Qualitative Comparative Case Study Research Articles

Bringing a systems approach to living donor kidney transplantation

BackgroundLiving donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure. Efforts to increase LDKT have focused on micro-level interventions and the need for systems thinking has been highlighted. We aimed to identify and compare health system-level attributes and processes that are facilitators and barriers to LDKT. MethodsWe conducted a qualitative comparative case study analysis of three Canadian provincial healthcare systems with variable LDKT performance (Quebec:low, Ontario:moderate-high, British Columbia:high). Data collection entailed semi-structured interviews (n=91), document review (n=97) and focus groups (n=5 with 40 participants), analyzed using inductive thematic analysis. ResultsOur findings showed a strong relationship between the degree of centralized coordination between governing organizations and the capacity to deliver LDKT: 1) Macro-level coordination between governing organizations in British Columbia and Ontario increased capacities, while Québec was seen as decentralized with little formal coordination; 2) A higher degree of centralized coordination facilitated more effective resource deployment in the form of human resources and initiatives in British Columbia and Ontario, whereas in Québec resource deployment relied on hospital budgets leading to competition for resources and reduced capacity of initiatives; 3) Informal resource sharing through strong communities of practice and local champions facilitated LDKT in Ontario and British Columbia and was limited in Québec. ConclusionOur findings suggest that interventions that account for full-system function, particularly macro-level coordination between governing organizations can improve LDKT delivery. Findings may be used to guide structured organizational change towards increasing LDKT and mitigating the global burden of kidney failure.

Home is where the heart is? A comparative analysis of Flemish and Danish parties' organizational linkages with the EU

AbstractIn the light of the crucial role political parties play in connecting citizens with political decisions, this article assesses national parties' organizational linkages with the European level. It focuses on explaining variation between parties and the motivations they have to organize the way they do. Building on qualitative comparative case studies of Danish and Flemish parties, this study finds that country‐level factors override party‐level factors. Particularly the domestic political relevance of European affairs, combined with historical ties with European integration and distance from Brussels, determine the nature of parties' multilevel linkages. Contributing to the literature on parties as multilevel organization in the EU, these findings call attention to the great difficulty parties face in reaching beyond the confines of the nation‐state, despite the important role they play in providing the EU with the necessary democratic legitimacy.

The Community’s Understanding and Responses Regarding Land Subsidence, Waterlogging, and the Link Between the Two in Rural South-western Coastal Bangladesh

Land subsidence has triggered severe waterlogging problems in the southwestern coastal zone of Bangladesh, which affects the biodiversity as well as people’s lives, and livelihoods. The members of the affected community, however, appear to have a poor understanding of the nature of land subsidence and its consequences. This study, therefore, aims to assess the community members’ understanding of as well as the actions that they take to solve problems of this nature in the rural, southwestern coastal zone of Bangladesh. A qualitative comparative case study approach was employed in this study, where two rural communities from the southwestern coastal districts were selected as the cases. By subjecting the data to thematic analysis, the study found that, although a few civil society members and activists are, to some extent, aware of the occurrence of land subsidence and its linkage with waterlogging, however, most of the members of the communities lack adequate knowledge or an understanding about the nature, causes and consequences of the land subsidence issue and its connection to the waterlogging problem in their locality. Thus, it was found that they take no or very few measures to cope with the risk of land subsidence. The study’s findings imply that the policymakers should formulate a strategy for making the members of the community aware of the nature, causes, and consequences of land subsidence issues.

