Qualitative Comparative Case Study Research Articles

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.

Contextualizing inclusion policy: views from Jordanian special education teachers

Jordan’s 2017 Public Law No. 20, Rights of Persons with Disabilities Act has given rise to a renewed focus on inclusive education. Using a qualitative comparative case study design, the purpose of this study was to examine factors impacting how schools in Jordan are defining, interpreting and enacting inclusion. Four shadow teachers working in schools to promote inclusive education participated in interviews and weekly journaling prompts. Data were analyzed using cultural–historical activity theory (CHAT) and sensemaking. Results showed support for inclusion by the community when there are adequate resources and supportive administration. Additionally, the shadow teachers have taken on a progressive role as coaches to general education teachers, while promoting social inclusion. This study establishes the utility of CHAT and sensemaking in global research on inclusive practices. The results provide areas of strength in Jordanian schools that should be built on to increase inclusion of students with disabilities.

Business-nonprofit hybrid organizing: a dynamic approach to balancing benefits and costs.

Efforts to address complex public health challenges can benefit from cross-sector collaboration, while also fostering growing business sector engagement in promoting health equity. What form business-nonprofit collaboration should take, however, is a difficult question for managers and leaders. Hybrid organizational forms, which combine for-profit and nonprofit elements within a single organization in unconventional ways, offer an innovative and potentially promising approach. Yet, while existing typologies of cross-sector collaboration have identified hybrid forms at one end of a continuum of possible forms of collaboration, these typologies do not differentiate the diversity such hybrid forms may take, and the costs and benefits of these innovative hybrid forms are poorly understood. This leaves managers interested in promoting public health through business-nonprofit hybrid organizing with limited guidance about how to maximize potential merits while mitigating drawbacks. We performed a qualitative comparative case study of three examples of business-nonprofit hybrid organizing. Data collection included 113 interviews with representatives from 42 organizations and observation of case study activities. We used thematic analysis within and across cases to characterize the form of hybrid organizing in each case and to examine benefits and costs of different forms for supporting initiatives. We identified two hybrid, collaborative forms - Appended and Blended forms. Each form had benefits and costs, the significance of which shifted over time contingent on changing strategic priorities and operating environments. Benefits and costs of particular forms become more or less important for establishing and sustaining initiatives under different conditions, requiring a dynamic view. No particular form of business-nonprofit hybrid organizing is inherently better than another. Optimizing hybrid organizing and ensuring resilient collaborations may mean allowing collaborative forms to evolve. Practitioners can manage tradeoffs between benefits and costs through an ongoing process of assessing the fit between a given collaborative form, strategic priorities, and relevant features of the operating environment. This dynamic view offers important insights for ensuring the resilience of business-nonprofit collaborative efforts to enhance public health.

Management and Governance of Public and Private Multicampus Universities in a Slippery Higher Education Environment in Ghana

This paper analysed the management and governance of public and private sector Multi-campus Universities (MCUs) in the increasingly turbulent and competitive environment of higher education institutions (HEIs) in Ghana. University for Development Studies (UDS) and the Presbyterian University College, Ghana (PUCG) were case studied. The robustness of their governance and management systems were critically examined in the light of the intense competition among HEIs in the country. The qualitative research design and comparative case study approach were adopted for the study. Information was collected from eight principal officers of the two MCUs through face-to-face interviews. The information was subjected to content analysis. The results revealed that there are no significant differences in the management and governance of the two HEIs. Both of MCUs do not appoint senior or principal officers to manage their campuses and neither do they statutorily empower the Campus Heads to function effectively. However, they both recognized the need to properly structure the office of the Campus Heads to enable them to effectively participate in the governance system at the top level. The paper recommended that PUCG should appoint a Director of Works and Physical Development (WPD) to handle and manage key issues relating to physical resources and development. In addition, both universities should appoint senior or principal officers (Pro-Vice Chancellors or Vice Presidents) as Campus Heads and place them as top managers instead of lower managers as it exists currently. Finally, the two MCUs should decentralize significant autonomy to the Campus Heads to enable them to effectively manage and coordinate the daily operations and activities of the campuses.

