single case study advantages

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The Advantages and Limitations of Single Case Study Analysis

• Published 2020
• Political Science

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Case Study – Methods, Examples and Guide

Table of Contents

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

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

Types of Case Study

Types and Methods of Case Study are as follows:

Single-Case Study

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

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

Multiple-Case Study

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

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

Exploratory Case Study

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

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

Descriptive Case Study

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

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

Instrumental Case Study

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

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

Case Study Data Collection Methods

Here are some common data collection methods for case studies:

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

Observations

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

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

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

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

How to conduct Case Study Research

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

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

Examples of Case Study

Here are some examples of case study research:

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

Application of Case Study

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

Business and Management

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

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

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

Social Sciences

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

Law and Ethics

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

Purpose of Case Study

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

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

Case studies can also serve other purposes, including:

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

Advantages of Case Study Research

There are several advantages of case study research, including:

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

Limitations of Case Study Research

There are several limitations of case study research, including:

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

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Methodology

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

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

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

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

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

Table of contents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Research bias

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

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The Ultimate Guide to Qualitative Research - Part 1: The Basics

• Introduction and overview
• What is qualitative research?
• What is qualitative data?
• Examples of qualitative data
• Qualitative vs. quantitative research
• Mixed methods
• Qualitative research preparation
• Theoretical perspective
• Theoretical framework
• Literature reviews

Research question

• Conceptual framework
• Conceptual vs. theoretical framework

Data collection

• Qualitative research methods
• Focus groups
• Observational research

What is a case study?

Applications for case study research, what is a good case study, process of case study design, benefits and limitations of case studies.

• Ethnographical research
• Ethical considerations
• Confidentiality and privacy
• Power dynamics
• Reflexivity

Case studies

Case studies are essential to qualitative research , offering a lens through which researchers can investigate complex phenomena within their real-life contexts. This chapter explores the concept, purpose, applications, examples, and types of case studies and provides guidance on how to conduct case study research effectively.

Whereas quantitative methods look at phenomena at scale, case study research looks at a concept or phenomenon in considerable detail. While analyzing a single case can help understand one perspective regarding the object of research inquiry, analyzing multiple cases can help obtain a more holistic sense of the topic or issue. Let's provide a basic definition of a case study, then explore its characteristics and role in the qualitative research process.

Definition of a case study

A case study in qualitative research is a strategy of inquiry that involves an in-depth investigation of a phenomenon within its real-world context. It provides researchers with the opportunity to acquire an in-depth understanding of intricate details that might not be as apparent or accessible through other methods of research. The specific case or cases being studied can be a single person, group, or organization – demarcating what constitutes a relevant case worth studying depends on the researcher and their research question .

Among qualitative research methods , a case study relies on multiple sources of evidence, such as documents, artifacts, interviews , or observations , to present a complete and nuanced understanding of the phenomenon under investigation. The objective is to illuminate the readers' understanding of the phenomenon beyond its abstract statistical or theoretical explanations.

Characteristics of case studies

Case studies typically possess a number of distinct characteristics that set them apart from other research methods. These characteristics include a focus on holistic description and explanation, flexibility in the design and data collection methods, reliance on multiple sources of evidence, and emphasis on the context in which the phenomenon occurs.

Furthermore, case studies can often involve a longitudinal examination of the case, meaning they study the case over a period of time. These characteristics allow case studies to yield comprehensive, in-depth, and richly contextualized insights about the phenomenon of interest.

The role of case studies in research

Case studies hold a unique position in the broader landscape of research methods aimed at theory development. They are instrumental when the primary research interest is to gain an intensive, detailed understanding of a phenomenon in its real-life context.

In addition, case studies can serve different purposes within research - they can be used for exploratory, descriptive, or explanatory purposes, depending on the research question and objectives. This flexibility and depth make case studies a valuable tool in the toolkit of qualitative researchers.

Remember, a well-conducted case study can offer a rich, insightful contribution to both academic and practical knowledge through theory development or theory verification, thus enhancing our understanding of complex phenomena in their real-world contexts.

What is the purpose of a case study?

Case study research aims for a more comprehensive understanding of phenomena, requiring various research methods to gather information for qualitative analysis . Ultimately, a case study can allow the researcher to gain insight into a particular object of inquiry and develop a theoretical framework relevant to the research inquiry.

Why use case studies in qualitative research?

Using case studies as a research strategy depends mainly on the nature of the research question and the researcher's access to the data.

Conducting case study research provides a level of detail and contextual richness that other research methods might not offer. They are beneficial when there's a need to understand complex social phenomena within their natural contexts.

The explanatory, exploratory, and descriptive roles of case studies

Case studies can take on various roles depending on the research objectives. They can be exploratory when the research aims to discover new phenomena or define new research questions; they are descriptive when the objective is to depict a phenomenon within its context in a detailed manner; and they can be explanatory if the goal is to understand specific relationships within the studied context. Thus, the versatility of case studies allows researchers to approach their topic from different angles, offering multiple ways to uncover and interpret the data .

The impact of case studies on knowledge development

Case studies play a significant role in knowledge development across various disciplines. Analysis of cases provides an avenue for researchers to explore phenomena within their context based on the collected data.

This can result in the production of rich, practical insights that can be instrumental in both theory-building and practice. Case studies allow researchers to delve into the intricacies and complexities of real-life situations, uncovering insights that might otherwise remain hidden.

Types of case studies

In qualitative research , a case study is not a one-size-fits-all approach. Depending on the nature of the research question and the specific objectives of the study, researchers might choose to use different types of case studies. These types differ in their focus, methodology, and the level of detail they provide about the phenomenon under investigation.

Understanding these types is crucial for selecting the most appropriate approach for your research project and effectively achieving your research goals. Let's briefly look at the main types of case studies.

Exploratory case studies

Exploratory case studies are typically conducted to develop a theory or framework around an understudied phenomenon. They can also serve as a precursor to a larger-scale research project. Exploratory case studies are useful when a researcher wants to identify the key issues or questions which can spur more extensive study or be used to develop propositions for further research. These case studies are characterized by flexibility, allowing researchers to explore various aspects of a phenomenon as they emerge, which can also form the foundation for subsequent studies.

Descriptive case studies

Descriptive case studies aim to provide a complete and accurate representation of a phenomenon or event within its context. These case studies are often based on an established theoretical framework, which guides how data is collected and analyzed. The researcher is concerned with describing the phenomenon in detail, as it occurs naturally, without trying to influence or manipulate it.

Explanatory case studies

Explanatory case studies are focused on explanation - they seek to clarify how or why certain phenomena occur. Often used in complex, real-life situations, they can be particularly valuable in clarifying causal relationships among concepts and understanding the interplay between different factors within a specific context.

Intrinsic, instrumental, and collective case studies

These three categories of case studies focus on the nature and purpose of the study. An intrinsic case study is conducted when a researcher has an inherent interest in the case itself. Instrumental case studies are employed when the case is used to provide insight into a particular issue or phenomenon. A collective case study, on the other hand, involves studying multiple cases simultaneously to investigate some general phenomena.

Each type of case study serves a different purpose and has its own strengths and challenges. The selection of the type should be guided by the research question and objectives, as well as the context and constraints of the research.

The flexibility, depth, and contextual richness offered by case studies make this approach an excellent research method for various fields of study. They enable researchers to investigate real-world phenomena within their specific contexts, capturing nuances that other research methods might miss. Across numerous fields, case studies provide valuable insights into complex issues.

Critical information systems research

Case studies provide a detailed understanding of the role and impact of information systems in different contexts. They offer a platform to explore how information systems are designed, implemented, and used and how they interact with various social, economic, and political factors. Case studies in this field often focus on examining the intricate relationship between technology, organizational processes, and user behavior, helping to uncover insights that can inform better system design and implementation.

Health research

Health research is another field where case studies are highly valuable. They offer a way to explore patient experiences, healthcare delivery processes, and the impact of various interventions in a real-world context.

Case studies can provide a deep understanding of a patient's journey, giving insights into the intricacies of disease progression, treatment effects, and the psychosocial aspects of health and illness.

Asthma research studies

Specifically within medical research, studies on asthma often employ case studies to explore the individual and environmental factors that influence asthma development, management, and outcomes. A case study can provide rich, detailed data about individual patients' experiences, from the triggers and symptoms they experience to the effectiveness of various management strategies. This can be crucial for developing patient-centered asthma care approaches.

Other fields

Apart from the fields mentioned, case studies are also extensively used in business and management research, education research, and political sciences, among many others. They provide an opportunity to delve into the intricacies of real-world situations, allowing for a comprehensive understanding of various phenomena.

Case studies, with their depth and contextual focus, offer unique insights across these varied fields. They allow researchers to illuminate the complexities of real-life situations, contributing to both theory and practice.

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Understanding the key elements of case study design is crucial for conducting rigorous and impactful case study research. A well-structured design guides the researcher through the process, ensuring that the study is methodologically sound and its findings are reliable and valid. The main elements of case study design include the research question , propositions, units of analysis, and the logic linking the data to the propositions.

The research question is the foundation of any research study. A good research question guides the direction of the study and informs the selection of the case, the methods of collecting data, and the analysis techniques. A well-formulated research question in case study research is typically clear, focused, and complex enough to merit further detailed examination of the relevant case(s).

Propositions

Propositions, though not necessary in every case study, provide a direction by stating what we might expect to find in the data collected. They guide how data is collected and analyzed by helping researchers focus on specific aspects of the case. They are particularly important in explanatory case studies, which seek to understand the relationships among concepts within the studied phenomenon.

Units of analysis

The unit of analysis refers to the case, or the main entity or entities that are being analyzed in the study. In case study research, the unit of analysis can be an individual, a group, an organization, a decision, an event, or even a time period. It's crucial to clearly define the unit of analysis, as it shapes the qualitative data analysis process by allowing the researcher to analyze a particular case and synthesize analysis across multiple case studies to draw conclusions.

Argumentation

This refers to the inferential model that allows researchers to draw conclusions from the data. The researcher needs to ensure that there is a clear link between the data, the propositions (if any), and the conclusions drawn. This argumentation is what enables the researcher to make valid and credible inferences about the phenomenon under study.

Understanding and carefully considering these elements in the design phase of a case study can significantly enhance the quality of the research. It can help ensure that the study is methodologically sound and its findings contribute meaningful insights about the case.

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Conducting a case study involves several steps, from defining the research question and selecting the case to collecting and analyzing data . This section outlines these key stages, providing a practical guide on how to conduct case study research.

Defining the research question

The first step in case study research is defining a clear, focused research question. This question should guide the entire research process, from case selection to analysis. It's crucial to ensure that the research question is suitable for a case study approach. Typically, such questions are exploratory or descriptive in nature and focus on understanding a phenomenon within its real-life context.

Selecting and defining the case

The selection of the case should be based on the research question and the objectives of the study. It involves choosing a unique example or a set of examples that provide rich, in-depth data about the phenomenon under investigation. After selecting the case, it's crucial to define it clearly, setting the boundaries of the case, including the time period and the specific context.

Previous research can help guide the case study design. When considering a case study, an example of a case could be taken from previous case study research and used to define cases in a new research inquiry. Considering recently published examples can help understand how to select and define cases effectively.

Developing a detailed case study protocol

A case study protocol outlines the procedures and general rules to be followed during the case study. This includes the data collection methods to be used, the sources of data, and the procedures for analysis. Having a detailed case study protocol ensures consistency and reliability in the study.

The protocol should also consider how to work with the people involved in the research context to grant the research team access to collecting data. As mentioned in previous sections of this guide, establishing rapport is an essential component of qualitative research as it shapes the overall potential for collecting and analyzing data.

Collecting data

Gathering data in case study research often involves multiple sources of evidence, including documents, archival records, interviews, observations, and physical artifacts. This allows for a comprehensive understanding of the case. The process for gathering data should be systematic and carefully documented to ensure the reliability and validity of the study.

Analyzing and interpreting data

The next step is analyzing the data. This involves organizing the data , categorizing it into themes or patterns , and interpreting these patterns to answer the research question. The analysis might also involve comparing the findings with prior research or theoretical propositions.

Writing the case study report

The final step is writing the case study report . This should provide a detailed description of the case, the data, the analysis process, and the findings. The report should be clear, organized, and carefully written to ensure that the reader can understand the case and the conclusions drawn from it.

Each of these steps is crucial in ensuring that the case study research is rigorous, reliable, and provides valuable insights about the case.

