray WK, Day J, Briggs TW, Harrison S. Identifying unwarranted variation in clinical practice between healthcare providers in England: Analysis of administrative data over time for the Getting It Right First Time programme. J Eval Clin Pract. 2021;27(4):743–50.

Wabe N, Thomas J, Scowen C, Eigenstetter A, Lindeman R, Georgiou A. The NSW Pathology Atlas of Variation: Part I—Identifying Emergency Departments With Outlying Laboratory Test-Ordering Practices. Ann Emerg Med. 2021;78(1):150–62.

Jamal A, Babazono A, Li Y, Fujita T, Yoshida S, Kim SA. Elucidating variations in outcomes among older end-stage renal disease patients on hemodialysis in Fukuoka Prefecture, Japan. PLoS ONE. 2021;16(5): e0252196.

Sutherland K, Levesque JF. Unwarranted clinical variation in health care: definitions and proposal of an analytic framework. J Eval Clin Pract. 2020;26(3):687–96.

Tanenbaum SJ. Reducing variation in health care: The rhetorical politics of a policy idea. J Health Polit Policy Law. 2013;38(1):5–26.

Atsma F, Elwyn G, Westert G. Understanding unwarranted variation in clinical practice: a focus on network effects, reflective medicine and learning health systems. Int J Qual Health Care. 2020;32(4):271–4.

Horbar JD, Rogowski J, Plsek PE, Delmore P, Edwards WH, Hocker J, Kantak AD, Lewallen P, Lewis W, Lewit E. Collaborative quality improvement for neonatal intensive care. Pediatrics. 2001;107(1):14–22.

Van Maanen J: Tales of the field: On writing ethnography: University of Chicago Press; 2011.

Golden-Biddle K, Locke K. Appealing work: An investigation of how ethnographic texts convince. Organ Sci. 1993;4(4):595–616.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

Glaser BG. The constant comparative method of qualitative analysis. Soc Probl. 1965;12:436–45.

Willis R. The use of composite narratives to present interview findings. Qual Res. 2019;19(4):471–80.

Vojdani A, Vojdani E, Saidara E, Maes M. Persistent SARS-CoV-2 Infection, EBV, HHV-6 and other factors may contribute to inflammation and autoimmunity in long COVID. Viruses. 2023;15(2):400.

Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med. 2022;28(5):911–23.

Connors JM, Ariëns RAS. Uncertainties about the roles of anticoagulation and microclots in postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. J Thromb Haemost. 2023;21(10):2697–701.

Patel MA, Knauer MJ, Nicholson M, Daley M, Van Nynatten LR, Martin C, Patterson EK, Cepinskas G, Seney SL, Dobretzberger V. Elevated vascular transformation blood biomarkers in Long-COVID indicate angiogenesis as a key pathophysiological mechanism. Mol Med. 2022;28(1):122.

Greenhalgh T, Sivan M, Delaney B, Evans R, Milne R: Long covid—an update for primary care. bmj 2022, 378.

Parkin A, Davison J, Tarrant R, Ross D, Halpin S, Simms A, Salman R, Sivan M. A multidisciplinary NHS COVID-19 service to manage post-COVID-19 syndrome in the community. J Prim Care Commun Health. 2021;12:21501327211010990.

NHS England: COVID-19 Post-Covid Assessment Service, vol. Accessed 5th March 2024 at https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-post-covid-assessment-service/ . London: NHS England; 2024.

Sivan M, Halpin S, Gee J, Makower S, Parkin A, Ross D, Horton M, O'Connor R: The self-report version and digital format of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) for Long Covid or Post-COVID syndrome assessment and monitoring. Adv Clin Neurosci Rehabil 2021;20(3).

The EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.

Sivan M, Preston NJ, Parkin A, Makower S, Gee J, Ross D, Tarrant R, Davison J, Halpin S, O’Connor RJ, et al. The modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) patient-reported outcome measure for Long Covid or Post-COVID syndrome. J Med Virol. 2022;94(9):4253–64.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

Van Dixhoorn J, Duivenvoorden H. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res. 1985;29(2):199–206.

Evans R, Pick A, Lardner R, Masey V, Smith N, Greenhalgh T: Breathing difficulties after covid-19: a guide for primary care. BMJ 2023;381.

Van Dixhoorn J, Folgering H: The Nijmegen Questionnaire and dysfunctional breathing. In . , vol. 1: Eur Respiratory Soc; 2015.