Language Politeness Education through Language Behaviour Habits: Concerning the Indonesian and Japanese Viewpoints

Language politeness has universal characteristics. It means that speech communities from any country have their own language politeness based on the applicable norms. Language politeness education starts from family. Meanwhile, outside family communities, such as schools or society, language politeness education is greatly needed to create positive interactions between language users and certain communities. This research discussed language politeness education in two languages (Indonesian and Japanese) using a comparative qualitative case study in library research. The results of the study informed that Indonesian and Japanese are two languages that implement language politeness through both verbal and non-verbal languages. Verbal language is shown by the chosen polite words, while non-verbal language is shown by the speaking body gestures.

The Role of Human Resource Management in Institutional Effectiveness: A Comparative Study of Two Ghanaian Universities

This paper examined the role of human resource management in institutional effectiveness. The objectives were to examine innovative strategies adopted by two public universities in Ghana to promote effectiveness in human resource management as part of the quality assurance strategies of such universities and compare the various systems used in managing human resources in both institutions. Using a comparative qualitative case study research design through semi-structured interviews and content analysis, the study found that both institutions did not have comprehensive (stand-alone) human resource (HR) policies to guide everyday HR practices however, separate policies existed for specific HR functions. Again, KNUST has a decentralised section for specific units but UENR operates a centralised human resource division. The study found that both institutions did not have strong systems for conducting HR audits. The study recommends that universities put structures and mechanisms in place to ensure continuous organisational feedback, perform a functional audit and design systems for assessment of HR policies to ensure that they are responsive to institutional/national laws and policies and promote effectiveness.

Computational thinking infusion as transformative teaching: investigating content area teacher perspectives and practices

ABSTRACT Background and Context Using a transformative learning framework, this qualitative study examines the perspectives and practices of 70 middle and high school content area teachers who attended two or more summer professional development workshops. Objective This study describes how teachers’ disciplinary perspectives and backgrounds influence their understanding of CT infusion and their implementation of CT-infused lessons. Method Data sources for this qualitative comparative case study analysis included: retrospective video reflections, implementation surveys, post-PD surveys, and instructional materials. Findings Analysis revealed differences in terms of disorienting dilemmas teachers faced, shifts in their frames of reference, the form of classroom CT infusion, and their integration of specific CT concepts. Implications This study contributes a comparative analysis of how teachers from different content areas come to understand CT infusion and implement CT-infused pedagogical practices to support their disciplinary teaching. Findings indicate the importance of including all teachers, STEM and non-STEM, in CT infusion efforts.

Regulating During Crisis: A Qualitative Comparative Case Study of Nursing Regulatory Responses to the COVID-19 Pandemic

The COVID-19 pandemic placed intense pressure on nursing regulatory bodies to ensure an adequate healthcare workforce while maintaining public safety. Our objectives were to analyze regulatory bodies' responses during the pandemic, examine how nursing regulators conceptualize the public interest during a public health crisis, and explore the influence of a public health crisis on the balancing of regulatory principles. We aimed to develop a clearer understanding of regulating during a crisis by identifying themes within regulatory responses. We conducted a qualitative comparative case study examining the pandemic responses of eight nursing regulators in three Canadian provinces and three U.S. states. Data were collected from semi-structured interviews with 19 representatives of nursing regulatory bodies and 206 publicly available documents and analyzed thematically. Five themes were constructed from the data: (1) risk-based responses to reduce regulatory burden; (2) agility and flexibility in regulatory pandemic responses; (3) working with stakeholders for a systems-based approach; (4) valuing consistency in regulatory approaches across jurisdictions; and (5) the pandemic as a catalyst for innovation. Specifically, we identified that the meaning of "public interest" in the context of high workforce demand was a key consideration for regulators. Our results demonstrate the intensity of effort involved in nursing regulatory responses and the significant contribution of nursing regulation to the healthcare system's pandemic response. Our results also indicate a shift in thinking around broader public interest issues, beyond the conduct and competence of individual nurses, to include pressing societal issues. Regulators are beginning to grapple with these longer-term issues and policy tensions.

Institutionalizing collaborative regional governance in organizationally thin regions—Regional development agencies and the neglect of social innovations

This article compares one emerging and three established regional development agencies in rural regions in Germany as examples of collaborative governance for socially innovative regional development. We ask, firstly, how an emergent collaborative regional governance network can be institutionalized in the long term based on participatory mechanisms on several levels as well as between actors with different goals and values. Secondly, how an organizationally thin, rural context influences the governance network in steering the social innovation promotion and what kind of development for whom do different governance networks mobilize. Research was conducted as a qualitative comparative case study with semi-structured expert interviews. The findings highlight that the institutionalization of collaborative governance is supported by funding and policies from upper scales and the model of regional development agency enhances the learning of collaborative governance between public institutions. However, the goal and beneficiaries of the development are mainly the classic economic actors, whereas transformative grassroots movements enhancing social innovation are largely ignored by public-driven collaborative governance.

