Qualitative Multiple Case Study Research Articles

Hybrid emergency care at the home for patients – A multiple case study

IntroductionHealthcare systems worldwide are facing numerous challenges, such as an aging population, reduced availability of hospital beds, staff reductions and closure of emergency departments (ED). These issues can exacerbate crowding and boarding problems in the ED, negatively impacting patient safety and the work environment. In Sweden a hybrid of prehospital and intrahospital emergency care has been established, referred to in this article as Medical Emergency Team (MET), to meet the increasing demand for emergency care. MET, consisting of physicians and nurses, moving emergency care from EDs to patients’ home. Physicians and nurses may encounter challenges in their healthcare work, such as limited resources for example medical equipment, sampling and examination, in unfamiliar varying home environments. There is a lack of knowledge about how these challenges can influence patient care. Therefore, the aim of this study was to explore the healthcare work of the METs when addressing patients’ emergency care needs in their homes, with a focus on the METs reasoning and actions.MethodsUsing a qualitative multiple case study design, two METs in southwestern Sweden were explored. Data were collected from September 2023 – January 2024 and consist of field notes from participant observations, short interviews and written reflections. A qualitative manifest content analysis with an inductive approach was used as the analysis method.ResultThe result of this study indicates that physicians and nurses face several challenges in their daily work, such as recurring interruptions, miscommunication and faltering teamwork. Some of these problems may arise because physicians and nurses are not accustomed to working together as a team in a different care context. These challenges can lead to stress, which ultimately can expose patients to unnecessary risks.ConclusionWhen launching a new service like METs, which is a hybrid of prehospital and intrahospital emergency care, it is essential to plan and prepare thoroughly to effectively address the challenges and obstacles that may arise. One way to prepare is through team training. Team training can help reduce hierarchical structures by enabling physicians and nurses to feel that they can contribute, collaborate, and take responsibility, leading to a more dynamic and efficient work environment.

Stressors and coping strategies in older people hospitalised for hip surgery following a fall: a multiple case study

BackgroundMore than half of older persons admitted to an emergency department after a fall have a hip fracture and require surgery for a total hip replacement. This procedure has a high risk of postoperative complications and consequences for older persons, their informal caregivers, and the healthcare system. This study aimed to explore the perceptions of older persons, their informal caregivers and health professionals about intra-personal, inter-personal and extra-personal stressors arising from hip surgery following the fall of an older person hospitalised in orthopaedics, as well as the coping strategies used and the results obtained.MethodsA qualitative multiple case study. The sample consisted of eight cases. Each case consisted of one older person, their informal caregiver and the professionals involved in their care: a nurse, an orthopaedic surgeon and a physiotherapist. A total of 32 participants were recruited. Data were collected between August 2018 and February 2019 in a public hospital in French-speaking Switzerland. Intra- and inter-case analyses were performed.ResultsFive topics emerged: two concerning stressors for older persons (the physical and psychological consequences of the fall and hospitalisation; the loss of relational and environmental markers and habits); two relating to the coping strategies used to face the stressors (being resilient and involved in their own care; partially meeting the older person’s needs); and one regarding the results of the strategies used (reassurance through consideration of some of their needs).ConclusionsOlder persons hospitalised for hip surgery after a fall are confronted with various intra-, inter- and extra-personal stressors and have to explore, together with their informal caregivers, strategies to cope with the consequences of these stressors. Healthcare professionals should possess efficient intervention strategies to help identify and support older persons who experience various types of stressors during hospitalisation for hip surgery following a fall.

The activities, competencies, and conditions necessary for public-health policy advisers in a Dutch local government setting to contribute to a healthier living environment: a qualitative multiple-case study

The activities, competencies, and conditions necessary for public-health policy advisers in a Dutch local government setting to contribute to a healthier living environment: a qualitative multiple-case study

Facilitation of practical work in Natural Sciences: experiences and approaches of junior teachers