Courtney R, Greenwood KM. Preliminary investigation of a measure of dysfunctional breathing symptoms: The Self Evaluation of Breathing Questionnaire (SEBQ). Int J Osteopathic Med. 2009;12(4):121–7.

Espinosa-Gonzalez A, Master H, Gall N, Halpin S, Rogers N, Greenhalgh T. Orthostatic tachycardia after covid-19. BMJ (Clinical Research ed). 2023;380:e073488–e073488.

PubMed Google Scholar

Bungo M, Charles J, Johnson P Jr. Cardiovascular deconditioning during space flight and the use of saline as a countermeasure to orthostatic intolerance. Aviat Space Environ Med. 1985;56(10):985–90.

CAS PubMed Google Scholar

Sivan M, Corrado J, Mathias C. The Adapted Autonomic Profile (Aap) Home-Based Test for the Evaluation of Neuro-Cardiovascular Autonomic Dysfunction. Adv Clin Neurosci Rehabil. 2022;3:10–13. https://doi.org/10.47795/QKBU46715 .

Lee C, Greenwood DC, Master H, Balasundaram K, Williams P, Scott JT, Wood C, Cooper R, Darbyshire JL, Gonzalez AE. Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study. J Med Virol. 2024;96(3): e29486.

World Health Organization: Clinical management of covid-19 - living guideline. Geneva: WHO. Accessed 4th October 2023 at https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2 ; 2023.

Ahmed I, Mustafaoglu R, Yeldan I, Yasaci Z, Erhan B: Effect of pulmonary rehabilitation approaches on dyspnea, exercise capacity, fatigue, lung functions and quality of life in patients with COVID-19: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2022.

Dillen H, Bekkering G, Gijsbers S, Vande Weygaerde Y, Van Herck M, Haesevoets S, Bos DAG, Li A, Janssens W, Gosselink R, et al. Clinical effectiveness of rehabilitation in ambulatory care for patients with persisting symptoms after COVID-19: a systematic review. BMC Infect Dis. 2023;23(1):419.

Learmonth Y, Dlugonski D, Pilutti L, Sandroff B, Klaren R, Motl R. Psychometric properties of the fatigue severity scale and the modified fatigue impact scale. J Neurol Sci. 2013;331(1–2):102–7.

Webster K, Cella D, Yost K. The Functional Assessment of Chronic Illness T herapy (FACIT) Measurement System: properties, applications, and interpretation. Health Qual Life Outcomes. 2003;1(1):1–7.

Mundt JC, Marks IM, Shear MK, Greist JM. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180(5):461–4.

Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, Wallace E. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–53.

Shahid A, Wilkinson K, Marcu S, Shapiro CM: Visual analogue scale to evaluate fatigue severity (VAS-F). In: STOP, THAT and one hundred other sleep scales . edn.: Springer; 2011:399–402.

Parker M, Sawant HB, Flannery T, Tarrant R, Shardha J, Bannister R, Ross D, Halpin S, Greenwood DC, Sivan M. Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome. J Med Virol. 2023;95(1): e28373.

Kenny RA, Bayliss J, Ingram A, Sutton R. Head-up tilt: a useful test for investigating unexplained syncope. The Lancet. 1986;327(8494):1352–5.

Drury MOC: Science and Psychology. In: The selected writings of Maurice O’Connor Drury: On Wittgenstein, philosophy, religion and psychiatry. edn.: Bloomsbury Publishing; 2017.

Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342(25):1887–92.

Mongtomery K: How doctors think: Clinical judgment and the practice of medicine: Oxford University Press; 2005.

Download references

Acknowledgements

We are grateful to clinic staff for allowing us to study their work and to patients for allowing us to sit in on their consultations. We also thank the funder of LOCOMOTION (National Institute for Health Research) and the patient advisory group for lived experience input.

This research is supported by National Institute for Health Research (NIHR) Long Covid Research Scheme grant (Ref COV-LT-0016).