The type, depth, and quality of data in your study can significantly influence the validity and utility of the study. In case study research, data is usually collected from multiple sources to provide a comprehensive and nuanced understanding of the case. This section will outline the various methods of collecting data used in case study research and discuss considerations for ensuring the quality of the data.

Interviews are a common method of gathering data in case study research. They can provide rich, in-depth data about the perspectives, experiences, and interpretations of the individuals involved in the case. Interviews can be structured , semi-structured , or unstructured , depending on the research question and the degree of flexibility needed.

Observations

Observations involve the researcher observing the case in its natural setting, providing first-hand information about the case and its context. Observations can provide data that might not be revealed in interviews or documents, such as non-verbal cues or contextual information.

Documents and artifacts

Documents and archival records provide a valuable source of data in case study research. They can include reports, letters, memos, meeting minutes, email correspondence, and various public and private documents related to the case.

These records can provide historical context, corroborate evidence from other sources, and offer insights into the case that might not be apparent from interviews or observations.

Physical artifacts refer to any physical evidence related to the case, such as tools, products, or physical environments. These artifacts can provide tangible insights into the case, complementing the data gathered from other sources.

Ensuring the quality of data collection

Determining the quality of data in case study research requires careful planning and execution. It's crucial to ensure that the data is reliable, accurate, and relevant to the research question. This involves selecting appropriate methods of collecting data, properly training interviewers or observers, and systematically recording and storing the data. It also includes considering ethical issues related to collecting and handling data, such as obtaining informed consent and ensuring the privacy and confidentiality of the participants.

Data analysis

Analyzing case study research involves making sense of the rich, detailed data to answer the research question. This process can be challenging due to the volume and complexity of case study data. However, a systematic and rigorous approach to analysis can ensure that the findings are credible and meaningful. This section outlines the main steps and considerations in analyzing data in case study research.

Organizing the data

The first step in the analysis is organizing the data. This involves sorting the data into manageable sections, often according to the data source or the theme. This step can also involve transcribing interviews, digitizing physical artifacts, or organizing observational data.

Categorizing and coding the data

Once the data is organized, the next step is to categorize or code the data. This involves identifying common themes, patterns, or concepts in the data and assigning codes to relevant data segments. Coding can be done manually or with the help of software tools, and in either case, qualitative analysis software can greatly facilitate the entire coding process. Coding helps to reduce the data to a set of themes or categories that can be more easily analyzed.

Identifying patterns and themes

After coding the data, the researcher looks for patterns or themes in the coded data. This involves comparing and contrasting the codes and looking for relationships or patterns among them. The identified patterns and themes should help answer the research question.

Interpreting the data

Once patterns and themes have been identified, the next step is to interpret these findings. This involves explaining what the patterns or themes mean in the context of the research question and the case. This interpretation should be grounded in the data, but it can also involve drawing on theoretical concepts or prior research.

Verification of the data

The last step in the analysis is verification. This involves checking the accuracy and consistency of the analysis process and confirming that the findings are supported by the data. This can involve re-checking the original data, checking the consistency of codes, or seeking feedback from research participants or peers.

Like any research method , case study research has its strengths and limitations. Researchers must be aware of these, as they can influence the design, conduct, and interpretation of the study.

Understanding the strengths and limitations of case study research can also guide researchers in deciding whether this approach is suitable for their research question . This section outlines some of the key strengths and limitations of case study research.

Benefits include the following:

• Rich, detailed data: One of the main strengths of case study research is that it can generate rich, detailed data about the case. This can provide a deep understanding of the case and its context, which can be valuable in exploring complex phenomena.
• Flexibility: Case study research is flexible in terms of design , data collection , and analysis . A sufficient degree of flexibility allows the researcher to adapt the study according to the case and the emerging findings.
• Real-world context: Case study research involves studying the case in its real-world context, which can provide valuable insights into the interplay between the case and its context.
• Multiple sources of evidence: Case study research often involves collecting data from multiple sources , which can enhance the robustness and validity of the findings.

On the other hand, researchers should consider the following limitations:

• Generalizability: A common criticism of case study research is that its findings might not be generalizable to other cases due to the specificity and uniqueness of each case.
• Time and resource intensive: Case study research can be time and resource intensive due to the depth of the investigation and the amount of collected data.
• Complexity of analysis: The rich, detailed data generated in case study research can make analyzing the data challenging.
• Subjectivity: Given the nature of case study research, there may be a higher degree of subjectivity in interpreting the data , so researchers need to reflect on this and transparently convey to audiences how the research was conducted.

Being aware of these strengths and limitations can help researchers design and conduct case study research effectively and interpret and report the findings appropriately.

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10 Case Study Advantages and Disadvantages

Chris Drew (PhD)

Dr. Chris Drew is the founder of the Helpful Professor. He holds a PhD in education and has published over 20 articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education. [Image Descriptor: Photo of Chris]

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A case study in academic research is a detailed and in-depth examination of a specific instance or event, generally conducted through a qualitative approach to data.

The most common case study definition that I come across is is Robert K. Yin’s (2003, p. 13) quote provided below:

“An empirical inquiry that investigates a contemporary phenomenon within its real-life context, especially when the boundaries between phenomenon and context are not clearly evident.”

Researchers conduct case studies for a number of reasons, such as to explore complex phenomena within their real-life context, to look at a particularly interesting instance of a situation, or to dig deeper into something of interest identified in a wider-scale project.

While case studies render extremely interesting data, they have many limitations and are not suitable for all studies. One key limitation is that a case study’s findings are not usually generalizable to broader populations because one instance cannot be used to infer trends across populations.

Case Study Advantages and Disadvantages

1. in-depth analysis of complex phenomena.

Case study design allows researchers to delve deeply into intricate issues and situations.

By focusing on a specific instance or event, researchers can uncover nuanced details and layers of understanding that might be missed with other research methods, especially large-scale survey studies.

As Lee and Saunders (2017) argue,

“It allows that particular event to be studies in detail so that its unique qualities may be identified.”

This depth of analysis can provide rich insights into the underlying factors and dynamics of the studied phenomenon.

2. Holistic Understanding

Building on the above point, case studies can help us to understand a topic holistically and from multiple angles.

This means the researcher isn’t restricted to just examining a topic by using a pre-determined set of questions, as with questionnaires. Instead, researchers can use qualitative methods to delve into the many different angles, perspectives, and contextual factors related to the case study.

We can turn to Lee and Saunders (2017) again, who notes that case study researchers “develop a deep, holistic understanding of a particular phenomenon” with the intent of deeply understanding the phenomenon.

3. Examination of rare and Unusual Phenomena

We need to use case study methods when we stumble upon “rare and unusual” (Lee & Saunders, 2017) phenomena that would tend to be seen as mere outliers in population studies.

Take, for example, a child genius. A population study of all children of that child’s age would merely see this child as an outlier in the dataset, and this child may even be removed in order to predict overall trends.

So, to truly come to an understanding of this child and get insights into the environmental conditions that led to this child’s remarkable cognitive development, we need to do an in-depth study of this child specifically – so, we’d use a case study.

4. Helps Reveal the Experiences of Marginalzied Groups

Just as rare and unsual cases can be overlooked in population studies, so too can the experiences, beliefs, and perspectives of marginalized groups.

As Lee and Saunders (2017) argue, “case studies are also extremely useful in helping the expression of the voices of people whose interests are often ignored.”

Take, for example, the experiences of minority populations as they navigate healthcare systems. This was for many years a “hidden” phenomenon, not examined by researchers. It took case study designs to truly reveal this phenomenon, which helped to raise practitioners’ awareness of the importance of cultural sensitivity in medicine.

5. Ideal in Situations where Researchers cannot Control the Variables

Experimental designs – where a study takes place in a lab or controlled environment – are excellent for determining cause and effect . But not all studies can take place in controlled environments (Tetnowski, 2015).

When we’re out in the field doing observational studies or similar fieldwork, we don’t have the freedom to isolate dependent and independent variables. We need to use alternate methods.

Case studies are ideal in such situations.

A case study design will allow researchers to deeply immerse themselves in a setting (potentially combining it with methods such as ethnography or researcher observation) in order to see how phenomena take place in real-life settings.

6. Supports the generation of new theories or hypotheses

While large-scale quantitative studies such as cross-sectional designs and population surveys are excellent at testing theories and hypotheses on a large scale, they need a hypothesis to start off with!

This is where case studies – in the form of grounded research – come in. Often, a case study doesn’t start with a hypothesis. Instead, it ends with a hypothesis based upon the findings within a singular setting.

The deep analysis allows for hypotheses to emerge, which can then be taken to larger-scale studies in order to conduct further, more generalizable, testing of the hypothesis or theory.

7. Reveals the Unexpected

When a largescale quantitative research project has a clear hypothesis that it will test, it often becomes very rigid and has tunnel-vision on just exploring the hypothesis.

Of course, a structured scientific examination of the effects of specific interventions targeted at specific variables is extermely valuable.

But narrowly-focused studies often fail to shine a spotlight on unexpected and emergent data. Here, case studies come in very useful. Oftentimes, researchers set their eyes on a phenomenon and, when examining it closely with case studies, identify data and come to conclusions that are unprecedented, unforeseen, and outright surprising.

As Lars Meier (2009, p. 975) marvels, “where else can we become a part of foreign social worlds and have the chance to become aware of the unexpected?”

Disadvantages

1. not usually generalizable.

Case studies are not generalizable because they tend not to look at a broad enough corpus of data to be able to infer that there is a trend across a population.

As Yang (2022) argues, “by definition, case studies can make no claims to be typical.”

Case studies focus on one specific instance of a phenomenon. They explore the context, nuances, and situational factors that have come to bear on the case study. This is really useful for bringing to light important, new, and surprising information, as I’ve already covered.

But , it’s not often useful for generating data that has validity beyond the specific case study being examined.

2. Subjectivity in interpretation

Case studies usually (but not always) use qualitative data which helps to get deep into a topic and explain it in human terms, finding insights unattainable by quantitative data.

But qualitative data in case studies relies heavily on researcher interpretation. While researchers can be trained and work hard to focus on minimizing subjectivity (through methods like triangulation), it often emerges – some might argue it’s innevitable in qualitative studies.

So, a criticism of case studies could be that they’re more prone to subjectivity – and researchers need to take strides to address this in their studies.

3. Difficulty in replicating results

Case study research is often non-replicable because the study takes place in complex real-world settings where variables are not controlled.

So, when returning to a setting to re-do or attempt to replicate a study, we often find that the variables have changed to such an extent that replication is difficult. Furthermore, new researchers (with new subjective eyes) may catch things that the other readers overlooked.

Replication is even harder when researchers attempt to replicate a case study design in a new setting or with different participants.

Comprehension Quiz for Students

Question 1: What benefit do case studies offer when exploring the experiences of marginalized groups?

a) They provide generalizable data. b) They help express the voices of often-ignored individuals. c) They control all variables for the study. d) They always start with a clear hypothesis.

Question 2: Why might case studies be considered ideal for situations where researchers cannot control all variables?

a) They provide a structured scientific examination. b) They allow for generalizability across populations. c) They focus on one specific instance of a phenomenon. d) They allow for deep immersion in real-life settings.

Question 3: What is a primary disadvantage of case studies in terms of data applicability?

a) They always focus on the unexpected. b) They are not usually generalizable. c) They support the generation of new theories. d) They provide a holistic understanding.

Question 4: Why might case studies be considered more prone to subjectivity?

a) They always use quantitative data. b) They heavily rely on researcher interpretation, especially with qualitative data. c) They are always replicable. d) They look at a broad corpus of data.

Question 5: In what situations are experimental designs, such as those conducted in labs, most valuable?

a) When there’s a need to study rare and unusual phenomena. b) When a holistic understanding is required. c) When determining cause-and-effect relationships. d) When the study focuses on marginalized groups.

Question 6: Why is replication challenging in case study research?

a) Because they always use qualitative data. b) Because they tend to focus on a broad corpus of data. c) Due to the changing variables in complex real-world settings. d) Because they always start with a hypothesis.

Lee, B., & Saunders, M. N. K. (2017). Conducting Case Study Research for Business and Management Students. SAGE Publications.

Meir, L. (2009). Feasting on the Benefits of Case Study Research. In Mills, A. J., Wiebe, E., & Durepos, G. (Eds.). Encyclopedia of Case Study Research (Vol. 2). London: SAGE Publications.

Tetnowski, J. (2015). Qualitative case study research design.  Perspectives on fluency and fluency disorders ,  25 (1), 39-45. ( Source )

Yang, S. L. (2022). The War on Corruption in China: Local Reform and Innovation . Taylor & Francis.