Comparative study: perceptions of multiple education stakeholders on children with disabilities and goals of special education in Oman and the Philippines

PurposeThis comparative study explored the perceptions of educational stakeholders in Oman and the Philippines concerning children with disabilities and the goals of special education. Stakeholders' perspectives can influence their professional behaviours and attitudes, which, in turn, can profoundly impact children with disabilities who already face numerous challenges. Hence, comprehending the viewpoints of these stakeholders is vital for fostering socially just education for individuals with disabilities.Design/methodology/approachThis study employed a qualitative comparative case study approach with a horizontal comparison strategy, and both convenience and purposeful sampling techniques were used for participant selection. The study involved 53 participants from both countries, including policymakers, teacher educators, in-service teachers and student teachers from general and special education domains. Data were gathered through individual interviews and themes were subsequently discerned via data analysis.FindingsDespite the different cultural and historical contexts and distinct roles of stakeholders in both countries, the results indicate more parallels than disparities in their perceptions. The primary congruence underscored in this research was imperative to critically assess the language and ideology surrounding the goals of special education, such as mainstreaming and normalisation.Originality/valueAlthough numerous studies have probed the perceptions of various educational stakeholders concerning children with disabilities and educational goals, there is limited research that encompasses the perspectives of the seven distinct stakeholder groups. The consistency of language usage across both countries and among all stakeholders underscores the need for a rigorous cross-country examination involving all educational participants.

Knowledge Entrainment in Large-Scale Transformation Projects:The Evidence-Based Strategy and the Innovation-Based Strategy

Prior research has indicated that knowledge integration is essential for succeeding with large-scale transformation (LST) projects. However, research has largely ignored the processual properties of knowledge integration. This article embarks on the notion of knowledge entrainment and demonstrates the criticality of the processual nature of knowledge integration. Through a comparative qualitative case study of two LST projects in the healthcare sector, two knowledge entrainment strategies were identified (the evidence-based strategy and the innovation-based strategy). Data analysis uncovered triggers, practices, and outcomes of the two knowledge entrainment strategies. Additionally, the central role of temporary project management offices (PMOs) for arranging knowledge entrainment within the LST projects is demonstrated.

Engineering culture under stress: A comparative case study of undergraduate mechanical engineering student experiences

AbstractBackgroundEngineering culture research to date has described the culture as rigid, chilly, and posing many barriers to entry. However, the COVID‐19 pandemic provided an important opportunity to explore how engineering culture responds to a major disruption.PurposeThe purposes of this study are to understand how elements of engineering culture emerged in mechanical engineering students' perceptions of their classroom experiences during the pandemic and how their experiences varied across two national contexts.MethodThis qualitative comparative case study examines undergraduate mechanical engineering students' perceptions of their experiences taking courses during the pandemic at two universities—one in the United States and one in South Africa. Semistructured interviews were conducted across both sites with 21 students and contextualized with 3 faculty member interviews. Student interviews were analyzed using an iterative process of deductive coding, inductive coding, and pattern coding.ResultsWe identified two key themes that characterized participants' experiences during the pandemic: hardness and access to resources. We found that students at both sites experienced two types of hardness—intrinsic and constructed—and were more critical of constructed forms of hardness. We found that the South African university's response to facilitating student access to resources was viewed by students as more effective when compared with the US university.ConclusionsWe found that hardness remained a central feature of engineering culture, based on student perceptions, and found that students expressed awareness of resource‐related differences. A key distinction emerged between intrinsic and constructed hardness.

The sustainability of developmental programs by the U.S. and China in Sub-Saharan Africa: a comparison of effectiveness

This descriptive comparative qualitative case study examines the sustainability of development programs in Sub-Saharan Africa. We evaluated economic, social, environmental, and institutional development programs from the People’s Republic of China (PRC) and the U.S. to Sub-Saharan Africa for sustainable development to fill the research gap on these technique’s success and effects on Sub-Saharan Africa. Using purposive sampling, we chose eight Sub-Saharan African countries representing distinct geographies and economies. The College of William & Mary’s AID Data-GeoCoded Chinese Official Finance Dataset, China Africa Research Initiative, and USAID’s Foreign Aid Explorer provided data. Results revealed a complex view of Sub-Saharan Africa’s development policy success. Proposition 1, which claims China’s economic tactics exceed those of the U.S., is supported by significant infrastructure investments but presents sustainability problems. Proposition 2, praising the social development initiatives of the U.S., is supported by gains in healthcare and education in other countries. However, context-specific issues persist. Proposition 3 shows that U.S. conservation collaborations have improved environmental preservation. Proposition 4 claims that both countries’ institutional development plans fail. The results highlight local government buy-in issues and the need for adaptation. Some of the ideas find support in recent research; however, country and context differences require unique tactics. Development efforts in Sub-Saharan Africa should focus on long-term sustainability, local objectives, and environmental implications. Effective institutional growth requires adaptation and a strong awareness of local governing dynamics, and policymakers, development practitioners, and scholars may gain insight into sustainability and development projects in Sub-Saharan Africa from this research. A holistic approach that balances economic, social, environmental, and institutional factors is needed to attain sustainable development goals.