Background This study delved into the experiences and approaches employed by junior teachers in facilitating practical work in Natural Sciences during the teaching and learning process. In South Africa, Grade 7 marks the final year of primary school education, with learners typically aged between 11 to 13. The researchers noted significant challenges faced by junior Grade 7 teachers in preparing, organizing, and carrying out practical work within the context of teaching and learning in Natural Sciences. Methods In the present study, a qualitative multiple-case study design was employed. Three grade 7 Natural Sciences junior-level teachers were purposefully selected as participants. Data was gathered through classroom observations, semi-structured interviews, and document analysis. Results The study findings revealed that certain grade 7 junior Natural Sciences teachers found it challenging to manage practical work during teaching and learning. Some teachers also faced difficulties in maintaining discipline during practical work and demonstrations, both inside and outside the classroom. To cope with the demands of facilitating practical work in Natural Sciences teaching and learning, teachers employed various approaches, such as group work, observations, demonstrations, illustrations, projects, and inquiry-based scientific investigations. Conclusion It is recommended that teachers should receive professional training on effectively facilitating practical work to support the new teaching and learning methods outlined in the Curriculum Assessment Policy Statement. They should also be equipped with pedagogical content knowledge to help them achieve the goals of practical work in teaching and learning Natural Sciences.

ENHANCING ESL NOVICE TEACHERS’ PROFESSIONAL DEVELOPMENT: ROLES OF PEERS IN OBSERVATIONAL LEARNING THROUGH PEER MENTORING

The transition from pre-service training to real-world classrooms can be daunting for novice English as a Second Language (ESL) teachers. A qualitative multiple-case study approach was employed to determine the impact of peer mentoring on ESL teachers’ professional development through mutual classroom observations. Specifically, peer mentors’ guidance on novice ESL teachers in developing effective instructions was appraised by applying Lortie’s (1975) apprenticeship of observation. The data were collected through interviews with three novice ESL teachers from public primary schools who participated in peer mentoring partnerships, classroom observations, and participants’ personal journal entries. Thematic analysis was performed, which demonstrated that peer mentoring facilitated a) enhanced instructional practices, b) a shift in the novices’ mindset and c) a collaborative interaction in the professional learning community. The findings posited that peer mentoring provided an alternative observational learning approach for novice ESL teachers in terms of effective instructional strategies from colleagues while obtaining specific feedback on professional development. Resultantly, a nuanced comprehension of the approach employed by novice ESL teachers to enhance instructional expertise via peer support was provided. Practical implications were contributed to existing ESL training programs, novice ESL teachers, and educational institutions.

Adaptive responses to contextualised and differentiated school improvement. Identifying institutional profiles of secondary schools

ABSTRACT This paper reports a qualitative multiple case study of secondary schools that experienced sustained processes of quality improvement. We aimed to analyse the heterogeneity in school improvement processes and identify the factors and conditions contributing to this variation. We identified six dimensions to characterize different approaches to high school improvement: curriculum comprehensiveness, student selection/inclusion, student participation and youth cultures, leadership distribution, community openness, and market situation. Based on our cross-case analysis, we proposed an empirically grounded typology composed by four high school profiles: i) traditional academically oriented public high schools; ii) comprehensive high schools from small communities; iii) restrictive metropolitan popular high schools; and iv) vocational high schools. We show the implications of this typology for understanding how high schools actively relate to both their contexts and educational policy, and ‘translated’ these external pressures into idiosyncratic responses. We found that key educational decisions such as curricular approaches and the various emphases placed on learning by high schools, the type of organisational leadership or degree of openness to youth participation, were linked to more structural decisions made by schools regarding their position in the local educational market, their degree of selectivity, and the type of relationships established with their environment.

Next Steps for Medical Specialist Enterprises in the Netherlands: Building Strong Clinical Governance and Leadership; Comment on "Alignment in the HospitalPhysician Relationship: A Qualitative Multiple Case Study of Medical Specialist Enterprises in the Netherlands"

This commentary article responds to the research into development of Medical Specialist Enterprises (MSEs) in the Netherlands conducted by Ubels and van Raaij. The MSEs are a relatively new phenomenon in the Netherlands and similar conceptually to medically-led developments in other health systems. With the foundation for medical specialist organisation in place this provides several opportunities for further development. This commentary considers these opportunities, drawing from the example of New Zealand. This is because New Zealand has had considerable experience with clinically-led organisation which provides useful lessons for the MSEs. The lessons include building strong clinical governance with a focus on collaboration with other health professionals and management, working with primary care to support community service delivery, building integrated care, developing whole of system planning and service delivery approaches and population health management.

