Social science research has an honourable tradition of
de-familiarising activity, processes and culture which have become embedded as
normal practice - `how we do things here’.
A key research approach is
organisational case study research. But
there is often little understanding of the art (or science) of research into
organisations or what makes a good case study.
This was the subject of a recent seminar
hosted by the Health Services Research Network at Manchester Business School. Kieran Walshe chaired the event, with a
formidable array of talent from different fields. The unifying theme was the organisational
case study, but the approaches ranged widely from historical archival research
to contemporaneous sense-making of new organisations. We heard from a range of disciplines,
including management and organisational studies as well as health services
research. And the subjects of research
ranged from code-breaking units to operating theatres to clinical genetic
centres.
We opened with Chris Grey (Royal Holloway London),
talking of his fascinating work on wartime signals intelligence in Bletchley
Park (http://taralamont.blogspot.co.uk/2012/10/from-bletchley-park-to-nice.html). Contemporary sources and official historians
described the chaotic nature of the organisation – so how did it achieve such
astonishing results? Chris Grey used a
compelling range of evidence and analysis to argue that the success was because
and not despite its organisational hybridity.
He described it as a `twisting together’ of routine data processing and
semi-mechanised work with esoteric, highly skilled cryptanalysis. Its organisational porosity – sucking in expertise
from other sources (such as indexing capacity from the retail sector) – gave it
an adaptability which was used to `patch’ organisational fissures at a local
level without recourse to more elaborate longwinded structural solutions. The provisional, adaptive nature of the
enterprise was not a weakness, but its greatest strength.
We moved rapidly from signals intelligence to de-coding the
work that surgeons do. Justin Waring (University
of Nottingham) explained the use of ethnography to `make strange’ the
ritualistic responses to events and shared norms of professional and
inter-professional groups – in this case, operating teams. His work has helped us to understand for
instance what kind of adverse events are seen as worth reporting by surgeons
and why. He also explained the strengths
of case study research as a method – particularly, the ability to zoom out (to
explain the context and inter-connectedness of forms) and zoom in (to provide
depth and focus on particular processes) within a single study.
Ewan Ferlie (Kings College London) described a broad arc of
organisational case study research and its epistemic context, from the classic single
case such as Lukacs’ account of five days of the Dunkirk crisis (refreshing to
have a different example from the much-cited Allison’s account of the Cuban
missile crisis) to broader organisational research ranging from Mintzberg to
Pettigrew. He talked about his work on managed
clinical networks, using tracer activity such as implementation of NICE
guidelines on urology and observational research to `look at what people do not
what they say’. There was some
discussion about good practice in case study design. Where social scientists are often equivocal
about the optimal number of study sites, Ewan Ferlie was robust – in his experience, the right number is
always eight!
Graham Martin (University of Leicester) then picked up
issues about methods and design in describing his work on the sustainability of
new genetic services. He cited classic
works from Yin to Gerring, but cautioned against over-reliance on deductive
logic, as there will always be uncontrolled variance in the dynamic, complex
world of healthcare. Although his study
had used a clear 2x2 sampling frame for genetic services, based on key
variables of interest, the status of participating sites changed during the
course of the study. He also noted that
the best organisational case studies needed adaptive, highly skilled researchers
in the field, with iterative cycles of data collection and analysis. He had found practical suggestions helpful
from case study methodologists such as Eisenhardt – for instance, her
suggestion of creating paired comparisons to look for points of commonality and
divergence in a structured way.
We ended with a presentation from Nick Emmel (University of
Leeds) which was almost philosophical.
He noted that the hallmark of organisational case study research was
that the question `what is a case’ or `what do I have a case of?’ is constantly
posed throughout the research. This in
itself was a key research tactic to interpret and explain activity and causal
mechanisms. The cases might change and
evolve during the course of the study.
He emphasised that the selection of appropriate topics was crucial – the
ideal cases should bundle together ideas, contexts and outcomes to develop and
test theories of the middle range. Overall, Nick Emmel’s contention was that we
should move from an idea of a case as a passive noun to a more active verb
`casing’ where cases are created from the
research activity.
If these stimulating thoughts were becoming a little
abstract, the audience provided some grounding during questions. One researcher questioned whether case study
research was more or less accessible to managers than other forms of evidence. On the plus side, this kind of research
provided stories which was a powerful form of transmitting learning (and
familiar to senior leaders in the NHS who had been through management or
business school). But others challenged
the timescale for carrying out longterm observational research and how this
could deliver usable findings to managers who needed immediate answers. It was agreed that there was a place for 3-5
year indepth studies, but not all knowledge gaps needed primary research.
There were interesting points about the different team
composition needed for good case study research. Participants noted that biomedical research
was often predicated on a hands-off principal investigator and much work done
by teams of junior researchers. In case
study work, senior researchers needed to engage in the fieldwork and respond to
emerging data challenges and design. The
quality of analysis and write-up was particularly important for this kind of
research.
Other participants noted the exceptional nature of some of
these interesting, atypical cases. Would this provide distorted findings? On the contrary, some researchers argued that
outliers might yield important learning but it would always be important to
contextualise the case against the population from which it was drawn.
So a rich and stimulating seminar, which reminded us of the
strengths of organisational case study research for health. It remains the best way to provide what
Flyvberg calls `concrete, context-dependent knowledge’. Participants agreed it was not appropriate to
identify a single blueprint for case study research, given the diversity of methods,
but greater attention could be paid to study design. This
included making explicit choices about sampling or selecting cases and actively
looking for data which challenged emerging lines of enquiry. There
were practical tips which could be shared from more experienced research teams,
especially given the challenges of ensuring consistency but flexibility in
comparative case study work. Best
studies allowed for `thick description’ – one of the strengths of case study
research - within a rigorous, analytical, theory-driven framework. A key problem was how to generalise findings
from descriptive, context-dependent case studies. This was difficult but possible through
cross-case analysis and in deliberate theory-building. Although there were no easy answers, it may
be helpful to identify common standards and tenets of good practice for those
funding, delivering and using research of this kind. At its best, case study research provides the
shock of recognition – literally, thinking or seeing afresh the organisations where
we work and receive healthcare.
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