How authenticity is negotiated and experienced by clergy and tourists at religious World Heritage sites: taking a closer look into the ‘preserve as found’ strategy

ABSTRACT Drawing on an existing debate regarding the conservation of living heritage, this paper delves into the dissonance and contestation that emerges during the aesthetic treatment of religious wall paintings. The Cypriot UNESCO painted churches open a window for the examination of how policy makers, clergy and visitors negotiate the materiality of religion. This multi-method qualitative comparative case study aims to understand how the ‘material-focused’ Authorised Heritage Discourse retains its hegemony during the conservation of living heritage and how AHD-led practices (‘preserve as found’ strategy) impact visitors’ perceived authenticity and experience. The findings demonstrate that over the years, a centralised decision-making system has been maintained in Cyprus that limits polyvocality, perpetuating AHD-led practices. However, evidence of reconciliation between AHD and living tradition was found, challenging the current assumption that considers anti-restoration (objective authenticity) and living religious tradition as antithetic practices. Interviews showcased that for most social agents, deliberate damage, patina, and graffiti triggered an immersive and highly reflective experience while the prospect of restoration provoked ‘pre-nostalgia,’ a self-awareness that restoration may result in significant cultural loss. The paper concludes that, in future conservation and interpretation strategies, ‘evidence of time’ should be considered a salient quality of ‘heritaged’ churches.

Managing under austerity: a qualitative study of management–union relations during attempts to cut labour costs in three South African public hospitals

PurposeIn this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.Design/methodology/approachA comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.FindingsManagement in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.Originality/valueFinding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

A Systematic Literature Review on Improving Quality of Master Programs through (re)Designing Teacher Training

Master’s education is dynamically evolving worldwide. As M-level programs play a crucial role in improving job prospects for university graduates, our review focused on how a well-designed master's program could train candidates to become proactive and goal-oriented learners as well as practitioner-teachers. The methodology employed in this study was a systematic literature review (SLR) of academic articles that centered on M-level programs. The literature search process involved several stages, including identifying relevant studies for thematic analysis, evaluating their quality, pinpointing patterns and significant results, and discussing the extent of consensus across the research questions posed. The total sample of this SLR comprised 81 studies. Three main typologies were prevalent: theoretical and qualitative studies (n=45), case studies or comparative case studies (n=18), empirical studies (n=14), and a mixed-method approach (n=4). The majority of articles suggested innovative perspectives on M-level program development and delivery (60.94%). Another significant portion of the studies (22.22%) presented experiences or comparative analyses of best practices in M-level programs. A smaller number (17.28%) involved presenting empirical data on the impact of master’s training on students’ satisfaction or their motivation to pursue a master’s program. Thematic analysis confirmed recurring themes on innovative approaches to (re)designing M-level programs and providing comprehensive data systematically, emphasizing the urgent need for universities to (re)design improved programs (also at the master's level) and services to meet the demands of the current and future labor market.

COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation

BackgroundCompared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)’s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care.MethodsThis study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic).ResultsFour themes emerged from the interviews: (1) Vaccination uptake and timing— While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing— Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care— Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers’ Conspiracy Theories and Objectivity Claims— Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources.ConclusionsThese findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans’ beliefs, are also key to effectively delivering vaccine messaging to this population.