Yin, R. (2003). Case Study research. Thousand Oaks, CA: Sage.

• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd/ 10 Reasons you’re Perpetually Single
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Case Study Research Method in Psychology

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

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Definition of case study along with its advantages and disadvantages

Case study is defined as “An event, an entity, an individual or even a unit of analysis” (Yin, 1989). A case study is also defined as an “Empirical inquiry that investigates a contemporary phenomenon within its real-life context using multiple sources of evidence” (Anderson, 1993). The case is also concerned on the reasoning of why and how the events happen so that the contextual realities could be captured and the variations in what was initially planned and what actually occurred could be perceived.

The case study is qualitative type of method; therefore, it has the same advantages as that of qualitative method. Case study can be either single or multiple cases. Single case is the analysis of one single phenomenon. According to Yin, Single cases are the most appropriate to confirm or challenge a theory or to represent a unique or extreme case.

Advantages of the case study:

• As we can observe the case directly and relate it to theoretical part, we can get the data directly from the case and analyse it.
• Results obtained through case study are more practical than ideal. As a researcher we observe and read the case directly: it is direct and simple method.
• It is a flexible method of doing research, because researcher is free to discover and address issues as they arrive in their experiments.

Limitations of case study:

It narrows down the area of research: the research is limited to an individual or group individuals the results inferred by research are not universal. So it is difficult to generalise the results.

Anderson, G.J. (1993). Fundamentals of Educational Research. Falmer Press teachers’ library series. [Online]. Taylor & Francis Group. Available from: https://books.google.co.in/books?id=B5CGPwAACAAJ. Yin, R.K. (1989). Case study research: Design and methods. Applied Social Research Series. [Online]. London: Sage. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.461.5170&rep=rep1&type=pdf.

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Methodologic and Data-Analysis Triangulation in Case Studies: A Scoping Review

Margarithe charlotte schlunegger.

1 Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland

2 Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany

Maya Zumstein-Shaha

Rebecca palm.

3 Department of Health Care Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany

Associated Data

Supplemental material, sj-docx-1-wjn-10.1177_01939459241263011 for Methodologic and Data-Analysis Triangulation in Case Studies: A Scoping Review by Margarithe Charlotte Schlunegger, Maya Zumstein-Shaha and Rebecca Palm in Western Journal of Nursing Research

We sought to explore the processes of methodologic and data-analysis triangulation in case studies using the example of research on nurse practitioners in primary health care.

Design and methods:

We conducted a scoping review within Arksey and O’Malley’s methodological framework, considering studies that defined a case study design and used 2 or more data sources, published in English or German before August 2023.

Data sources:

The databases searched were MEDLINE and CINAHL, supplemented with hand searching of relevant nursing journals. We also examined the reference list of all the included studies.

In total, 63 reports were assessed for eligibility. Ultimately, we included 8 articles. Five studies described within-method triangulation, whereas 3 provided information on between/across-method triangulation. No study reported within-method triangulation of 2 or more quantitative data-collection procedures. The data-collection procedures were interviews, observation, documentation/documents, service records, and questionnaires/assessments. The data-analysis triangulation involved various qualitative and quantitative methods of analysis. Details about comparing or contrasting results from different qualitative and mixed-methods data were lacking.

Conclusions:

Various processes for methodologic and data-analysis triangulation are described in this scoping review but lack detail, thus hampering standardization in case study research, potentially affecting research traceability. Triangulation is complicated by terminological confusion. To advance case study research in nursing, authors should reflect critically on the processes of triangulation and employ existing tools, like a protocol or mixed-methods matrix, for transparent reporting. The only existing reporting guideline should be complemented with directions on methodologic and data-analysis triangulation.

Case study research is defined as “an empirical method that investigates a contemporary phenomenon (the ‘case’) in depth and within its real-world context, especially when the boundaries between phenomenon and context may not be clearly evident. A case study relies on multiple sources of evidence, with data needing to converge in a triangulating fashion.” 1 (p15) This design is described as a stand-alone research approach equivalent to grounded theory and can entail single and multiple cases. 1 , 2 However, case study research should not be confused with single clinical case reports. “Case reports are familiar ways of sharing events of intervening with single patients with previously unreported features.” 3 (p107) As a methodology, case study research encompasses substantially more complexity than a typical clinical case report. 1 , 3

A particular characteristic of case study research is the use of various data sources, such as quantitative data originating from questionnaires as well as qualitative data emerging from interviews, observations, or documents. Therefore, a case study always draws on multiple sources of evidence, and the data must converge in a triangulating manner. 1 When using multiple data sources, a case or cases can be examined more convincingly and accurately, compensating for the weaknesses of the respective data sources. 1 Another characteristic is the interaction of various perspectives. This involves comparing or contrasting perspectives of people with different points of view, eg, patients, staff, or leaders. 4 Through triangulation, case studies contribute to the completeness of the research on complex topics, such as role implementation in clinical practice. 1 , 5 Triangulation involves a combination of researchers from various disciplines, of theories, of methods, and/or of data sources. By creating connections between these sources (ie, investigator, theories, methods, data sources, and/or data analysis), a new understanding of the phenomenon under study can be obtained. 6 , 7

This scoping review focuses on methodologic and data-analysis triangulation because concrete procedures are missing, eg, in reporting guidelines. Methodologic triangulation has been called methods, mixed methods, or multimethods. 6 It can encompass within-method triangulation and between/across-method triangulation. 7 “Researchers using within-method triangulation use at least 2 data-collection procedures from the same design approach.” 6 (p254) Within-method triangulation is either qualitative or quantitative but not both. Therefore, within-method triangulation can also be considered data source triangulation. 8 In contrast, “researchers using between/across-method triangulation employ both qualitative and quantitative data-collection methods in the same study.” 6 (p254) Hence, methodologic approaches are combined as well as various data sources. For this scoping review, the term “methodologic triangulation” is maintained to denote between/across-method triangulation. “Data-analysis triangulation is the combination of 2 or more methods of analyzing data.” 6 (p254)

Although much has been published on case studies, there is little consensus on the quality of the various data sources, the most appropriate methods, or the procedures for conducting methodologic and data-analysis triangulation. 5 According to the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) clearinghouse for reporting guidelines, one standard exists for organizational case studies. 9 Organizational case studies provide insights into organizational change in health care services. 9 Rodgers et al 9 pointed out that, although high-quality studies are being funded and published, they are sometimes poorly articulated and methodologically inadequate. In the reporting checklist by Rodgers et al, 9 a description of the data collection is included, but reporting directions on methodologic and data-analysis triangulation are missing. Therefore, the purpose of this study was to examine the process of methodologic and data-analysis triangulation in case studies. Accordingly, we conducted a scoping review to elicit descriptions of and directions for triangulation methods and analysis, drawing on case studies of nurse practitioners (NPs) in primary health care as an example. Case studies are recommended to evaluate the implementation of new roles in (primary) health care, such as that of NPs. 1 , 5 Case studies on new role implementation can generate a unique and in-depth understanding of specific roles (individual), teams (smaller groups), family practices or similar institutions (organization), and social and political processes in health care systems. 1 , 10 The integration of NPs into health care systems is at different stages of progress around the world. 11 Therefore, studies are needed to evaluate this process.

The methodological framework by Arksey and O’Malley 12 guided this scoping review. We examined the current scientific literature on the use of methodologic and data-analysis triangulation in case studies on NPs in primary health care. The review process included the following stages: (1) establishing the research question; (2) identifying relevant studies; (3) selecting the studies for inclusion; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consulting experts in the field. 12 Stage 6 was not performed due to a lack of financial resources. The reporting of the review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review) guideline by Tricco et al 13 (guidelines for reporting systematic reviews and meta-analyses [ Supplementary Table A ]). Scoping reviews are not eligible for registration in PROSPERO.

Stage 1: Establishing the Research Question

The aim of this scoping review was to examine the process of triangulating methods and analysis in case studies on NPs in primary health care to improve the reporting. We sought to answer the following question: How have methodologic and data-analysis triangulation been conducted in case studies on NPs in primary health care? To answer the research question, we examined the following elements of the selected studies: the research question, the study design, the case definition, the selected data sources, and the methodologic and data-analysis triangulation.

Stage 2: Identifying Relevant Studies

A systematic database search was performed in the MEDLINE (via PubMed) and CINAHL (via EBSCO) databases between July and September 2020 to identify relevant articles. The following terms were used as keyword search strategies: (“Advanced Practice Nursing” OR “nurse practitioners”) AND (“primary health care” OR “Primary Care Nursing”) AND (“case study” OR “case studies”). Searches were limited to English- and German-language articles. Hand searches were conducted in the journals Nursing Inquiry , BMJ Open , and BioMed Central ( BMC ). We also screened the reference lists of the studies included. The database search was updated in August 2023. The complete search strategy for all the databases is presented in Supplementary Table B .

Stage 3: Selecting the Studies

Inclusion and exclusion criteria.

We used the inclusion and exclusion criteria reported in Table 1 . We included studies of NPs who had at least a master’s degree in nursing according to the definition of the International Council of Nurses. 14 This scoping review considered studies that were conducted in primary health care practices in rural, urban, and suburban regions. We excluded reviews and study protocols in which no data collection had occurred. Articles were included without limitations on the time period or country of origin.

Inclusion and Exclusion Criteria.

Screening process

After the search, we collated and uploaded all the identified records into EndNote v.X8 (Clarivate Analytics, Philadelphia, Pennsylvania) and removed any duplicates. Two independent reviewers (MCS and SA) screened the titles and abstracts for assessment in line with the inclusion criteria. They retrieved and assessed the full texts of the selected studies while applying the inclusion criteria. Any disagreements about the eligibility of studies were resolved by discussion or, if no consensus could be reached, by involving experienced researchers (MZ-S and RP).

Stages 4 and 5: Charting the Data and Collating, Summarizing, and Reporting the Results

The first reviewer (MCS) extracted data from the selected publications. For this purpose, an extraction tool developed by the authors was used. This tool comprised the following criteria: author(s), year of publication, country, research question, design, case definition, data sources, and methodologic and data-analysis triangulation. First, we extracted and summarized information about the case study design. Second, we narratively summarized the way in which the data and methodological triangulation were described. Finally, we summarized the information on within-case or cross-case analysis. This process was performed using Microsoft Excel. One reviewer (MCS) extracted data, whereas another reviewer (SA) cross-checked the data extraction, making suggestions for additions or edits. Any disagreements between the reviewers were resolved through discussion.

A total of 149 records were identified in 2 databases. We removed 20 duplicates and screened 129 reports by title and abstract. A total of 46 reports were assessed for eligibility. Through hand searches, we identified 117 additional records. Of these, we excluded 98 reports after title and abstract screening. A total of 17 reports were assessed for eligibility. From the 2 databases and the hand search, 63 reports were assessed for eligibility. Ultimately, we included 8 articles for data extraction. No further articles were included after the reference list screening of the included studies. A PRISMA flow diagram of the study selection and inclusion process is presented in Figure 1 . As shown in Tables 2 and ​ and3, 3 , the articles included in this scoping review were published between 2010 and 2022 in Canada (n = 3), the United States (n = 2), Australia (n = 2), and Scotland (n = 1).

PRISMA flow diagram.

Characteristics of Articles Included.

Overview of Within-Method, Between/Across-Method, and Data-Analysis Triangulation.

Research Question, Case Definition, and Case Study Design

The following sections describe the research question, case definition, and case study design. Case studies are most appropriate when asking “how” or “why” questions. 1 According to Yin, 1 how and why questions are explanatory and lead to the use of case studies, histories, and experiments as the preferred research methods. In 1 study from Canada, eg, the following research question was presented: “How and why did stakeholders participate in the system change process that led to the introduction of the first nurse practitioner-led Clinic in Ontario?” (p7) 19 Once the research question has been formulated, the case should be defined and, subsequently, the case study design chosen. 1 In typical case studies with mixed methods, the 2 types of data are gathered concurrently in a convergent design and the results merged to examine a case and/or compare multiple cases. 10

Research question

“How” or “why” questions were found in 4 studies. 16 , 17 , 19 , 22 Two studies additionally asked “what” questions. Three studies described an exploratory approach, and 1 study presented an explanatory approach. Of these 4 studies, 3 studies chose a qualitative approach 17 , 19 , 22 and 1 opted for mixed methods with a convergent design. 16

In the remaining studies, either the research questions were not clearly stated or no “how” or “why” questions were formulated. For example, “what” questions were found in 1 study. 21 No information was provided on exploratory, descriptive, and explanatory approaches. Schadewaldt et al 21 chose mixed methods with a convergent design.