Social Policy Expansion and Retrenchment in Latin America: Causal Paths to Successful Reform

Abstract The literature on social policy expansion and retrenchment in Latin America is vast, but scholars differ in how they explain outcomes, arriving at different conclusions about the role of democracy, left parties, favorable economic conditions, and social movements. What can welfare state developments since the end of the commodity boom teach us about the theoretical power of these arguments? This paper engages this question, seeking to explain recent incidents of successful social policy reform in 10 presidential administrations in Argentina, Brazil, Chile, and Uruguay. Using a combination of crisp-set qualitative comparative analysis (csQCA) and case studies, we identify multiple paths toward successful social policy expansion and retrenchment. The QCA results highlight two key findings. First, social policy expansion was generally carried out by programmatic parties (often, though not always, from the left). Second, retrenchment is most likely when nonprogrammatic right parties face fiscal constraints. The case studies affirm these findings and show that differences in electoral competition, social movement pressure, and policy legacies shape the contexts in which expansion and retrenchment is feasible. The results provide new insight into social policy reform, underscoring the relevance of complex forms of causality.

Sustainability of health services in refugee hosting districts: a qualitative study of health services in three west Nile refugee hosting districts, Uganda

BackgroundHumanitarian health assistance programmes have expanded from temporary approaches addressing short-term needs to providing long-term interventions in emergency settings. Measuring sustainability of humanitarian health services is important towards improving the quality of health services in refugee settings.ObjectiveTo explore the sustainability of health services following the repatriation of refugees from the west Nile districts of Arua, Adjumani and Moyo.MethodsThis was a qualitative comparative case study conducted in three west Nile refugee-hosting districts of Arua, Adjumani, and Moyo. In-depth interviews were conducted with 28 purposefully selected respondents in each of the three districts. Respondents included health workers and managers, district civic leaders, planners, chief administrative officers, district health officers, project staff of aid agencies, refugee health focal persons and community development officers.ResultsThe study shows that in terms of organization capacity, the District Health Teams provided health services to both refugee and host communities with minimal support from aid agencies. Health services were available in most former refugee hosting areas in Adjumani, Arua and Moyo districts. However, there were several disruptions notably reduction and inadequate services due to shortage of drugs and essential supplies, lack of health workers, and closure or relocation of health facilities in around former settlements. To minimize disruptions the district health office reorganized health services. In restructuring health services, the district local governments closed or upgraded health facilities to address reduced capacity and catchment population. Health workers employed by aid agencies were recruited into government services while others who were deemed excess or unqualified were laid off. Equipment and machinery including machines and vehicles were transferred to the district health office in specific health facilities. Funding for health services was mainly provided by the Government of Uganda through the Primary Health Care Grant. Aid agencies, however, continued to provide minimal support health services for refugees who remained in Adjumani district.ConclusionOur study showed that while humanitarian health services are not designed for sustainability, several interventions continued at the end of the refugee emergency in the three districts. The embeddedness of the refugee health services in the district health systems ensured health services continued through public service delivery structures. It is important to strengthen the capacity of the local service delivery structures and ensure health assistance programmes are integrated into local health systems to promote sustainability.

Health System-Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis.

Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT. Our objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces. This research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question. This project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023. By investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT. DERR1-10.2196/44172.

Adoption of C-reactive protein point-of-care tests for the management of acute childhood infections in primary care in the Netherlands and England: a comparative health systems analysis