THE IMPLEMENTATION OF GOVERNANCE PRINCIPLES IN ISLAMIC MICROFINANCE: A COMPARATIVE ANALYSIS BETWEEN TÜRKİYE AND INDONESIA

This study compares implementing the governance principles in Islamic microfinance with a social objective in Türkiye and Indonesia. The relevance of this study is to investigate the best practices to apply governance concepts to Islamic microfinance to achieve IKSAR and BMT MUDA’s social goals. Governance principles in two organizations were studied in this qualitative comparative case study. As for the selection research site, IKSAR and BMT MUDA both have an adequate report until 2021 on their website. The study found that both IKSAR and BMT MUDA tried to realize the governing principles, which meet ethical duty in some areas, namely their top management trying to fulfill SharÊ‘ah compliance by SharÊ‘ah experts, responsibility in their human resources, fairness decision-making, understanding the importance of transparency and accountability to report and disclose to stakeholder, including the public, through their website. BMT MUDA appears to disclose more information than IKSAR, which is relatively new, has less funding, and is staffed by volunteers. However, they can use human resources with their current technology and report more regularly. It would increase their transparency, attract contributors, and build public trust, hence boosting their long-term social impact.

Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers.

In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met. This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection. Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care. Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.

The formation of municipal risk management: a comparison of seven cities

PurposeThis study aims to explore the formation of municipal risk management (RM) and the reasons for the differences of RM practices between the seven biggest cities in Finland.Design/methodology/approachThe empirical data of this comparative qualitative case study comprises 33 interviews conducted with municipal managers. Supplementary material includes documentary material on municipal rules governing RM as well as annual reports and risk tools used in the municipalities.FindingsThis study found differences in cities with respect to when, how and why RM practices had evolved. The results indicate that differences in RM practices and development paths between cities are largely explained by the differences in the original reason to initiate RM, time span since its introduction, professional and educational backgrounds of risk managers, local risk events and accounting infrastructure such as RM tools developed in a city. These findings also suggest that even within the same municipality, different functions can be at different phases regarding RM.Originality/valueThis study reports on RM as a new form of accounting in the field of Finnish municipalities. This highlights how fairly uniform considerations at the field level lead to variation in the elaboration of RM practices at the municipal level. The study finds that different paths in the development of local RM involve iterative evolution between the phases of emergence, largely explained by contextual differences. This study contributes to understanding the emergence of new accounting forms in a municipal RM context.

The use of creative case studies to explore non-verbal and non-ambulant children and young people’s well-being

Background and purposeThe aim of this paper is to describe and critically analyse creative research methods, exploring how these can offer ways to enable non-verbal and non-ambulant children and young people with cerebral palsy, to express their views about their well-being. The context of this research explored their choices for recreational activities, seeking to understand how their level of participation impacted upon their well-being. MethodsA qualitative comparative case study design was chosen comprising of two interviews, using photographs and diaries to elicit discussion, supported by observations. These observations provided evidence of well-being indicators that were interpreted by the researcher, alongside their parents. Seven participants volunteered, aged nine to sixteen years. Data were analysed utilising Braun and Clark’s six stages. Firstly, each case’s data sources were coded, themes identified, then across cases comparisons, arriving at three final themes. Triangulation of data sources which made up each case, enhanced the trustworthiness in this study. ResultsObservations were key to providing insight into their well-being. Interpretation of this rich data, supported by their parents, revealed that the participants could self-advocate, as shown by their intentional behaviours, to choose their level of participation. DiscussionThe researcher’s ability to be creative in the data collection methods is original in physiotherapy. It was important to work in partnership with parents, to ensure the correct interpretation of their intentional behaviours from the observations. The diaries and photographs added a unique contribution to knowledge, which enabled the non-verbal participants inclusion, empowering them to express their well-being. Study registrationThis study is registered with the International Study + Clinical Trials Network Register (ISRCTN) Number:42717948. Contribution of paper•This creative approach to a qualitative case study design has offered a new way to explore the well-being of participants who would not be able to carry out a typical interview. In this case it was with non-verbal and non-ambulant children and young people with complex cerebral palsy. The data has illustrated how they can be empowered to indicate their well-being, as their own advocates. It is important this work continues to provide deeper insight into this under-reported group. Physiotherapists should consider how they can include other non-verbal populations in research.•Physiotherapists who work with non-verbal children and young people with complex disabilities, need to find a way to hear their voices. A creative qualitative case study design offers this flexibility and should be considered as an authentic method for data collection in future studies. Children and young people with complex disabilities deserve to see themselves represented in research.•Physiotherapists are unlikely to work alone to achieve advocacy on behalf of non-verbal populations. Teamwork with designers, illustrators and town planners can contribute to move this agenda forwards. This can then increase the choices and opportunities for disabled children to enhance their well-being.