Case definition and case study design

A total of 5 studies defined the case as an organizational unit. 17 , 18 - 20 , 22 Of the 8 articles, 4 reported multiple-case studies. 16 , 17 , 22 , 23 Another 2 publications involved single-case studies. 19 , 20 Moreover, 2 publications did not state the case study design explicitly.

Within-Method Triangulation

This section describes within-method triangulation, which involves employing at least 2 data-collection procedures within the same design approach. 6 , 7 This can also be called data source triangulation. 8 Next, we present the single data-collection procedures in detail. In 5 studies, information on within-method triangulation was found. 15 , 17 - 19 , 22 Studies describing a quantitative approach and the triangulation of 2 or more quantitative data-collection procedures could not be included in this scoping review.

Qualitative approach

Five studies used qualitative data-collection procedures. Two studies combined face-to-face interviews and documents. 15 , 19 One study mixed in-depth interviews with observations, 18 and 1 study combined face-to-face interviews and documentation. 22 One study contained face-to-face interviews, observations, and documentation. 17 The combination of different qualitative data-collection procedures was used to present the case context in an authentic and complex way, to elicit the perspectives of the participants, and to obtain a holistic description and explanation of the cases under study.

All 5 studies used qualitative interviews as the primary data-collection procedure. 15 , 17 - 19 , 22 Face-to-face, in-depth, and semi-structured interviews were conducted. The topics covered in the interviews included processes in the introduction of new care services and experiences of barriers and facilitators to collaborative work in general practices. Two studies did not specify the type of interviews conducted and did not report sample questions. 15 , 18

Observations

In 2 studies, qualitative observations were carried out. 17 , 18 During the observations, the physical design of the clinical patients’ rooms and office spaces was examined. 17 Hungerford et al 18 did not explain what information was collected during the observations. In both studies, the type of observation was not specified. Observations were generally recorded as field notes.

Public documents

In 3 studies, various qualitative public documents were studied. 15 , 19 , 22 These documents included role description, education curriculum, governance frameworks, websites, and newspapers with information about the implementation of the role and general practice. Only 1 study failed to specify the type of document and the collected data. 15

Electronic health records

In 1 study, qualitative documentation was investigated. 17 This included a review of dashboards (eg, provider productivity reports or provider quality dashboards in the electronic health record) and quality performance reports (eg, practice-wide or co-management team-wide performance reports).

Between/Across-Method Triangulation

This section describes the between/across methods, which involve employing both qualitative and quantitative data-collection procedures in the same study. 6 , 7 This procedure can also be denoted “methodologic triangulation.” 8 Subsequently, we present the individual data-collection procedures. In 3 studies, information on between/across triangulation was found. 16 , 20 , 21

Mixed methods

Three studies used qualitative and quantitative data-collection procedures. One study combined face-to-face interviews, documentation, and self-assessments. 16 One study employed semi-structured interviews, direct observation, documents, and service records, 20 and another study combined face-to-face interviews, non-participant observation, documents, and questionnaires. 23

All 3 studies used qualitative interviews as the primary data-collection procedure. 16 , 20 , 23 Face-to-face and semi-structured interviews were conducted. In the interviews, data were collected on the introduction of new care services and experiences of barriers to and facilitators of collaborative work in general practices.

Observation

In 2 studies, direct and non-participant qualitative observations were conducted. 20 , 23 During the observations, the interaction between health professionals or the organization and the clinical context was observed. Observations were generally recorded as field notes.

In 2 studies, various qualitative public documents were examined. 20 , 23 These documents included role description, newspapers, websites, and practice documents (eg, flyers). In the documents, information on the role implementation and role description of NPs was collected.

Individual journals

In 1 study, qualitative individual journals were studied. 16 These included reflective journals from NPs, who performed the role in primary health care.

Service records

Only 1 study involved quantitative service records. 20 These service records were obtained from the primary care practices and the respective health authorities. They were collected before and after the implementation of an NP role to identify changes in patients’ access to health care, the volume of patients served, and patients’ use of acute care services.

Questionnaires/Assessment

In 2 studies, quantitative questionnaires were used to gather information about the teams’ satisfaction with collaboration. 16 , 21 In 1 study, 3 validated scales were used. The scales measured experience, satisfaction, and belief in the benefits of collaboration. 21 Psychometric performance indicators of these scales were provided. However, the time points of data collection were not specified; similarly, whether the questionnaires were completed online or by hand was not mentioned. A competency self-assessment tool was used in another study. 16 The assessment comprised 70 items and included topics such as health promotion, protection, disease prevention and treatment, the NP-patient relationship, the teaching-coaching function, the professional role, managing and negotiating health care delivery systems, monitoring and ensuring the quality of health care practice, and cultural competence. Psychometric performance indicators were provided. The assessment was completed online with 2 measurement time points (pre self-assessment and post self-assessment).

Data-Analysis Triangulation

This section describes data-analysis triangulation, which involves the combination of 2 or more methods of analyzing data. 6 Subsequently, we present within-case analysis and cross-case analysis.

Mixed-methods analysis

Three studies combined qualitative and quantitative methods of analysis. 16 , 20 , 21 Two studies involved deductive and inductive qualitative analysis, and qualitative data were analyzed thematically. 20 , 21 One used deductive qualitative analysis. 16 The method of analysis was not specified in the studies. Quantitative data were analyzed using descriptive statistics in 3 studies. 16 , 20 , 23 The descriptive statistics comprised the calculation of the mean, median, and frequencies.

Qualitative methods of analysis

Two studies combined deductive and inductive qualitative analysis, 19 , 22 and 2 studies only used deductive qualitative analysis. 15 , 18 Qualitative data were analyzed thematically in 1 study, 22 and data were treated with content analysis in the other. 19 The method of analysis was not specified in the 2 studies.

Within-case analysis

In 7 studies, a within-case analysis was performed. 15 - 20 , 22 Six studies used qualitative data for the within-case analysis, and 1 study employed qualitative and quantitative data. Data were analyzed separately, consecutively, or in parallel. The themes generated from qualitative data were compared and then summarized. The individual cases were presented mostly as a narrative description. Quantitative data were integrated into the qualitative description with tables and graphs. Qualitative and quantitative data were also presented as a narrative description.

Cross-case analyses

Of the multiple-case studies, 5 carried out cross-case analyses. 15 - 17 , 20 , 22 Three studies described the cross-case analysis using qualitative data. Two studies reported a combination of qualitative and quantitative data for the cross-case analysis. In each multiple-case study, the individual cases were contrasted to identify the differences and similarities between the cases. One study did not specify whether a within-case or a cross-case analysis was conducted. 23

Confirmation or contradiction of data

This section describes confirmation or contradiction through qualitative and quantitative data. 1 , 4 Qualitative and quantitative data were reported separately, with little connection between them. As a result, the conclusions on neither the comparisons nor the contradictions could be clearly determined.

Confirmation or contradiction among qualitative data

In 3 studies, the consistency of the results of different types of qualitative data was highlighted. 16 , 19 , 21 In particular, documentation and interviews or interviews and observations were contrasted:

• Confirmation between interviews and documentation: The data from these sources corroborated the existence of a common vision for an NP-led clinic. 19
• Confirmation among interviews and observation: NPs experienced pressure to find and maintain their position within the existing system. Nurse practitioners and general practitioners performed complete episodes of care, each without collaborative interaction. 21
• Contradiction among interviews and documentation: For example, interviewees mentioned that differentiating the scope of practice between NPs and physicians is difficult as there are too many areas of overlap. However, a clear description of the scope of practice for the 2 roles was provided. 21

Confirmation through a combination of qualitative and quantitative data

Both types of data showed that NPs and general practitioners wanted to have more time in common to discuss patient cases and engage in personal exchanges. 21 In addition, the qualitative and quantitative data confirmed the individual progression of NPs from less competent to more competent. 16 One study pointed out that qualitative and quantitative data obtained similar results for the cases. 20 For example, integrating NPs improved patient access by increasing appointment availability.

Contradiction through a combination of qualitative and quantitative data

Although questionnaire results indicated that NPs and general practitioners experienced high levels of collaboration and satisfaction with the collaborative relationship, the qualitative results drew a more ambivalent picture of NPs’ and general practitioners’ experiences with collaboration. 21

Research Question and Design

The studies included in this scoping review evidenced various research questions. The recommended formats (ie, how or why questions) were not applied consistently. Therefore, no case study design should be applied because the research question is the major guide for determining the research design. 2 Furthermore, case definitions and designs were applied variably. The lack of standardization is reflected in differences in the reporting of these case studies. Generally, case study research is viewed as allowing much more freedom and flexibility. 5 , 24 However, this flexibility and the lack of uniform specifications lead to confusion.

Methodologic Triangulation

Methodologic triangulation, as described in the literature, can be somewhat confusing as it can refer to either data-collection methods or research designs. 6 , 8 For example, methodologic triangulation can allude to qualitative and quantitative methods, indicating a paradigmatic connection. Methodologic triangulation can also point to qualitative and quantitative data-collection methods, analysis, and interpretation without specific philosophical stances. 6 , 8 Regarding “data-collection methods with no philosophical stances,” we would recommend using the wording “data source triangulation” instead. Thus, the demarcation between the method and the data-collection procedures will be clearer.

Within-Method and Between/Across-Method Triangulation

Yin 1 advocated the use of multiple sources of evidence so that a case or cases can be investigated more comprehensively and accurately. Most studies included multiple data-collection procedures. Five studies employed a variety of qualitative data-collection procedures, and 3 studies used qualitative and quantitative data-collection procedures (mixed methods). In contrast, no study contained 2 or more quantitative data-collection procedures. In particular, quantitative data-collection procedures—such as validated, reliable questionnaires, scales, or assessments—were not used exhaustively. The prerequisites for using multiple data-collection procedures are availability, the knowledge and skill of the researcher, and sufficient financial funds. 1 To meet these prerequisites, research teams consisting of members with different levels of training and experience are necessary. Multidisciplinary research teams need to be aware of the strengths and weaknesses of different data sources and collection procedures. 1

Qualitative methods of analysis and results

When using multiple data sources and analysis methods, it is necessary to present the results in a coherent manner. Although the importance of multiple data sources and analysis has been emphasized, 1 , 5 the description of triangulation has tended to be brief. Thus, traceability of the research process is not always ensured. The sparse description of the data-analysis triangulation procedure may be due to the limited number of words in publications or the complexity involved in merging the different data sources.

Only a few concrete recommendations regarding the operationalization of the data-analysis triangulation with the qualitative data process were found. 25 A total of 3 approaches have been proposed 25 : (1) the intuitive approach, in which researchers intuitively connect information from different data sources; (2) the procedural approach, in which each comparative or contrasting step in triangulation is documented to ensure transparency and replicability; and (3) the intersubjective approach, which necessitates a group of researchers agreeing on the steps in the triangulation process. For each case study, one of these 3 approaches needs to be selected, carefully carried out, and documented. Thus, in-depth examination of the data can take place. Farmer et al 25 concluded that most researchers take the intuitive approach; therefore, triangulation is not clearly articulated. This trend is also evident in our scoping review.

Mixed-methods analysis and results

Few studies in this scoping review used a combination of qualitative and quantitative analysis. However, creating a comprehensive stand-alone picture of a case from both qualitative and quantitative methods is challenging. Findings derived from different data types may not automatically coalesce into a coherent whole. 4 O’Cathain et al 26 described 3 techniques for combining the results of qualitative and quantitative methods: (1) developing a triangulation protocol; (2) following a thread by selecting a theme from 1 component and following it across the other components; and (3) developing a mixed-methods matrix.

The most detailed description of the conducting of triangulation is the triangulation protocol. The triangulation protocol takes place at the interpretation stage of the research process. 26 This protocol was developed for multiple qualitative data but can also be applied to a combination of qualitative and quantitative data. 25 , 26 It is possible to determine agreement, partial agreement, “silence,” or dissonance between the results of qualitative and quantitative data. The protocol is intended to bring together the various themes from the qualitative and quantitative results and identify overarching meta-themes. 25 , 26

The “following a thread” technique is used in the analysis stage of the research process. To begin, each data source is analyzed to identify the most important themes that need further investigation. Subsequently, the research team selects 1 theme from 1 data source and follows it up in the other data source, thereby creating a thread. The individual steps of this technique are not specified. 26 , 27

A mixed-methods matrix is used at the end of the analysis. 26 All the data collected on a defined case are examined together in 1 large matrix, paying attention to cases rather than variables or themes. In a mixed-methods matrix (eg, a table), the rows represent the cases for which both qualitative and quantitative data exist. The columns show the findings for each case. This technique allows the research team to look for congruency, surprises, and paradoxes among the findings as well as patterns across multiple cases. In our review, we identified only one of these 3 approaches in the study by Roots and MacDonald. 20 These authors mentioned that a causal network analysis was performed using a matrix. However, no further details were given, and reference was made to a later publication. We could not find this publication.