BackgroundThe use of point of care (POC) tests varies across Europe, but research into what drives this variability is lacking. Focusing on CRP POC tests, we aimed to understand what factors contribute to high versus low adoption of the tests, and also to explore whether they are used in children.MethodsWe used a comparative qualitative case study approach to explore the implementation of CRP POC tests in the Netherlands and England. These countries were selected because although they have similar primary healthcare systems, the availability of CRP POC tests in General Practices is very different, being very high in the former and rare in the latter. The study design and analysis were informed by the non-adoption, abandonment, spread, scale-up and sustainability (NASSS) framework. Data were collected through a review of documents and interviews with stakeholders. Documents were identified through a scoping literature review, search of websites, and stakeholder recommendation. Stakeholders were selected purposively initially, and then by snowballing. Data were analysed thematically.ResultsSixty-five documents were reviewed and 21 interviews were conducted. The difference in the availability of CRP POC tests is mainly because of differences at the wider national context level. In the two countries, early adopters of the tests advocated for their implementation through the generation of robust evidence and by engaging with all relevant stakeholders. This led to the inclusion of CRP POC tests in clinical guidelines in both countries. In the Netherlands, this mandated their reimbursement in accordance with Dutch regulations. Moreover, the prevailing better integration of health services enabled operational support from laboratories to GP practices. In England, the funding constraints of the National Health Service and the prioritization of alternative and less expensive antimicrobial stewardship interventions prevented the development of a reimbursement scheme. In addition, the lack of integration between health services limits the operational support to GP practices. In both countries, the availability of CRP POC tests for the management of children is a by-product of the test being available for adults. The tests are less used in children mainly because of concerns regarding their accuracy in this age-group.ConclusionsThe engagement of early adopters combined with a more favourable and receptive macro level environment, including the role of clinical guidelines and their developers in determining which interventions are reimbursed and the operational support from laboratories to GP practices, led to the greater adoption of the tests in the Netherlands. In both countries, CRP POC tests, when available, are less used less in children. Organisations considering introducing POC tests into primary care settings need to consider how their implementation fits into the wider health system context to ensure achievable plans.

Recognition of prior learning in professional education from an organisational perspective

ABSTRACT Recognition of prior learning (RPL) is often said to facilitate lifelong learning and occurs when already-acquired learning outcomes are officially valued. The education system is a central arena of RPL, allowing facilitated access to or shortening of study programmes. This study explores RPL practices in Switzerland. We ask the following research question: How do professional education institutions regulate, practice, and justify RPL? We start from the premise that RPL practices in higher education institutions are shaped by national RPL policies, professional bodies, and the nature of the respective labour markets. However, within these framework conditions, higher education institutions also create their own organisational policies, thereby promoting or hindering RPL. In addition, the study programme’s knowledge domain and the responsible persons’ pedagogic agency, shaped by their pedagogic concepts and individual attitudes, are also guiding factors. To answer our research question, we conducted qualitative comparative case studies and compared the RPL practices of professional education institutions that offer study programmes for hospitality management and social education. Our results show that organisations offering the same professional study programmes regulate, practice, and justify RPL differently, indicating the importance of organisational gatekeepers’ pedagogic agency.

Land Acquisition Governance and Its Implications for Renewable Energy Development in Indonesia and the Philippines

This article examines the role of multilateral social and environmental safeguards in land acquisition for renewable energy (RE) development in Southeast Asia. We assessed the development of two large-scale wind projects in Indonesia and the Philippines through a qualitative comparative case study analysis. We find that the influence of safeguards is the product of two factors: the timing of multilateral funds in project development and the relative ease through which developers can acquire land through non-safeguard-compliant pathways. Our findings highlight the continued importance of land use policy and planning in mediating the social and environmental impacts of RE infrastructure.

Affordances and constraints of the teacher-to-teacher online marketplace of ideas: understanding early career elementary teachers’ perceptions

Recognizing the role that online platforms hold in education, this study explores how three early career elementary teachers perceive the affordances and constraints of online curriculum sharing platforms. Using pedagogical design capacity as a theoretical framework, we engaged in a comparative qualitative case study to examine the ways early career teachers in differing contexts approach platforms like TeachersPayTeachers and Instagram. Findings emphasize the participants’ perceived affordances and constraints of these platforms and the curricular materials found in these spaces. Additionally, we identify three distinct points of interest for the teaching profession and future research to better understand teachers’ use of these platforms and the application of their pedagogical design capacity when working to supplement and design curriculum.