Engagement in Hybrid Project Teams - A Comparative Case Study of Project Managers' Experiences in Denmark and the US

This study is intended to create new practitioner-focused knowledge on hybrid work in project teams to be consumed and applied by project management professionals and others who manage or work in virtual/hybrid teams. The study focused on the low levels of engagement among employees worldwide, particularly in Denmark and the U.S. The purpose of the qualitative comparative case study was to explore how project managers in Denmark and the U.S. perceive the impact of hybrid work on team member engagement and to understand the strategies used to enhance and sustain team member engagement in hybrid project teams. This research was framed according to Matthews et al.’s model of employee engagement in project-based organizations. Data were collected by interviewing 15 Danish project managers and nine U.S. project managers who participated in three focus groups. Thematic analysis and NVivo were used to code and analyze the data. The findings revealed that while Danish project managers were less enthusiastic about hybrid work than their American counterparts, their strategies for enhancing hybrid team member engagement were similar. This comparative case study produced a series of insights into project managers’ experiences with hybrid work and effective practices and strategies that help foster engagement in hybrid teams. More research is needed on why engagement levels are very low in different cultural contexts to clarify contributing factors and propose solutions.

Contextual Factors Influencing the Implementation of a Multifaceted Intervention to Improve Teamwork and Quality for Hospitalized Patients: A Multisite Qualitative Comparative Case Study

Many hospitals have begun to implement models that combine interventions to redesign care for medical patients. These models include localization of physicians to specific units, nurse-physician co-leadership, and interprofessional rounds. Understanding contextual factors, the circumstances surrounding an implementation effort that influence its success, is essential to provide guidance to leaders implementing similar models of care. A multisite qualitative comparative case study was conducted with four hospitals in the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) study. Researchers conducted observations and semistructured interviews with 40 health care professionals and four implementation mentors. Researchers used inductive qualitative content analysis, reviewed fidelity of implementation trends, and performed cross-case analysis to identify contextual factors and their influence on implementation. Four contextual factors were associated with implementation success: (1) senior hospital leader involvement and organizational support; (2) alignment of RESET with organizational, hospital, and professional group priorities; (3) site leaders' engagement in RESET and relationship with one another; and (4) perceptions of need and intervention benefits among professionals. Implementation was optimal when senior leadership was stable and tangibly involved; organizational, hospital, and group goals were aligned; site leaders were committed and collaborated well; and nurses and physicians perceived a need for and benefits from the interventions. Four interrelated contextual factors are associated with the implementation of combined interventions to redesign care for hospitalized medical patients. Hospital leaders should consider these findings prior to implementing similar interventions and be prepared to address challenges related to these factors during implementation.

Cultural Implications Regarding Privacy in Digital Contact Tracing Algorithms: Method Development and Empirical Ethics Analysis of a German and a Japanese Approach to Contact Tracing.