Case Studies in Nursing Research and Recommendations

Because it focused on the implementation of NPs in primary health care, the setting of this scoping review was narrow. However, triangulation is essential for research in this area. This type of research was found to provide a good basis for understanding methodologic and data-analysis triangulation. Despite the lack of traceability in the description of the data and methodological triangulation, we believe that case studies are an appropriate design for exploring new nursing roles in existing health care systems. This is evidenced by the fact that case study research is widely used in many social science disciplines as well as in professional practice. 1 To strengthen this research method and increase the traceability in the research process, we recommend using the reporting guideline and reporting checklist by Rodgers et al. 9 This reporting checklist needs to be complemented with methodologic and data-analysis triangulation. A procedural approach needs to be followed in which each comparative step of the triangulation is documented. 25 A triangulation protocol or a mixed-methods matrix can be used for this purpose. 26 If there is a word limit in a publication, the triangulation protocol or mixed-methods matrix needs to be identified. A schematic representation of methodologic and data-analysis triangulation in case studies can be found in Figure 2 .

Schematic representation of methodologic and data-analysis triangulation in case studies (own work).

Limitations

This study suffered from several limitations that must be acknowledged. Given the nature of scoping reviews, we did not analyze the evidence reported in the studies. However, 2 reviewers independently reviewed all the full-text reports with respect to the inclusion criteria. The focus on the primary care setting with NPs (master’s degree) was very narrow, and only a few studies qualified. Thus, possible important methodological aspects that would have contributed to answering the questions were omitted. Studies describing the triangulation of 2 or more quantitative data-collection procedures could not be included in this scoping review due to the inclusion and exclusion criteria.

Conclusions

Given the various processes described for methodologic and data-analysis triangulation, we can conclude that triangulation in case studies is poorly standardized. Consequently, the traceability of the research process is not always given. Triangulation is complicated by the confusion of terminology. To advance case study research in nursing, we encourage authors to reflect critically on methodologic and data-analysis triangulation and use existing tools, such as the triangulation protocol or mixed-methods matrix and the reporting guideline checklist by Rodgers et al, 9 to ensure more transparent reporting.

Supplemental Material

Acknowledgments.

The authors thank Simona Aeschlimann for her support during the screening process.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material: Supplemental material for this article is available online.

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• Published: 31 August 2024

Optimizing gas lift for enhanced recovery in the Asmari formation: a case study of Abu Ghirab field in Southeastern Iraq

• Maaly S. Asad 1 ,
• Ahmed N. Al-Dujaili 2 &
• Abdulkareem A. Khalil 1  

Scientific Reports volume  14 , Article number:  20293 ( 2024 ) Cite this article

Metrics details

• Natural gas
• Structural geology

The gas lift technique applies gas bubble injection into the vertical wells to raise production. Gas and liquid rates, shifts in flow regimes, and system equilibrium influence this process. This study explores the efficient implementation of gas lift techniques to maximize production from the Asmari Formation in the Abu Ghirab Field, southeastern Iraq, using a continuous gas lift for maximum production rate by PIPESIM TM software. The results of the gas lift design for the four wells (AGCS-33, 26, 28, and 36) show that the Vogel method provided the best results for the gas lift design, and faults and facies distribution impact the gas lift injection and oil production rates. These will become evident with wells AGCS-33 and 36 as their proximity to faults will increase oil production rates with a gas injection rate limit of 7 MMSCF/d. Conversely, for wells 26 and 28, the limit will marginally rise, starting at 5 MMSCF/d. In addition, the effect of gas lift is clearly in the middle western of the crest, which shows an increasing percentage of oil production of 136.6% at minimum rate and 198.5% at maximum for the well AGCS-26, 89.7% and 105.7% for the well AGCS-36. Wellhead pressure has a significant impact on gas-lift performance, and improving gas-lift efficiency can be accomplished using an electric control valve. The feasibility of implementing gas lift in the Asmari Formation depends on the water cut, well location, and water saturation distribution within the Formation.

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Introduction.

Natural gases are normally associated with crude oil during early stages of production. The formation gas and reservoir pressure provide sufficient energy to lift fluid from the reservoir to the surface 1 . However, over time, this energy will be depleted, leading to a rise in the water cuts if the reservoir is not associated with an aquifer. Eventually, the pressure will become inadequate for lifting the fluid from the bottom to the top, leading to the discontinuation of flow 2 . It is essential to augment the fluid's power through some form of artificial lift to resume production in a well or boost from a poorly flowing well 3 . Gas lift and gas injection augment flow and production from a reservoir 4 . Gas lift is considered a primary artificial lift technique used throughout the well's lifespan, while miscible gas injection is a secondary or tertiary enhanced recovery method 5 . Gas injection can be implemented in older or tight wells where additional assistance is required 6 . One key distinction between the two methods lies in the gas flow direction: gas injection is directed into the reservoir, while gas lift is directed into the wellbore and towards the surface 7 . A significant difference is that gas injection often necessitates a high-pressure compressor or pump because the injected gas competes with the existing reservoir pressure to access the formation 8 , on the other hand, gas lift pressures depend primarily on the well's depth and tend to decrease at equivalent depths 9 . The gas lift technique involves gas bubble injection into the vertical wells to enhance production by reducing the tubing pressure gradient 10 . This process is influenced by various fluid-flow phenomena, including gas and liquid rates, shifts in flow regimes, and system equilibrium issues 11 .

The gas lift system is straightforward regarding equipment and operational principles, as depicted in Fig.  1 . Choosing the most suitable artificial lift technique is critical for long-term Well production. An inappropriate choice could lead to poor outcomes and increased operating costs 12 . Various approaches are utilized in gas lift operations. In the continuous method, gas is injected into the well at an appropriate depth and rate to mix with oil in high-flow-rate wells (exceeding 0.5 STB/D/psi). The intermittent technique will be appropriate for low-pressure reservoirs with lower flow rates (less than 0.5 STB/D/psi) 13 and oil accumulates in the wellbore, and gas surge is injected into the oil column to achieve the desired production 14 . The gas lift performance curve (GLPC) illustrates the production rate concerning the gas injection rate 15 . A modified threshold pressure gradient (TGP) method considering pressure sensitivity and realistic reservoir fluid Seepage capacity considering various miscible degree and pore scale was evaluated 16 . A quantitative approach was developed to address excessive gas production in field depletion development, even if the formation pressure is below the dew point 17 .

Gas lift system (Guet and Oom 2006).

Advantages and limitations of gas lift

The gas lift system is versatile, adapting to different production rate ranges and depths of lift. It can be compared to other artificial lift methods if injection gas pressure and volume are available 4 (Fig.  2 ). Gas lift is one of the most adaptable artificial lift techniques. An inadequately designed system will manage to lift some fluid 16 . Highly deviated wells with highly formed Liquid Ratio (GLR) prone to sand production are ideal candidates for gas lift implementation when artificial lift is necessary 17 . The main limitations for gas lift operations include the absence of formation gas or an external gas source, well spacing, and the availability of space for compressors on offshore platforms 18 . Generally, gas lifts are unsuitable for single-well installations, and widely spaced wells are not conducive to a centrally located power system 19 . Implementing gas lift can exacerbate issues related to dense crude production, super-saturated brine, or emulsions 20 . Gas lift operations may be impractical with old casing, sour gas, and long, small-ID flow lines 21 . Additionally, the reliability of gas lift operations can be compromised by wet gas without adequate dehydration 22 .

Gas lift, ESP and jet pump performance curve 23 .

• Nodal analysis

Nodal analysis generates the gas lift performance curve according to actual pressure and temperature with an appropriate multiphase flow correlation 24 . The optimum gas-lift injection rate (GLIR) is often only set to deliver the most increased production rate on the (GLPC) (Fig.  3 a). The maximum GLIR and oil rate can be useable to establish the optimal valve depth setting and the wellhead pressure ( P wh) 25 . Computer models can be utilized to analyze Well behavior, conduct diagnostics, redesign, and others to generate Well relationships (GLPC), and complete optimization 26 . The lift gas can be examined for a single well by nodal analysis 27 . The back pressure consequences can be assessed by gas injection on two wells earlier to analyze the wells network. Sequential Linear Programming (SLP) techniques were suggested for gas lift, and the resulting lift performance curves were considered to be linear through a first-order Taylor series expansion. The linear model may be an inadequate expression of the highly nonlinear system, and non-instantaneously flowing (NIF) wells can be problematic (Fig.  3 b) 28 . Recent researches utilize separable programming, the adjacency condition, and particular order sets to qualify each well's lift performance curve and optimize the linear solver's performance 29 , whereas a better precise well model was presented depending on mass, energy, and momentum equilibrium 30 . A better-suited model for field-wide simulation was presented, with no field applications to test this model. The compositional models over simple black oil are also recommended practice for better accuracy 31 , 32 .

Gas lift performance curve at a given wellhead pressure ( P wh), ( a ) by nodal analysis, ( b ) by sequential linear programming 25 , 28 .

This study is considered the first for the Asmari Formation in the Abu Ghirab Field, characterized by excessive fault distributions that make any developing plan very difficult. Therefore, this study tried to evaluate the increase in the oil production rate according to the location of the wells and the best gas injection rate and pressure by selecting four wells in different pads for the field. For future work, the authors will modify this work by the whole oilfield simulation using Pipesim ™ and CMG ™.

Geological setting

He Abu Ghirab oil field was discovered in 1971 and entered the production line in 1976. It is located in the southeastern part of Iraq with an area of 106.8 km within a mountainous area ranging from 70 to 160 m of height formed of two domes with a saddle area between these domes 33 (Fig.  4 ). It is part of the Kirkuk embayment zone in the unstable stand of the Arabian plate 34 . This region is active due to the crash of the Arabian and Iranian plates, so the Abu Ghirab field has a complicated structure. Figure  5 shows the stratigraphic column of the area 35 .

Abu Ghirab oil field, Southeastern Iraq 35 .

Stratigraphic column of Abu Ghirab 43 .

The Asmari Formation is part of Tertiary deposits (Oligocene-Lower Miocene) in southeast Iraq 36 , 37 , 38 , 39 , 40 . Kirkuk Group includes three sub-zones: A- Upper Kirkuk consists of limestone, dolomite, and some sandstone 41 . B- Buzurgan Member of dolomite, sandstone, limestone, and upper shale in the upper part 42 . In the Abu Ghirab structure, the pre-geological studies indicate the presence of two distinct types of forces caused by folding movement 44 . These forces led to tension forces in the upper portion of the structure and compression forces in the lower parts. As a result, the structure exhibited tangential deformation, taking on a longitudinal shape. The intensity of deformation was high in the limbs, while the anticline axis displayed low intensity 38 .

Data and methods

This study delivers an all-around outline of artificial lift for the Asmari Formation in the Abu Ghirab Field. Commercial software PIPESIM ™ is used in this study to determine the Well performance. The PIPESIM ™ includes option for determining artificial lift performance to estimate the optimum quantity of gas injected, and injection pressure, as well as optimum injection depth and understanding the impact of these factors on production, the estimation of the optimal injection conditions when water cut shifts 45 , 46 . Figure  6 shows the locations of wells under study (AGCS 26, 28, 33, and 36). The facies logs were obtained from wireline logs and facies model constructed by Petrel ™ 47 , 48 (Fig.  7 ). AGCS-33 well is located in the north part of the south dome in the Abu Ghirab field and completed to develop the Asmari reservoir with a total depth of 3214.0 m, then perforated and acidized at flow back unit (A) with three different choke sizes. The well AGCS-26 is located in the north part of the south dome of the Abu Ghirab field with the producing Unit (A and B) of the Asmari reservoir (Fig.  6 ), a total perforated thickness of 75m. AGCS-26 well was put into production on Dec. 21, 2014. Other wells (AGCS-28 and 36) in the south part of the south dome, but with different characteristics (Fig.  8 and Table 1 ).