PeerOnCall: Exploring how organizational culture shapes implementation of a peer support app for public safety personnel

BackgroundPublic safety personnel (PSP) such as firefighters, paramedics, and police are exposed to traumatic situations, which increase their risk for mental health issues. However, many PSP do not seek help in a timely manner. Peer support interventions have the potential to decrease stigma and increase treatment-seeking behaviours among PSP. However, little is known regarding how the organizational culture of public safety organizations (PSOs) affects the implementation of a peer-based intervention. This study aims to understand the extent to which organizational culture, including masculinity contest cultures (MCC), within Canadian PSOs could affect implementation of PeerOnCall, a new peer support app for PSP. MethodsA qualitative multiple case study design was adopted, integrating semi-structured interviews with organizational champions from five PSOs. One to three champions from each PSO acted as key informants regarding their organizations. Interviews explored champions' perceptions of how organizational culture might shape implementation. Interview data were analyzed using inductive thematic analysis. ResultsThree themes were identified in analysis of the champion interviews. The first theme focused on external drivers and the second theme focused on internal drivers of organizational culture shift. The third theme focused on how culture can create resistance to implementation. Importantly, the MCC norm of show no weakness was described as a source of potential resistance when implementing the app. ConclusionsEach PSO had a unique and changing culture. Understanding how champions anticipate the role of culture in shaping implementation of an app-based intervention like PeerOnCall can guide the creation of contextually relevant strategies that optimize implementation within PSOs. Recommendations for optimizing implementation and areas for further study are provided.

Bridging the Gap: Understanding the Workplace Environment and Leadership Preferences of Generation Z

This study explores the unknown workplace environment and leadership preferences of Generation Z and employers. Using Employee Engagement Theory (EET) as the theoretical framework, a qualitative multiple case study approach was employed to investigate these preferences and employers' perceptions. The study involved eight Generation Z employees and eight employers. Key themes identified include the impact of supervisor kindness, fairness, and work ethic on employee motivation and mood; the influence of leadership and social characteristics on workplace environment effects; the association of employee experience and growth prioritization with strong motivation and performance; and the positive effects of relaxed or well-organized fast-paced environments on mood and performance. Findings indicate that leadership styles significantly impact Generation Z perceptions. Future research should explore the preferences of Generation Z employers and other generational employees, including a quantitative approach to measure perceptions of leadership effectiveness.

Agile transformation in the energy sector: empowering autonomous teams

Purpose This study aims to explore how to structure an energy organization to be more agile in the context of digitalization and find the common success factors and challenges the organizations face to transform. Design/methodology/approach A qualitative multiple-case study of an energy company and an online market company, both from the Nordic countries, was conducted in 2023. Data were collected through in-depth individual interviews with 16 participants. Findings This research provides valuable insights into the challenges and critical success factors crucial for a successful digital transformation. The study illuminates the interplay between technological advancements and organizational shifts, the adoption of agile methodologies, the importance of inclusive leadership and the integration of autonomous teams in realizing digital transformation goals. The research emphasizes the profound impact of these factors on the transformational journey within organizations. In particular, the adoption of agile methodologies takes on heightened significance in the swiftly evolving business landscape of today, calling for a transition from project-centric approaches to more adaptive and sustainable product-centric models. Originality/value The study contributes to the practice and enhanced understanding of organizing business and technology teams in energy companies to achieve fast flow. The analysis and discussion of various empirical findings shed light on the success factors and challenges of digital transformation – issues that many organizations are currently or will likely soon be grappling with. The impact of different organizational structures on agility in an organization has yet to be thoroughly studied.

The Succession Planning of Family-Own Merchandising Business in Davao De Oro: A Multiple Case Study

This qualitative multiple case study aimed to explore strategies that managers/owners of family-owned businesses used to prepare future generations to assume managerial roles in the business. They were chosen through maximum variation sampling. The experiences and coping strategies of the five cases were examined using in-depth interviews. Triangulations of the gathered data was done in each case by interviewing their family members and friends and examination of historical documents. It was analyzed using thematic analysis resulting to five emergent themes on merchandizing business as regards succession planning: business continuity, hands-on training, formal education and coaching, motivational leadership, and job description formulation. The emergent themes for coping mechanism included the following: learning by doing, transparent selection process, and crisis management strategy. The five cases were not generally similar as there were only two cases who have similar declaration on their experiences on merchandizing business as regards to succession planning. As regards their coping strategies, one of the five cases adopted some approaches different from the rest of the cases.