Digital contact tracing algorithms (DCTAs) have emerged as a means of supporting pandemic containment strategies and protecting populations from the adverse effects of COVID-19. However, the impact of DCTAs on users' privacy and autonomy has been heavily debated. Although privacy is often viewed as the ability to control access to information, recent approaches consider it as a norm that structures social life. In this regard, cultural factors are crucial in evaluating the appropriateness of information flows in DCTAs. Hence, an important part of ethical evaluations of DCTAs is to develop an understanding of their information flow and their contextual situatedness to be able to adequately evaluate questions about privacy. However, only limited studies and conceptual approaches are currently available in this regard. This study aimed to develop a case study methodology to include contextual cultural factors in ethical analysis and present exemplary results of a subsequent analysis of 2 different DCTAs following this approach. We conducted a comparative qualitative case study of the algorithm of the Google Apple Exposure Notification Framework as exemplified in the German Corona Warn App and the Japanese approach of Computation of Infection Risk via Confidential Locational Entries (CIRCLE) method. The methodology was based on a postphenomenological perspective, combined with empirical investigations of the technological artifacts within their context of use. An ethics of disclosure approach was used to focus on the social ontologies created by the algorithms and highlight their connection to the question about privacy. Both algorithms use the idea of representing a social encounter of 2 subjects. These subjects gain significance in terms of risk against the background of a representation of their temporal and spatial properties. However, the comparative analysis reveals 2 major differences. Google Apple Exposure Notification Framework prioritizes temporality over spatiality. In contrast, the representation of spatiality is reduced to distance without any direction or orientation. However, the CIRCLE framework prioritizes spatiality over temporality. These different concepts and prioritizations can be seen to align with important cultural differences in considering basic concepts such as subject, time, and space in Eastern and Western thought. The differences noted in this study essentially lead to 2 different ethical questions about privacy that are raised against the respective backgrounds. These findings have important implications for the ethical evaluation of DCTAs, suggesting that a culture-sensitive assessment is required to ensure that technologies fit into their context and create less concern regarding their ethical acceptability. Methodologically, our study provides a basis for an intercultural approach to the ethics of disclosure, allowing for cross-cultural dialogue that can overcome mutual implicit biases and blind spots based on cultural differences.

It’s Turtles All the Way down: Target Fixation and the Costs of Stakeholder Engagement in Environmental Management

While stakeholder engagement can benefit managers, its implications for decision-making are not well understood. Integrating literature on stakeholder engagement and institutional theory, this paper investigates the ramifications of stakeholder involvement on organizational decision-making. It employs a qualitative comparative case study of agency managers and stakeholders involved in sea turtle management at the Georgia Department of Natural Resources to investigate the motivations and goals of different organizational actors. The results demonstrate that stakeholders can be prone to target fixation, focusing on different goals than their organization intends. Furthermore, they reveal that stakeholders’ motivations are highly resistant to attempts to align them with organizational goals, creating goal misalignment which can disrupt decision-making. These findings provide a more holistic understanding of how stakeholder engagement influences organizational management processes, formalizes how target fixation operates at the individual level, and provides critical information for administrators deciding how to utilize engagement strategies in their work.

Unpack the black box of pilot sampling in policy experimentation: A qualitative comparative analysis of China's public hospital reform

AbstractGovernments increasingly use policy experimentation programs to seek solutions for complex problems. Because randomization and controllability are unrealistic for real‐world policy experiments, how subnational pilots are selected is crucial for generating sound evidence for national replication. However, the received wisdom on pilot sampling is thin and paradoxical. While some studies suggest that policymakers prefer to select regions with favorable conditions, others contend that securing representativeness remains the principal concern when it comes to pilot selection. This study resolves the paradox by elucidating the logic of selecting pilots in large policy experimentation programs. We focus on China's huge public hospital reform program and through a novel research design that combines comparative qualitative analysis and illustrative case studies we seek to explain the strategy for pilot selection. Our analyses reveal five distinctive pathways of pilot sampling: piloting for challenge, piloting for advancement, piloting for innovation, piloting for action, and piloting for regional generalization. Each modality represents a specific experimental purpose. We reveal that piloting serves as a versatile governance tool that can fulfill multiple functions in complex reforms.