Wells locations in Abo Ghirab field.

Facies model for Asmari formation in Abo Ghirab field 35 .

Completion of the wells ( a ) AGCS-33, ( b ) 26, ( c ) 28, ( d ) 36.

A natural gas was utilized in the continuous gas lift system after the necessary treatments. Table 2 shows properties and composition of the natural gas. A design for the gas lift system includes the depth of the injection valves, size of the valve port, number of valves, and amount of spacing between. PIPESIM ™ was used to simulate the gas lift process for wells (AGCS-33, 26, 28, and 36) based on the field data of the Abu Ghirab field.

Results and discussion

Productivity index (pi).

The productivity index (PI) is an important variable used to evaluate production well performances in the oil and gas industry. It's a measure of the amount of oil produced concerning the decrease in pressure. Equation 1 shows the correlation for estimating PI as q/Δp, where q is the production flow rate, and Δp is the drawdown pressure. PI is typically measured in bbl/day/psi units 49 . The results of the well performances are shown in Table 3 .

Inflow performance (IPR)

Inflow performance (IPR) is an empirical two-phase (oil + gas) inflow performance relationship correlation 50 .

The productivity of an oil well producing a solution-gas drive reservoir was investigated by Vogel using numerical simulation. Simulations covering a wide range of oil, PVT properties, and relative permeabilities were made. By dimensionless pressures and rates, Vogel found that well's productivity could be described by Eq.  2 (Vogel’s Equation) as shown in Fig.  9 and Table 3 .

Inflow performance for wells ( a ) AGCS-33, ( b ) 28, ( c ) AGCS-26/zone A, and AGCS-26/ zone B.

Figures  9 and 10 represent the inflow performance IPR of the four wells in the Asmari reservoir under different flow rates due to the decrease in the reservoir pressure during the production process. The productivity index PI was about 5.66 STB/d*psi for AGCS-33. As for AGCS-26, because it contains two zones, the productivity index (PI) for zone A is approximately 0.713 STB/d*psi, and for zone B is 1.166 STB/d*psi and the Absolute Open Flow (AOF) for AGCS-33 of 16,900 STB/d. Likewise, for AGCS-26, AOF is 2500 STB/d (zone A) and 3900 STB/d for zone B, about 2750 STB/d and 8500 STB/d for wells 28 and 36 respectively. An increase in PI leads to an increase in the AOF of the well, considered positive from a Production perspective, as increasing the AOF leads to increasing production, which is the main objective of this study. The PI in AGCS-33 is much greater than the PI in AGCS-26, and this is due to the PI perpendicular to the saturation of the layer, as the oil saturation in So AGCS-33 is much greater than AGCS-26, which contains water cuts of up to 55%.

Inflow performance for well AGCS-36.

The nodal analysis was performed by the PIPSIM simulator for the four wells (based on the oil production data) to determine the operating point that represents the field production simulation and the best, as well as the point that gives the best production rate with the best pressure (Fig.  11 ).

Nodal analysis for wells AGCS-33, 26, 28, and 36.

Figure  10 shows that a change in the reservoir pressure leads to a change in the production rate. A nodal analysis was conducted to determine the optimal production of the four wells before the gas lift and the production state. The operating point must be within certain limits that represent the relationship of the operating point to the production conditions. If the operating point is within these limits, the production is stable with no problems (Fig.  10 AGCS-33). For the wells AGCS-26, 28, and 36, the operating point is not within these limits, and there are problems in the production, such as the Inversion point problem for stable tubing production. This problem can be overcome by increasing the wellhead pressure from 720 to 800 psi during the gas injection.

Gas lift design

The simulator was designed as an integrated gas lift system for the two wells based on the fluid properties and Well information. The injection-pressure-operated gas lift valve (IPO) system was obtained from SLB (Camco) for Schlumberger with a valve size of 1.5 in (Tables 4 , 5 , 6 , 7 and Fig.  11 ).

The simulator will be spacing and choose which type of series, orifice, and port size is preferred for the Well design, the final distribution, and valve details in Tables 3 , 4 , 5 , 6 . Figure  12 shows the process of distributing injection valves. The depth of point for placing the valve is 6000 ft, 5600 ft, 7200 ft, and 6200 ft for the wells AGCS-33, 26, 28, and 36, respectively. The valve state is in continuous closure below these depths because the pressure inside the tube is greater than the annular. According to valve technology, it opens automatically when the annular pressure is higher than the pressure inside the tube. If the injection pressure inside the ring has reduced, the valve will be closed.

Valve design of the wells ( a ) AGCS-33, ( b ) 26, ( c ) 28, and ( d ) 36.

Gas lifting process

The amount of gas available for the injection process is essential for the production performance of the field. If limited gas is available for injection, the gas must be allocated to each well in the field to maximize the total field oil rate and enhance the gas-lift well's performance. Different gas rates (Table 8 ) were injected in the wells AGCS-33, 26, 28, and 36) (Table 9 ), which were produced by natural flow to investigate the effect of gas injection rate on production flow rate and how the gas-lift technique can be improved production rate.

Table 8 shows gas injection and liquid production rates with a maximum injection depth of MID for the well (AGCS-33) after gas lifting. The lift performance curves are plotted as the liquid rate of the well versus the gas injection rate for a gas injection pressure (2500 psi) and show the production system response to continuous gas lifting as shown in Fig.  12 a. The gas injection pressure at 1600 psi, and the production system responded to continuous gas lifting for the well (AGCS-26) after gas lifting (Fig.  12 b). The gas injection pressure at 100 psi and 2000 psi for the wells AGCS-28 and 36 (Fig.  12 c and d).

The results of gas lift design for the four wells (AGCS-33, 26, 28, and 36) show that the maximum oil production rate for the wells are 4678, 2806, 2050, and 4332 STB/d (Figs. 13 and 14 ). The gas injection rates are (6 to 7), 7, 4, and 6 MMSCF/d (Tables 8 and 9 ) at an operating pressure of 1300, 800, 30, 850 psi (Fig.  12 ). The available at casing head and the bottom hole following pressure is 4268, 4118, 3000, and 4100 psi (Fig.  11 ) with five, six, seven, and five injection point pressure (IPO) valve type (Fig.  11 ) respectively. According to Tables 8 and 9 and Figs.  13 and 14 , the maximum oil production rate that can obtained from gas lift design for the Asmari Formation in the Abu Ghirab Field, Southeastern Iraqis is (4678) STB/d for the well (AGCS-33) and 2806 STB/d for (AGCS-26). Production is affected by the gas lift system by several factors, the most essential of which are the gas injection rate and the gas injection pressure. Figures  13 and 14 show that increasing the gas injection rate can increase production to a certain extent due to the sliding phenomenon of the gaseous phase over the liquid phase. The injection pressure has a high effect on the production rate. When injection pressure is increased, the production rate increases until the limit that any increase in injection pressure leads to a slight increase in the production rate. When the production rate was plotted against injection pressure and gas injection rate, it was clear the production rate increased with increasing injection pressure to a limit that no economic benefit for further injection rates (Fig.  15 ).

Gas lifting for the well ( a ) AGCS-33, ( b ) 26.

Gas lifting for the well ( a ) AGCS-28, ( b ) 36.

The relationship of production rate to injection pressure and gas injection rate by lift gas injection for the well AGCS-33.

According to Tables 1 (current production bbl/d), 7, and 8 (production by gas lift), there is a significant increase in oil production in all wells (Fig.  16 ). The effect of gas lift Has increased oil production as seen at the middle of the crest in Fig.  16 , which shows an increasing percentage of oil production of 136.6% at minimum rate and 198.5% at maximum for the well AGCS-26, 89.7% and 105.7% for the well AGCS-36.

Top-increasing in oil production (bbl/day), bottom- increasing percentage by gas lift for the four wells.

Figure  17 shows that gas lift injection and oil production rates are affected by the faults near the well and the facies distribution. The validation of this are for wells 33 and 36 whose oil production rates increased till gas lift rates of 7 mmscf/day due to closeness to faults, while for wells 26 and 28, the limit will slightly increase starting with 5 MMSCF/d. There is no economic benefit to increasing the gas injection rate. Increasing the shale volume above and below the production zone will play a crucial role in the efficiency of the process.

A cross section of Facies model for ( a ) wells AGCS 33 and 26; ( b ) AGCS-36 and 28.

According to the Water cut, wells (AGCS-26, 28, and 33) show high rates while well AGCS-36 at a low rate during different periods due to the life of the well (Fig.  18 ). The results of Fig.  18 reflect the effect of water saturation levels on the well's production due to the location of the well and water saturation distribution in the Formation (Fig.  19 ). All these results will lead to the belief that the water cut must be considered if the gas lift process is applicable in the Asmari Formation.

Water cut values according to the oil production rate till the year of 2020.

Water saturation percentages in facies of the Asmari Formation before gas lift.

Conclusions

In conclusion, the case study of optimizing gas lift for the Asmari Formation in the Abu Ghirab Field, Southeastern Iraq, has provided valuable insights into the complexities and potential of maximizing reservoir production through efficient gas lift techniques. The findings emphasize the significance of considering various factors such as injection pressure and injection rate, valve design, and water cut-off. In this study, a gas lift valve was utilizable to control the gas injection rate by opening the valve with different percentages using PIPESIM ™.

The results of the gas lift design for the four wells (AGCS-33, 26, 28, and 36) show that the maximum oil production rate will increase according to the existence of faults and the facies distribution.

This method has proven successful in increasing the oil production rate with high efficiency and effectiveness. The maximum oil production rate that can obtained from gas lift design for the Asmari Formation in the Abu Ghirab Field, Southeastern Iraqis is (4678) STB/d for the well (AGCS-33) and 2806 STB/d for (AGCS-26).

The increase in the oil production by gas lift technique is obvious in the middle western of the crest, which shows an increasing percentage of oil production of 136.6% at minimum rate and 198.5% at maximum for the well AGCS-26, 89.7% and 105.7% for the well AGCS-36.

There is no economic benefit to increasing the gas injection rate for the wells far from the fault area.

Increasing the gas injection rate can increase production to a certain extent due to the sliding phenomenon of the klinkenberg effect. The production rate increases until the limit that any increase in injection pressure leads to a slight increase in the production rate.

The wellhead pressure significantly influences gas-lift performance, and enhancing gas-lift performance can be achieved by employing an electric control valve.

Production through gas-lifting would not only depend on injection rate but also can be optimized through the completion design and monitoring of the gas-lift supply pressure, total gas available, and other variables. Accordingly, the gas injection rate can be adjusted to yield maximum production rates.

Reservoir pressure, productivity index, and water cut-off are vital factors in the oil production rate.

The water cut must be considered if the gas lift process is applicable in the Asmari Formation according to the location of the well and water saturation distribution in the Formation.

Pre-development assessments to determine the feasibility of gas lift adoption are recommended. This technique will be suitable for severely heterogeneous Formations and prone to undesirable fluids breaking through early. Investigation of the impact of gas lifting on other types of wells, such as (multilateral wells and horizontal wells).

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author and Maaly S. Asad upon reasonable request.

Abbreviations

Density (lb/ft 3 )

Viscosity (cp)

Absolute open flow

Bottom hole pressure (psi)

Oil formation volume factor (bbl/STB)

Electrical submersible pump

Method by Wang and Litvak

Gas-lift injection rate (Scf)

Gas-lift performance curve

Gas liquid ratio (Scf/STB)

Gas oil ratio (Scf/STB)

Injection-pressure-operated gas lift valve

Inflow performance relationship

Productivity index

Slope value on a gas-lift performance curve.

Maximum injection depth (ft)

Molecular weight

Non-instantaneous flow

Bubble point pressure (psi)

Wellhead pressure (psi)

Reservoir pressure (psi)

Pound per square inch

Valve pressure (psi)

Flow rate (bbl/d)

Gas injected flow rate (MMscf/d)

Produced liquid flow rate (STB/d)

Standard cubic feet

Specific gravity

Sequential linear programming

Stock Tank Barrel

Water saturation (V/V)

Threshold pressure gradient (psi/ft)

Temperature of reservoir (F°)

Drawdown pressure (psi)

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Maaly S. Asad & Abdulkareem A. Khalil

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The authors confirm their contribution to the paper as follows: Study conception and design: M.S.A. and A.A.K. Data collection: Author M.S.A. Analysis and interpretation of results: M.S.A. and A.N.A. Draft manuscript preparation: A.N.A. checking and validation A.A.K. All authors reviewed the results and approved the final version of the manuscript. I would like to submit the manuscript entitled: Optimizing Gas Lift for Enhanced Recovery in the Asmari Formation: A Case Study of Abu Ghirab Field in Southeastern Iraq by Maaly S. Asad; Ahmed N. Al-Dujaili; Abdulkareem A. Khalil to be considered for publication as an original paper in the Scientific Reports Journal.