Implementing the patient partnership approach to quality improvement of care and services: A multiple case study protocol.

Patient and family partners are being increasingly engaged worldwide in processes aimed at the quality improvement (QI) of healthcare services. There is also growing interest in documenting these engagement processes within organizations to share and improve them. To support the provincial implementation of this approach, the Quebec's ministry of health and social services published, in 2018, the "Framework for the partnership approach between patients, their families and health and social service stakeholders". However, while this framework provides guidelines by describing each partner's role and the ways in which patient and family partners should be engaged in QI processes, it remains unclear how these recommendations were actually used and implemented by different healthcare organizations. The aim of this paper is to present the protocol of a multiple case study that is being conducted to document how this approach was implemented in different large healthcare organizations in Quebec. This study is being conducted in partnership with a patient partner/co-researcher. This qualitative multiple case study will be conducted in four large healthcare organizations in Quebec. Twelve to 15 key respondents will be recruited for each case. Data will be collected from multiple sources: 1) semi-structured individual interviews with the key respondents, 2) non-participant observations of the meetings of the QI committee engaging PFPs and 3) analysis of documents describing the implementation context, vision, structures and/or processes. The framework method will be used to conduct intracase and intercase qualitative data analysis. The multiple cases included will allow for comparisons between different ways of engaging PFPs in QI processes within an organization, the factors influencing these practices, their advantages and disadvantages, and their implementation outcomes. The conclusions drawn from this study will allow us to make recommendations regarding PFP engagement in the QI of care and services and to propose implementation examples for other organizations wishing to design and implement PFP engagement initiatives in their context in Quebec or elsewhere.

From EMI to CLIL: negotiating teacher identity

ABSTRACT In English-medium instruction (EMI), students learn content knowledge through their additional language. Despite the implicit English learning goals, EMI content subject teachers have been urged to provide more language support for their students. Such expectations may not be something that EMI teachers were professionally prepared for. It is then worth examining how EMI teachers (re)construct their identity when facing such new expectations. Based on Wenger’s [Wenger, E. (1998). Communities of Practice: Learning, Meaning, and Identity. Cambridge University Press] identity construction framework, this qualitative multiple case study reveals how three EMI teachers in Hong Kong and Mainland China secondary schools negotiated their identity when being supported to incorporate language teaching in their content lessons. From data collected in co-planning meetings, lesson observations and interviews, all the teachers were engaged in constructing the identity of language aware content teachers, but some of them appeared to experience identity conflicts. The contrast of the three cases reveals that teachers’ professional training, school context and curriculum requirement are important in shaping teachers’ professional identity. Teachers’ agency also impacts on how teachers negotiate their identity, especially when facing contextual constraints. These findings underscore the importance of preparing teachers both psychologically and practically in EMI teacher education.

Performing artists’ career trajectory from a career construction perspective

ABSTRACT The field of performing arts presents an often unpredictable area for career development. Yet many people are drawn to this field as their chosen career trajectory. This study examines the life-career experiences that shape performing artists' trajectories within the framework of career construction theory. Using a qualitative multiple case study design, data was generated by Career Interest Profiles (CIP), career construction interviews (CCI), life-design counseling, and publicly available information. Thematic analysis uncovered two primary themes: the unique journey of performing artists in constructing their careers and the trajectory of career development, which highlights the factors influencing perceived success or failure and the essential 'survival skill set. The research offers theoretical insights and practical understanding of protean careers in demanding industries.