Author information

Authors and affiliations.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK

Trisha Greenhalgh, Julie L. Darbyshire & Emma Ladds

Imperial College Healthcare NHS Trust, London, UK

LOCOMOTION Patient Advisory Group and Lived Experience Representative, London, UK

You can also search for this author in PubMed Google Scholar

Contributions

TG conceptualized the overall study, led the empirical work, supported the quality improvement meetings, conducted the ethnographic visits, led the data analysis, developed the theorization and wrote the first draft of the paper. JLD organized and led the quality improvement meetings, supported site-based researchers to collect and analyse data on their clinic, collated and summarized data on quality topics, and liaised with the patient advisory group. CL conceptualized and led the quality topic on POTS, including exploring reasons for some clinics’ reluctance to conduct testing and collating and analysing the NASA Lean Test data across all sites. EL assisted with ethnographic visits, data analysis, and theorization. JCS contributed lived experience of long covid and also clinical experience as an occupational therapist; she liaised with the wider patient advisory group, whose independent (patient-led) audit of long covid clinics informed the quality improvement prioritization exercise. All authors provided extensive feedback on drafts and contributed to discussions and refinements. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Trisha Greenhalgh .

Ethics declarations

Ethics approval and consent to participate.

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS study is sponsored by the University of Leeds and approved by Yorkshire & The Humber—Bradford Leeds Research Ethics Committee (ref: 21/YH/0276) and subsequent amendments.

Patient participants in clinic were approached by the clinician (without the researcher present) and gave verbal informed consent for a clinically qualified researcher to observe the consultation. If they consented, the researcher was then invited to sit in. A written record was made in field notes of this verbal consent. It was impractical to seek consent from patients whose cases were discussed (usually with very brief clinical details) in online MDTs. Therefore, clinical case examples from MDTs presented in the paper are fictionalized cases constructed from multiple real cases and with key clinical details changed (for example, comorbidities were replaced with different conditions which would produce similar symptoms). All fictionalized cases were checked by our patient advisory group to check that they were plausible to lived experience experts.

Consent for publication

No direct patient cases are reported in this manuscript. For details of how the fictionalized cases were constructed and validated, see “Consent to participate” above.

Competing interests

TG was a member of the UK National Long Covid Task Force 2021–2023 and on the Oversight Group for the NICE Guideline on Long Covid 2021–2022. She is a member of Independent SAGE.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Greenhalgh, T., Darbyshire, J.L., Lee, C. et al. What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography. BMC Med 22 , 159 (2024). https://doi.org/10.1186/s12916-024-03371-6

Download citation

Received : 04 December 2023

Accepted : 26 March 2024

Published : 15 April 2024

DOI : https://doi.org/10.1186/s12916-024-03371-6

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Post-covid-19 syndrome
Quality improvement
Breakthrough collaboratives
Warranted variation
Unwarranted variation
Improvement science
Ethnography
Idiographic reasoning
Nomothetic reasoning

BMC Medicine

ISSN: 1741-7015

Submission enquiries: [email protected]
General enquiries: [email protected]

IMAGES

How to Create a Case Study + 14 Case Study Templates
How to Create a Case Study + 14 Case Study Templates
190 Excellent Case Study Topics to Focus On
Create A Big Influence On Your Audience With These Powerful Case Study
How to Write a Business Case Study: Tips, Steps, Mistakes
49 Free Case Study Templates ( + Case Study Format Examples + )

VIDEO

case study research (background info and setting the stage)
Case study
Case Study Research in Software Engineering
what is case study research in Urdu Hindi with easy examples
CASE STUDY RESEARCH DESIGN
2023 PhD Research Methods: Qualitative Research and PhD Journey