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Asad, M.S., Al-Dujaili, A.N. & Khalil, A.A. Optimizing gas lift for enhanced recovery in the Asmari formation: a case study of Abu Ghirab field in Southeastern Iraq. Sci Rep 14 , 20293 (2024). https://doi.org/10.1038/s41598-024-71274-w

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The insights of allied health professionals transitioning from a matrix structure to a centralized profession-based structure within a public hospital setting

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• Gemma Turato   ORCID: orcid.org/0000-0002-9589-7425 1 ,
• John Whiteoak 2 &
• Florin Oprescu 2  

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To manage the challenges associated with increasing costs and demand for healthcare, administrators often propose a re-structure of the workforce to gain more efficiencies. However, this can have detrimental impacts on professions such as allied health if the uniqueness of this workforce is not taken into consideration before, during and after re-structuring. In the dynamic setting of public hospital bed-based services, allied health is highly complex, consisting of diverse professionals (e.g., audiology, physiotherapy, occupational therapy, podiatry, pharmacy, dietetics, social work, and speech pathology), each requiring different technical expertise, training pathways, professional governance, and accountability. This case study evaluates the outcomes of a re-structure of allied health professionals working in bed-based services who transitioned from a matrix to a centralized structure of service delivery. Qualitative data were collected in a survey across three years to gain the perceptions from allied health staff about the impacts of the new structure. The results demonstrated that a centralized profession-based structure with single points of accountability was superior to a matrix structure in this context. The benefits identified included improved governance, administration efficiencies and cost-savings gained by having the budget and professional management aligned. This resulted in improved workforce planning and flexibility that delivered care to patients based on clinical priority. Further benefits included professional skills training pathways and succession planning across clinical specialties which enhanced career opportunities, all of which improved wellbeing and morale. These findings add to the sparse research pertaining to the components (structural, human and systems) to consider when incorporating allied health professionals in a proposed organizational design and the contingencies they require to operate successfully within certain contexts.

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Introduction

To manage challenges associated with increasing costs and demand for healthcare, administrators have been looking for more efficient approaches in delivering quality care and enhancing performance. A common approach aimed at improving overall performance in many large organizations such as public hospitals has been to re-structure. However, past evidence has suggested that implementing structural change without due consideration of the unique requirements of health professionals such as allied health employees can have negative implications (Braithwaite et al. 2006 ; Law and Boyce 2003 ; Mickan et al. 2019 ). A review of allied health professionals (AHPs) working in Victoria, Australia concluded that there is no one best structural model for AHPs as they are a support workforce that connects and contributes to local priority requirements and systems (Buchan and Law 2016 ). Consequently, avoiding the ‘one size fits all’ approach is critical when an organization proposes a new structure that involves AHPs (Braithwaite et al. 2006 ; Law and Boyce 2003 ). This is the basic premise of organizational design theory which recognizes that there is not just one most suitable solution for organizing and that different organizations are not equally effective or efficient (Galbraith 1973 ; Burton and Obel 2018 ).

Organizational theory is defined by Jones ( 2013 ) as the “study of how organizations function and how they affect and are affected by the environment in which they operate” (pp. 30). The focus of organizational theory is to understand how to organize people and resources in order to achieve the organizations objectives (Greenwood and Miller 2020 ). Hence, in order to achieve its goals, the organization needs to focus on both structure and culture. Additionally, organizational design is about how and why various functions are chosen and puts pressure on individuals and work groups to behave in certain ways. Therefore, if the proper balance is not achieved, this can have significant impact on the organization’s performance (Jones 2013 ).

The multi-contingency theory of organizational design developed by Burton and Obel ( 2004 ) explains this further, by relating variations in organizational design to variations in the situation of the organization (i.e., its contingencies), which they conclude should be chosen based on the particular context. Furthermore, the description of the context should be multi-dimensional, including structural components (i.e., goals, strategy, structure, and tasks), human components (i.e., leadership, work processes, and people) and coordination (i.e., control systems, decision systems, information systems, and incentive mechanisms).

In this view, organizational design is more a process than a structure that is constantly adapting and evolving and planning for contingencies that may arise (Burton and Obel 2004 ). Further, the design of an organization shapes the flow of information, resources, and support, which effectively determines the powerholders (Myers 1996 ). Allied health employees are a good example of when the power imbalance in large healthcare organizations can create perceptions of inequitable treatment and lead to workers feeling disenfranchised. Even though AHPs constitute the second largest workforce within the health industry in Australia and make a significant contribution to health improvements, this contribution remains under recognized due to much of the health policy and funding focused predominantly on medicine and nursing (Buchan and Law 2016 ). Subsequently, AHPs are often not visible enough on the health policy agenda and there is little evidence available regarding their cost benefit and value. Consequently, there has been a relative lack of examination of the allied health workforce and how they contribute and influence in healthcare organizations. This has resulted in organizational designs that have minimal consideration given to AHPs and the contingencies that may impact their performance and wellbeing, which has ultimately resulted in unfavorable outcomes (Boyce 2006 ; Robinson and Compton 1996 ; Turato et al. 2023 ).

While there is some debate on the correct definition of this workforce (Turnbull et al. 2009 ), according to the Allied Health Professions Australia (AHPA, 2022), they are considered as health professionals that are separate to medicine, dental and nursing and provide specialized support across a variety of health services. Typically, these include audiology, dietetics, exercise physiology, occupational therapy, pharmacy, physiotherapy, podiatry, psychology, radiography, social work, and speech pathology. They usually operate autonomously and practice in an evidence-based paradigm, using an internationally recognized body of knowledge to provide optimal patient outcomes (AHPA, 2022).

The focus of AHPs in public hospital bed-based services is to work within a multidisciplinary team that delivers a coordinated approach to patient care (AHPA, 2022). This fast-paced context requires AHPs to make rapid clinical decisions frequently and be adaptable and flexible across clinical areas when under pressure to meet clinical demands (Philip 2015 ). They require highly technical knowledge and skills to deliver care in this setting (e.g., social worker organizing crisis accommodation, physiotherapist managing a severe respiratory condition to avoid an admission to the intensive care unit, occupational therapist fabricating a complex hand splint following trauma surgery, pharmacist assisting the medical team with medication management and dosage for acutely unwell patients). These types of pressures distinguish a public hospital bed-based setting from a community or primary care setting, in which the client group is not in the acute stages of treatment or requiring highly technical expertise from AHPs (Philip 2015 ). The relatively limited evidence suggests that for AHPs to function optimally in public hospital bed-based services requires an efficient and effective organizational design that takes into consideration both the multi-faceted nature of the allied health workforce and the layers of professional and clinical governance required to manage them effectively.

Given the specific needs of AHPs working in this sector of the hospital, this case study provides distinctive insights from AHPs, to better understand their operating requirements. This is important for hospital systems to understand if they are proposing to re-structure with the aim of delivering more efficient, sustainable, and effective services. Not taking into consideration the unique requirements of AHPs to function optimally and treating them the same as nursing and medicine is likely to result in poorer outcomes and impact performance (Turato et al. 2023 ). One of the key differences of AHPs when compared to nursing and medicine is the need for each individual allied health professional to navigate multiple identities with respect to their profession, the overarching allied health structure and alignment, and their inter-professional teams (Porter and Wilton 2020 ). The diversity of AHPs, each with different technical expertise, training pathways, sectors of practice and professional governance, makes AHPs working in hospital bed-based services highly complex. Therefore, as healthcare becomes increasingly complex, requiring seamless interdisciplinary teamwork and maximal return on investments in the health workforce, it is critical that the organizations in which AHPs work have considered the structural, human and system components of their design so that the widespread potential AHPs represent is fully realized (Australian Health Workforce Advisory Committee 2006 ).

In this study, the insights and experiences of hospital bed-based AHPs who were involved in a transition from a matrix to a centralized allied health structure were explored. The focus of the research was a large multi-site Australian public hospital and health service with five clinical orientated groupings (i.e., medical, surgical, women’s and children’s, community, and mental health). In 2017, the organization expanded to tertiary level services with the addition of a new hospital. In preparation for this, AHPs were dispersed into each of the five clinical groups under the management of a medical and nursing director. However, the matrix structure did not deliver upon the anticipated outcomes for AHPs working in the medical and surgical clinical groups with a range of unfavorable concerns reported (e.g., ambiguity, reduced workforce flexibility, increased cost, and low morale). Following consultation with key stakeholders and AHPs, a centralized allied health structure was implemented for AHPs working in the medical and surgical clinical units. To measure the outcomes, qualitative data were collected through an online survey in June 2020, 2021 and 2022 through open-ended questions and confirmatory meetings to verify generated themes.

This paper presents the findings of this iterative process and highlights the importance of implementing the ‘right structure’ which has the appropriate governance and support systems for AHPs working within hospital bed-based services. Further, it demonstrates the importance of healthcare administrators needing to be well informed about the complexities of AHPs before they consider embarking on structural change that incorporates AHPs in this context. This research contributes to relevant theory and practice by providing a deeper understanding of the type of structure and functions that may enhance AHPs experience of working in hospital bed-based services. Furthermore, the paper emphasizes that the unique contextual nuances of the work of AHPs are often overlooked during a re-structure, and this can have detrimental outcomes (Turato et al. 2023 ). Given there is limited empirical research about AHPs re-structuring in public hospital bed base services, understanding the experiences and insights of AHPs going through structural change, adds to the evidence that may enhance future structural re-organizations pertaining to this workforce and further maximize their potential and productivity in public hospital settings.

Background/theory

Organizational theory.

Organizational theory has developed over three eras’, with early organizational theorists classifying organizational structures as either mechanistic or organic (Anand and Daft 2007 ). The first era predominantly adopted mechanistic structures during the mid-1800s to the late 1970s and were designed for stable and simple organizational environments with low to moderate uncertainty. They were described as self-contained, top-down pyramids containing internal organizational processes that took in raw materials, transformed them into products which were then distributed to customers (Anand and Daft 2007 ). The second era included organic organizational structures and systems which were designed for unstable, complex, and changing environments, which mechanistic structures could not manage. This era gained momentum in the 1980s and extended through the mid-1990s and incorporated horizontal organic organizational designs with a flattened hierarchical, hybrid structure and cross-functional teams (Daft 2016 ).

A third era formed in the mid-1990s and extends to the present day, being driven by factors, such as the internet, global competition with low-cost labor; automation of supply chains and outsourcing of expertise to speed up production and delivery of products and services. During this period, structures evolved, including the functional, divisional, matrix, global geographic, modular, team-based, and virtual (Daft 2016 ). Given this case study focuses on the centralized divisional and matrix structures, a brief outline of each will be covered next.

The divisional structure incorporates several functional departments grouped under a division head. Each functional group in a division has its own marketing, sales, accounting, manufacturing, and production team. The advantages include, each specialty area can be more focused on the business and budget; employees understand their responsibilities; improved efficiencies of services; and easier coordination due to all the functions being accessible. The disadvantages of this structure include divisions becoming isolated and insular from one another and different systems, such as accounting, finance, and sales, may suffer from poor and infrequent communication and coordination of the organizations mission, direction, and values (Daft 2016 ).

The matrix structure is an organic structure aimed at responding to environmental uncertainty, complexity, and instability (Burton et al. 2015 ; Daft 2016 ). The matrix structure originated at a time in the 1960s when the United States aerospace firms contracted with the government. Since that time, this structure has been imitated and used by other industries and companies since it provides flexibility and helps integrate decision-making in functionally organized companies. The matrix design has formal authority along two dimensions: employees report to a functional, departmental boss and simultaneously to a product or project team boss. This dual reporting has been described as one of the significant weaknesses of matrix structures due to the confusion and conflicts employees experience in reporting to two bosses. Hence, a detailed design of the decision-making process at each junction point is required for a successful matrix organization (Burton et al. 2015 ; Daft 2016 ). Further, to be successful a matrix structure requires important contingencies, such as climate, leadership, knowledge sharing, information technology and incentives that are correctly designed and aligned with one another (Burton et al. 2015 ). The next section will briefly outline specific allied health structural approaches and summarize the implications for the provision of care by AHPs reported in literature.