The Implementation of Lean Manufacturing on Zero Waste Technologies in the Food Processing Industry: Insights from Food Processing Companies in Kosovo and North Macedonia

This study aims to investigate the impact of lean manufacturing (LM) practices in the food processing (FP) industries of Kosovo and North Macedonia. It focuses on examining the effects of LM practices on operational performance metrics and evaluating the challenges and opportunities in integrating lean principles with zero waste (ZW) technologies and sustainability objectives. A qualitative multiple case study approach was used to examine nine case studies from companies in Kosovo and North Macedonia, with four companies from Kosovo and five from North Macedonia. Semi-structured interviews, guided by themes derived from a comprehensive literature review, facilitated in-depth discussions on lean practices and their influence on operational metrics and ZW technologies. For analyzing the qualitative data, a thematic analysis approach was employed, involving a multi-step coding process that ensured a comprehensive exploration and interpretation of the data. The thematic analysis uncovered that LM practices, such as Just-In-Time (JIT), Total Productive/Preventive Maintenance (TPM), Statistical Process Control (SPC), and employee involvement, considerably improve efficiency, quality, and responsiveness. The results demonstrate a close relationship between LM practices and sustainability goals, especially in waste reduction and resource optimization. Identified challenges include organizational resistance to change and resource constraints, while opportunities for improvement were noted in employee involvement, supplier engagement, and continuous improvement initiatives. This study underscores the potential of LM methodologies to boost operational performance, foster sustainability, and tackle specific challenges within the industry, offering key insights for enhancing sustainable food production in both Kosovo and North Macedonia.

Role Expectations, Constraints, and Strategies: A Case of Departmental Heads in Vhembe West District, Limpopo Province, South Africa

Departmental heads (DHs) in primary schools have multiple roles and responsibilities to fulfil. They are expected to perform diverse roles that are not only limited to being class teachers but also as supervisors, coordinators, and departmental managers. Most of them do not receive formal training to become DHs, how to perform these roles, or how to respond to the challenges accompanying these roles and responsibilities. This study aims to establish strategies to manage constraints that prevent departmental heads from fulfilling their roles effectively within the Vhembe West District of Limpopo Province. The study employed an interpretive paradigm to understand the social realities that DHs experience at school. The study was conducted within the Theory of Constraints (TOC). The research design of this study was a multiple-qualitative case study. The population of the study was all DHs in Elim, Soutpansberg East, and Vhuronga Two (2) Circuits. Purposeful sampling was employed to draw a sample of 9 DHs. Data was collected through a semi-structured interview schedule and document analysis. The data was analysed thematically. Findings from this study revealed, amongst others, the following: the roles of all participants in monitoring, curriculum management, coordination, and planning activities to enhance the implementation of the curriculum. This study recommended, among others that DHs should be excluded from being full-time classroom teachers, and policymakers should reduce the current teaching load of DHs. The study contributes to the empowerment of DHs in their roles despite the huge workload of teaching and supervising teachers in their departments. This is possible through employing distributive leadership wherein they solicit the skills of senior teachers to assist them, thereby enhancing shared leadership, collective action, and collaborative decision-making. Keywords: Constraints, Departmental Heads, Departmental Head roles and responsibilities

“My child is my job now” – Care, work and careers of mothers with disabled children in the Norwegian welfare state

In this article, we investigate how mothers of disabled children in Norway experience the work–family conflict and its impact on their careers, highlighting the role of provision of health and welfare services. We use a qualitative multiple case study of 11 mothers with disabled children. Although Norway is characterized by high labor market participation for women and an emphasis on care policies that support working mothers, we show that mothers of disabled children still experience considerable work–family conflict, creating ill-health and income-related struggles. This conflict is heavily influenced by inadequate support from health and welfare services. However, some of the mothers also highlighted how caring for their disabled children led to growth and new career paths, using their care experiences to craft new careers. Drawing on Fraser's (2022) concept of the care crunch and a relational perspective on disability, we demonstrate how the social organization of care for disabled children undervalues the care work mothers do and puts disabled children at risk of receiving insufficient and unequal services.

Understanding adaptive responses in PrEP service delivery in Belgian HIV clinics: a multiple case study using an implementation science framework.