COMMENTS

120 Case Study Topics For College Students
Although the majority of academic definitions of case study talk about some process or research work related to the development of a particular person, group of people, or events over a period of time, types of case studies also involve specific analysis to identify problems and find the outcomes. Therefore, the majority of case study topics already include some challenge or an assumption that ...
Case Study Topics: 145 Inspiration Ideas
Case Study Topics for College Students. These case study topics cover a spectrum of academic disciplines and real-world scenarios, providing valuable insights and a foundation for comprehensive research. Navigating the challenges of time management in college. Case study on balancing academic and extracurricular commitments.
How to Use Case Studies in Research: Guide and Examples
1. Select a case. Once you identify the problem at hand and come up with questions, identify the case you will focus on. The study can provide insights into the subject at hand, challenge existing assumptions, propose a course of action, and/or open up new areas for further research. 2.
Case Study Methods and Examples
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. It is unique given one characteristic: case studies draw from more than one data source. Case studies are inherently multimodal or mixed ...
What Is a Case Study?
Revised on November 20, 2023. A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research. A case study research design usually involves qualitative methods, but quantitative methods are ...
Case Study Topics on Various Academic Subjects
Case Study Ideas and Topics to Get Inspired. Our comprehensive list of case study topics is here to help! From students and researchers, to professionals across industries - these thought-provoking subjects can jumpstart creativity, enable deeper insights into research findings and steer you toward the next big breakthrough.
Case Study
Defnition: A case study is a research method that involves an in-depth examination and analysis of a particular phenomenon or case, such as an individual, organization, community, event, or situation. It is a qualitative research approach that aims to provide a detailed and comprehensive understanding of the case being studied.
Case Study Methodology of Qualitative Research: Key Attributes and
A case study is one of the most commonly used methodologies of social research. This article attempts to look into the various dimensions of a case study research strategy, the different epistemological strands which determine the particular case study type and approach adopted in the field, discusses the factors which can enhance the effectiveness of a case study research, and the debate ...
Case Study
A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research. A case study research design usually involves qualitative methods, but quantitative methods are sometimes also used.
Case Study Research: In-Depth Understanding in Context
After first noting various contexts in which case studies are commonly used, the chapter focuses on case study research directly Strengths and potential problematic issues are outlined and then key phases of the process. The chapter emphasizes how important it is to design the case, to collect and interpret data in ways that highlight the ...
Writing a Case Study
A case study research paper examines a person, place, event, condition, phenomenon, or other type of subject of analysis in order to extrapolate key themes and results that help predict future trends, illuminate previously hidden issues that can be applied to practice, and/or provide a means for understanding an important research problem with greater clarity.
Case Study Method: A Step-by-Step Guide for Business Researchers
Although case studies have been discussed extensively in the literature, little has been written about the specific steps one may use to conduct case study research effectively (Gagnon, 2010; Hancock & Algozzine, 2016).Baskarada (2014) also emphasized the need to have a succinct guideline that can be practically followed as it is actually tough to execute a case study well in practice.
Case Study: Definition, Examples, Types, and How to Write
A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.
LibGuides: Research Writing and Analysis: Case Study
A Case study is: An in-depth research design that primarily uses a qualitative methodology but sometimes includes quantitative methodology. Used to examine an identifiable problem confirmed through research. Used to investigate an individual, group of people, organization, or event. Used to mostly answer "how" and "why" questions.
181+ Best Case Study Topics on Various Subjects for Students
Psychology Case Study Topics. Dyslexia and Cognitive Neuroscience. Intelligence vs creativity. Relation of Landscape Paintings with my art. Relation between Intelligence, Logic and Creativity. Reflective essay on pointing analysis. Essay on "Legacy of Andy Warhol". Essay on storytelling.
Top 40 Most Popular Case Studies of 2021
Two cases on the uses of debt and equity at Hertz claimed top spots in the CRDT's (Case Research and Development Team) 2021 top 40 review of cases. Hertz (A) took the top spot. The case details the financial structure of the rental car company through the end of 2019.
Planning Qualitative Research: Design and Decision Making for New
Several research topics and questions indicate a case study as an appropriate approach. The key criterion is the bounded system, so any research situation where the bounded system is central is a candidate for case study. ... A case study can be a complete research project in itself, such as in the study of a particular organization, community ...
How to Write a Case Study: from Outline to Examples
Explain what you will examine in the case study. Write an overview of the field you're researching. Make a thesis statement and sum up the results of your observation in a maximum of 2 sentences. Background. Provide background information and the most relevant facts. Isolate the issues.
(PDF) The case study as a type of qualitative research
Abstract. This article presents the case study as a type of qualitative research. Its aim is to give a detailed description of a case study - its definition, some classifications, and several ...
List of Current Topics to Write a Case Study
Business Case Study Topics. The detrimental effects of consumerism on the U.S. economy. Personnel management challenges at Amazon outlets. Exploring Australia's investment-driven industrial environment. Apple's pricing tactics for maximizing returns. The correlation between production excellence and innovative strategic thinking among CEOs.
Science: Articles, Research, & Case Studies on Science
by Desmond Dodd. Many assume that major oil and gas companies adamantly oppose climate-friendly regulation, but that's not true. A study of 30 years of corporate advocacy by Jonas Meckling finds that energy companies have backed clean-energy efforts when it aligns with their business interests. 12 Mar 2024. HBS Case.
(PDF) Case Study Research
The case study method is a research strategy that aims to gain an in-depth understanding of a specific phenomenon by collecting and analyzing specific data within its true context (Rebolj, 2013 ...
100+ Healthcare Research Topics (+ Free Webinar)
Here, we'll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, ... The role of veterinary medicine in public health: A case study of the COVID-19 pandemic;
The Macro Trends Driving Care Delivery
This issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on a variety of timely and important topics: climate change, integrating AI to improve clinical note quality, the U.S. Center for Medicare & Medicaid Innovation Center's new quality initiative, cancer care in rural settings, lung cancer screening in urban systems, overdose ...
AI improves accuracy of skin cancer diagnoses in Stanford Medicine-led
The study was funded by the National Institutes of Health (grants K24AR075060 and R01AR082109), Radiumhemmet Research, the Swedish Cancer Society and the Swedish Research Council. For more news about responsible AI in health and medicine, sign up for the RAISE Health newsletter.
Business school teaching case study: can green hydrogen's potential be
Ultimately, though, the promise of green hydrogen will hinge on how businesses and policymakers weigh several questions, trade-offs, and potential long-term consequences. We know from previous ...
Teaching difficult and sensitive topics in higher education: some
There are three key strategies important when thinking about and planning for teaching topics that could be described as difficult or sensitive. Prepare your students. Firstly, it is helpful to think about the ways that students encounter potentially difficult or sensitive topics across a module or a programme.
Two key brain systems are central to psychosis, Stanford Medicine-led
The study was funded by the Stanford Maternal and Child Health Research Institute's Uytengsu-Hamilton 22q11 Neuropsychiatry Research Program, FONDEYCT (the National Fund for Scientific and Technological Development of the government of Chile), ANID-Chile (the Chilean National Agency for Research and Development) and the U.S. National ...
Case Study: How Aggressively Should a Bank Pursue AI?
Anuj Shrestha. Summary. Siti Rahman, the CEO of Malaysia-based NVF Bank, faces a pivotal decision. Her head of AI innovation, a recent recruit from Google, has a bold plan. It requires a ...
What is quality in long covid care? Lessons from a national quality
Background Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards to reduce a so-called "postcode lottery" of care. The original aim of this study—to examine the nature of quality in long covid care and reduce unwarranted ...