Frames, interests, and incentives – a typology of institutionalizing RRI in the business sector derived from ten pioneering projects

ABSTRACT While in scientific and policy discourse on responsible research and innovation (RRI) the desirability and sustainability of innovations are central, the business sector follows different logics revolving around competitiveness, profits, and growth. They manifest themselves in different discursive frames, indicate potentially conflicting interests, and allow specific incentive mechanisms to be utilized. This paper builds on discursive institutionalism, presents a qualitative comparative case study of ten EU-funded pioneering projects, and derives a generalized typology. It contributes to the theoretical debate on institutionalizing RRI by applying discursive institutionalism and through a nuanced understanding of three leverage points for organizational change in the business sector. We conclude that frames, interests, and incentives are interlinked phenomena and thus should be considered comprehensively. As our typology addresses specific contexts at regional, corporate and process level, it can be further utilized to develop tailored policies and strategies capable of institutionalizing RRI in the business sector.

STRING OF PEARLS AND NECKLACE OF DIAMONDS: SINO-INDIAN GEO-STRATEGIC COMPETITION IN THE INDIAN OCEAN

The Indian Ocean holds immense vitality for its strategic trade routes and choke points. China and India are Asia’s two rising powers, who aim to dominate the Indian Ocean to satisfy their regional and global ambitions. This competitiveness for regional influence has resulted in geo-strategic competition in the Indian Ocean. China, through the strategy of ‘String of Pearls’, has increased its naval footprint by building ports in Pakistan, Sri Lanka, Bangladesh, and Myanmar. India has similarly responded with an alternative counterbalancing strategy ‘Necklace of Diamonds’ by deepening its relations and partnership with Iran, Oman, Singapore, Bangladesh, Myanmar, and other regional countries. This qualitative exploratory comparative case study finds that: China through its String of Pearls strategy intends to achieve great power status, boost its economy, and address its security concerns, especially those related with the Malacca Dilemma. India, through its Necklace of Diamonds strategy, is trying to counterbalance Chinese presence in the Indian Ocean. Moreover, India intends to enhance its political and economic clout – being the rising power of the region.

Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system.

To investigate how health and care leaders navigate the micro-politics of major system change (MSC) as manifest in the formulation and implementation of Sustainability and Transformation Partnerships (STPs) in the English National Health Service (NHS). A comparative qualitative case study of three STPs carried out between 2018-2021. Data collection comprised 72 semi-structured interviews with STP leaders and stakeholders; 49h of observations of STP executive meetings, management teams and thematic committees, and documentary sources. Interpretative analysis involved developing individual and cross case reports to understand the 'disagreements, 'people and interests' and the 'skills, behaviours and practice'. Three linked political fault-lines underpinned the micro-politics of formulating and implementing STPs: differences in meaning and value, perceptions of winners and losers, and structural differences in power and influence. In managing these issues, STP leaders engaged in a range of complementary strategies to understand and reconcile meanings, appraise and manage risks and benefits, and to redress longstanding power imbalances, as well as those related to their own ambiguous position. Given the lack of formal authority and breadth of system change, navigating the micro-politics of MSC requires political skills in listening and engagement, strategic appraisal of the political landscape and effective negotiation and consensus-building.

The "autonomy" of developing countries in the Olympic Movement: Assessing the fate of sports governance transplants in the Global South.

The International Olympic Committee (IOC) imposes very specific ideas on sports governance, more precisely on sports autonomy, on countries joining the Olympic Movement. Given that the idea of sports autonomy originated in the Global North, this article introduces the concept of governance transplants to evaluate the impact that being part of the Olympic Movement has on domestic sports governance in Global South developing countries. The article explores the extent to which the IOC is successful in implementing the norms and regulations on sports autonomy as a governance transplant at the national level in countries from the Global South that are part of the Olympic Movement. The article employs a comparative qualitative case study research design that explores the relations of the IOC, National Olympic Committees (NOCs), and national governments in Botswana, Guatemala and Sri Lanka. Research relies on a mix of document analyses and expert semi-structured interviews conducted during field trips to those countries. Interviews were transcribed and analyzed by means of thematic analysis. The analyses focus on domestic policies and contexts, formal and institutional compliance with sports autonomy, provision of public funding, and participation in national sport policy-making. Findings suggest that national structures and legacies have an impact on the way in which the autonomy of sport, as the governance transplant, is translated in those three countries. Although national governments enjoy some agency in "translating" governance transplants, results also suggest that misfits and tensions persist between governmental and sport stakeholders at the national and international level. Such misfits might force the IOC, as a private transnational regulator, to adopt a more pragmatic view on the enforcing of its governance transplants. The results are of relevance to existing discussions on global sports governance and debates as to whether the countries in the Global North might be able to impose their views and their governance transplants if the Global South gets a greater say in transnational sports governance.