In Belgium, oral HIV pre-exposure prophylaxis (PrEP) is primarily provided in specialized clinical settings. Optimal implementation of PrEP services can help to substantially reduce HIV transmission. However, insights into implementation processes, and their complex interactions with local context, are limited. This study examined factors that influence providers' adaptive responses in the implementation of PrEP services in Belgian HIV clinics. We conducted a qualitative multiple case study on PrEP care implementation in eight HIV clinics. Thirty-six semi-structured interviews were conducted between January 2021 and May 2022 with a purposive sample of PrEP care providers (e.g. physicians, nurses, psychologists), supplemented by 50 hours of observations of healthcare settings and clinical interactions. Field notes from observations and verbatim interview transcripts were thematically analysed guided by a refined iteration of extended Normalisation Process Theory. Implementing PrEP care in a centralized service delivery system required considerable adaptive capacity of providers to balance the increasing workload with an adequate response to PrEP users' individual care needs. As a result, clinic structures were re-organized to allow for more efficient PrEP care processes, compatible with other clinic-level priorities. Providers adapted clinical and policy norms on PrEP care (e.g. related to PrEP prescribing practices and which providers can deliver PrEP services), to flexibly tailor care to individual clients' situations. Interprofessional relationships were reconfigured in line with organizational and clinical adaptations; these included task-shifting from physicians to nurses, leading them to become increasingly trained and specialized in PrEP care. As nurse involvement grew, they adopted a crucial role in responding to PrEP users' non-medical needs (e.g. providing psychosocial support). Moreover, clinicians' growing collaboration with sexologists and psychologists, and interactions with PrEP users' family physician, became crucial in addressing complex psychosocial needs of PrEP clients, while also alleviating the burden of care on busy HIV clinics. Our study in Belgian HIV clinics reveals that the implementation of PrEP care presents a complex-multifaceted-undertaking that requires substantial adaptive work to ensure seamless integration within existing health services. To optimize integration in different settings, policies and guidelines governing PrEP care implementation should allow for sufficient flexibility and tailoring according to respective local health systems.

Not in the file: How competency committees work with undocumented contributions.

Competence committees (CCs) centre their work around documentation of trainees' performance; undocumented contributions (i.e. informal, unrecorded material like personal judgements, experiential anecdotes and contextual information) evoke suspicion even though they may play a role in decision making. This qualitative multiple case study incorporates insights from a social practice perspective on writing to examine the use of undocumented contributions by the CCs of two large post-graduate training programmes, one in a more procedural (MP) speciality and the other in a less procedural (LP) one. Data were collected via observations of meetings and semi-structured interviews with CC members. In the analysis, conversations were organised into triptychs of lead-up, undocumented contribution(s), and follow-up. We then created thick descriptions around the undocumented contributions, drawing on conversational context and interview data to assign possible motivations and significance. We found no instances in which undocumented contributions superseded the contents of a trainee's file or stood in for missing documentation. The number of undocumented contributions varied between the MP CC (six instances over two meetings) and the LP CC (22 instances over three meetings). MP CC discussions emphasised Entrustable Professional Activity (EPA) observations, whereas LP CC members paid more attention to narrative data. The divergent orientations of the CCs-adding an 'advis[ing]/guid[ing]' role versus focusing simply on evaluation-offers the most compelling explanation. In lead-ups, undocumented contributions were prompted by missing and flawed documentation, conflicting evidence and documentation at odds with members' perceptions. Recognising other 'red flags' in documentation often required professional experience. In follow-ups, purposes served by undocumented contributions varied with context and were difficult to generalise; we, therefore, provide deeper analysis of two vignettes to illustrate. Our data suggest undocumented contributions often serve best efforts to ground decisions in documentation. We would encourage CC practices and policies be rooted in more nuanced approaches to documentation.

Corporate Social Responsibility and Sustainable Tourism in Tourist Destinations: A Qualitative Case Study from Türkiye

ABSTRACT This study investigated the critical success factors for Türkiye’s competitiveness in sustainable tourism practices. The study is based on data collected from face-to-face qualitative interviews with key tourism stakeholders in Antalya (n = 15) and Istanbul (n = 15), Türkiye’s most popular and most visited cities. A qualitative multiple-case study approach was employed as a research design, and content analysis was used to analyze the data using an abductive technique. The findings confirm that an all-inclusive system creates the main obstacle to achieving sustainable tourism and corporate social responsibility (CSR) in Antalya, with overtourism being a main sustainability challenge in Istanbul. Further, it was found that the dependency between tour operators and hotels hinders the development of alternative tourism, subsequently causing barriers to the sustainability of destinations. Moreover, technology was proposed as the most influential driver in integrating sustainable tourism, CSR, and awareness.