What is case study research?

Analyze case study research

Explanatory

Descriptive

Exploratory

Critical instance

Instrumental

1. Select a case

2. Create a theoretical framework

3. Collect the data

4. Analyze your case

Case study topics

Get started today

Editor’s picks

Latest articles

Have a language expert improve your writing

What Is a Case Study? | Definition, Examples & Methods

Table of contents

Receive feedback on language, structure, and formatting

Prevent plagiarism. Run a free check.

Cite this Scribbr article

Is this article helpful?

Shona McCombes

Case Study Topics on Various Academic Subjects

What Is a Case Study?

How to Find Awesome Case Study Topics?

Case Study Ideas and Topics to Get Inspired

Top Notch Business Case Study Topics

MBA Case Study Topic Ideas

Education Case Study Topics

Psychology Case Study Topics

Environmental Science Case Study Topics

Management Case Study Topics

Case Study Topics for Marketing

Social Media Marketing Case Study Topics

Information Technology Case Study Topics

Human Rights Case Study Topics

Case Study Topics for Nursing

Readers also enjoyed

WHY WAIT? PLACE AN ORDER RIGHT NOW!

Case Study – Methods, Examples and Guide

Types of Case Study

Single-Case Study

Multiple-Case Study

Descriptive Case Study

Instrumental Case Study

Case Study Data Collection Methods

Observations

How to conduct Case Study Research

Examples of Case Study

Application of Case Study

Business and Management

Social Sciences

Law and Ethics

Purpose of Case Study

Advantages of Case Study Research

Limitations of Case Study Research

About the author

Muhammad Hassan

You may also like

Questionnaire – Definition, Types, and Examples

Observational Research – Methods and Guide

Quantitative Research – Methods, Types and...

Qualitative Research Methods

Explanatory Research – Types, Methods, Guide

Survey Research – Types, Methods, Examples

Have a language expert improve your writing

Case Study | Definition, Examples & Methods

Table of contents

Prevent plagiarism, run a free check.

Cite this Scribbr article

Is this article helpful?

Shona McCombes

22 Case Study Research: In-Depth Understanding in Context

Introduction

The Beginnings

Concepts and Purposes of Case Study

Everyday Usage: Stories We Tell

Professions Individual Cases

Case Studies in Teaching