Allied health models

During the mid-1990s, AHPs were commonly incorporated into the emerging organizational structures in healthcare, with a growing body of research being published about the impacts on AHPs (Law and Boyce 2003 ). It is generally recognized that allied health structures can be classified into four types: (1) the traditional medical model, (2) division of allied health, (3) clinical matrix and (4) integrated decentralization model (Boyce 1991 ). The traditional medical model is where individual profession-based departments report to a medical director (Boyce 1991 ; Law and Boyce 2003 ). This model is common practice in many smaller hospitals in which there are small numbers of AHPs. However, the model is rare in larger hospital settings in Australia where there are high employee numbers within each profession requiring professional governance and oversight (Boyce 2006 ).

In the allied health division model (i.e., centralized profession-based structure), a director of allied health is a member of the executive leadership group and AHPs are centralized into one division (Boyce 2001 ; Law and Boyce 2003 ). The main advantages of this model are argued to be improved communication flow between senior management and departmental managers, and it positions allied health as having more status and a collective identity (Boyce 2001 ). Disadvantages purported are the concentration of power in management, competition between the professions and less identification with a whole of organization view (Boyce 2001 ).

In healthcare organizations implementing the matrix structure involved giving financial control to clinical units and services being organized around patients rather than providers (Braithewaite et al. 2006 ; Law & Boyce 2003 ). This resulted in dispersing individual AHPs into clinical units with a dual authority relationship between professional and operational reporting lines (Boyce 2006 ). Often, an allied health advisor position at the executive level is appointed to address allied health issues occurring within the clinical sub-units (Boyce 2001 ). In the public hospital setting, literature suggests that a matrix structure delivers multiple benefits, such as reduced hospitalization time and costs, better accessibility for patients, and improved coordination of care (Braithwaite et al. 2006 ; Burton et al. 2015 ; Callan et al. 2007 ; Mueller and Neads 2005 ). The aim of including AHPs was to encourage better collaboration and cooperation across the multidisciplinary team (Porter and Wilton 2020 ). However, the growing evidence available reports many negative outcomes, including operational inefficiencies, loss of professional identity, ambiguity over dual reporting lines, low morale, poor job satisfaction and negative impacts to service delivery (Braithwaite et al. 2006 ; Callan et al. 2007 ; Porter and Wilton 2020 ; Robinson and Compton 1996 ; Turato et al. 2023 ).

The hybrid model classified as the integrated decentralization model is a combination of the allied health division and matrix structure (Boyce 1991 ). In this structure, allied health budgets remain under the control of allied health; however, clear documentation of how AHPs will provide care to each of the clinic units is often required. In this model, it is suggested that collaboration brings benefits of transparent operational and strategic planning, including the ability to implement research, clinical education, individual staff development and professional specific quality clinical services (Mueller and Neads 2005 ). However, this model requires good relationships between key stakeholders to ensure its viability.

The allied health models described above provide a brief overview of each with some demonstrating more potential advantages for AHPs. While the insights available on the impacts of structural change on AHPs is growing there is still limited research about the impacts for AHPs going through such change. In this study, the perceptions and experiences of AHPs who have transitioned from a matrix to a centralized allied health structure within public hospital bed-based services are explored. The aims of the study being to first add to the current gap in knowledge about factors that may mitigate negative experiences of AHPs when hospital administrators are considering a re-structure in this setting. Second, what structures and/or supporting strategies are required to meet the complex needs of AHPs working in this dynamic context. Hence, this case study addresses the following research question:

RQ1: What are the insights and experiences of AHPs transitioning from a matrix to a centralized profession-based structure within public hospital bed-based services?

Research context and case background

The region in Australia in which the study took place is described as peri-urban with an estimated population of 400,000 people in 2022. It is the fifth most populated area in Queensland and has grown steadily at an average annual rate of 2.4% year-on-year since 2018. It is a center for tourism, attracting more than 3.2 million visitors each year. The economy has outpaced most other regional economies in Australia in terms of growth over the last 15 years across several key sectors including healthcare, education, finance, and professional business services (Connection Australia 2023 ). The case study research occurred at a multi-campus hospital and health service, with a new tertiary facility opening in 2017. This facility provides tertiary level services to the community and the clinical capability to care for highly complex inpatient and ambulatory care services. The health service is an independent statutory body governed by a Board under the Hospital and Health Boards Act 2011. The health service operates according to a service agreement which identifies the services to be provided, funding arrangements, performance indicators and targets to ensure the expected health outcomes for the community are achieved.

To prepare for this expansion, the allied health workforce (approximately 600 staff) was integrated into the broader organization’s matrix structure in 2014. The organization believed this would support a multidisciplinary culture that was collaborative, reduce service gaps and improve consistency of allied health services. This in turn would involve AHPs in clinical directorate operational planning and improve the reporting of AHPs performance. The individual AHPs were assigned to one of five clinical orientated service groupings. These five groups were medical, surgical, women’s and families, mental health, and community. Medical imaging and pharmacy remained as standalone groups that reported operationally and professionally to a director of those professions. Each director subsequently reported to the service director in the medical group. The new tertiary facility provided the hospital and health service with a total bed count of approximately 884 beds in 2018, which increased to 1032 beds by 2022. The staffing grew from approximately 4500 full time (FTE) equivalent employees to 6500 in 2022 with an operating budget in the 2021–22 annual report of 1.45 billion dollars.

A consequence of the matrix structure was that the allied health executive lead and professional director roles were abolished. Figure  1 illustrates that these roles were replaced by allied health operational manager roles for each service group that were part of the multidisciplinary service group leadership team and a clinical director of allied health role which provided overall professional leadership for allied health.

Allied Health organizational chart following alignment to the matrix-oriented clinical directorate structure

The AHPs in the matrix structure reported operationally to an allied health manager and professionally to a professional leader role (i.e., horizontal gray line in Fig.  1 ) that did not have operational or budgetary responsibility. This resulted in many AHPs having dual reporting responsibilities to either an allied health manager or lead for operational requirements and a professional lead for professional governance (Turato et al. 2023 ).

The structural change to a matrix alignment was met with a range of negative consequences particularly within the medical and surgical groups (Turato et al. 2023 ). Some of these included confusion over reporting lines with multiple conversations needed to resolve workforce matters. Another included increased costs and inefficiencies due to more administration (e.g., several AHPs were aggregate employees with more than one position number for each clinical unit they were working for, with some staff having up to four position numbers). The increase in position numbers multiplied the paperwork involved to manage the employee, hence increasing the cost, time, potential errors, and re-work required. This led to limited opportunities for staff rotations and career opportunities due to the administration needed to manage this. Others included limited growth in staffing levels due to the budget being owned by each clinical unit and often allied health staffing was not advocated for or understood by the clinical unit (e.g., decisions about increasing allied health FTE and in which profession often had no robust planning or reasoning). A further concern raised by AHPs was the overall voice of allied health in the organization was minimized due to the matrix structure, which resulted in AHPs reporting a perceived lower status within the organization. All these factors ultimately led to lowered morale and wellbeing being reported (i.e., public sector employee opinion survey results from 2017 to 2019).

The negative impacts reported led to a strategic decision to implement a centralized allied health structure by amalgamating AHPs in the medical and surgical groups. The posited aims of the shift back to a centralized structure included:

Reduce patient risk through an enhanced discipline lens.

Decrease confusion over reporting lines and improved communication.

Decrease duplication of tasks for AHPs within each service group.

Improve flexibility to mobilize AHPs based on clinical priority.

Improve governance and accountability for AHPs.

Decrease administration time and structural inefficiencies.

Improve support to the facilities outside of the tertiary facility.

Improve the ability to implement new models of care, innovation, and research.

The centralized allied health structure commenced in January 2020 and re-introduced what had been dismantled in 2014. The structure abolished the professional lead and allied health manager roles and created professional director roles that were responsible for both operational and professional requirements. The clinical director allied health role was re-aligned to an executive director allied health role which reported to the chief executive. Figure  2 illustrates the organizational chart for the centralized allied health structure.

Allied Health Centralized Structure

Study design

This research presents qualitative data that were collected through an open-ended questionnaire using an online survey. The questions focused on why and/or how AHPs perceived the new centralized structure and was repeated annually for 3 years (i.e., 2020, 2021 and 2022). Follow-up confirmatory meetings with each profession were also conducted to confirm the themes derived from the survey feedback.

The survey asked participants to consent for their data to be used for research. Participants who did not provide consent were removed from the final research analysis. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of The Prince Charles Hospital, Queensland Health Human Research Committee (HREC 18/QPCH/238 on 30/08/2021).

Participants/data collection

Table 1 provides the types of professions and number of staff who consented to participate in the study. The new allied health structure incorporated hospital bed-based services within the Medical and Surgical groups with a total FTE of approximately 400 by 2022. During the planning phase of the study, staff expressed concern over being identifiable if they participated in a survey. For example, the professions with small numbers of staff (i.e., audiology, podiatry, psychology) perceived they could be identifiable if they were asked to disclose gender, age range, years in the profession / organization, level of education etc. Therefore, to encourage increased participation, demographic data were kept to a minimum, with the focus of the survey being on gaining qualitative feedback on the structural change.

This sector of the workforce is typically made up of a range of staffing levels from assistants, new graduates, base grade, senior, advanced and management levels. The staff who took part within each profession are typically representative of the professional roles that work in this sector. Not surprisingly, the professions of physiotherapy, occupational therapy and social work have higher numbers of clinicians working within bed-based services and hence have higher representation in the survey results. Additionally, the total number of employees who participated in the survey by profession is indicated in brackets in Table  1 to demonstrate how representative the sample is of the total population for that profession.

The profession of pharmacy was initially not included in the new centralized structure. This profession was incorporated into the new structure in 2021, but after the 2021 survey was administered. This would explain the no response rate from this profession in 2020 and 2021, but a higher completion rate in 2022. Medical imaging was not incorporated within the new allied health centralized structure and did not participate in the survey.

The response rate ranged from 25% (2020), 23% (2021) and 24% (2022) across the three years. This is a comparable response rate to a similar study published by Porter & Wilton ( 2020 ) on professional identity, in which they collected data following an organizational re-structuring in which AHPs were integrated into a matrix structure, within a large multi-site health network in Victoria, Australia. The survey response rate for each survey conducted pre and post was 23.4% and 20.8%.

The survey asked two open-ended questions about what AHPs perceived to be the barriers or issues regarding the centralized structure and what they believed were the enablers or suggestions to improve the implementation. In addition, participants were asked to provide feedback on the structural change against the aims and reasons for implementing the change (see Appendix 1 for a copy of the survey).

Data analysis

To analyze the narrative data, a manual thematic analysis was completed using a six-phase thematic analysis methodology developed by Braun and Clarke, ( 2006 ). The data analysis method contains a rigorous coding and categorizing methodology that is driven by the data collected during the evaluation process, rather than any analytic preconceptions (Nowell et al. 2017 ). The analysis involved an inductive approach that first identifies themes, which are analyzed initially in a descriptive form before progressing to an interpretive form. The interpretive form attempts to look beyond the surface of the data where the broader meaning and ultimate implications of the themes/patterns are deduced via engagement with the literature (Braun and Clarke 2006 ).

To extrapolate the underlying themes, the first phase involved migrating the raw narrative data from the surveys to column A in a Microsoft Excel worksheet (one sheet per survey question 3, 4 and 5). The primary researcher spent time reading and re-reading the raw data for each of these questions, noting down initial ideas, thoughts, and potential codes/themes (in column B). The primary researcher used this part of the process as a key phase of data analysis—in other words, as an interpretive act (Lapadat and Lindsay 1999 ) in which the primary researcher looked for meaning in the data.

The second phase included generating a single column of all comments per question 3, 4 and 5. The single column of data per question was sorted and reviewed to remove any duplicate entries. The next step was the coding process to determine the potential themes emerging from the data. There were no pre-determined thematic areas in place before the coding process was initiated. For the coding process, each individual cell (participant comment) from the single column of data per question 3, 4, and 5 was reviewed and assigned a potential thematic area, to which a cell color code was applied (yellow, blue, orange, gray etc.).

This data-driven, inductive approach ultimately led to the identification of initial thematic areas, each labeled with a different color. The types of themes that came out of the data were based on similarities of words to create the theme. For example, for the barriers/issues question 4, many participants talked about the problems related to arduous administration tasks. These types of comments were then coded to capture the essence of what the participants were expressing e.g., inefficient, and arduous administration. The codes were then assigned to potential themes for question 4 of which one included “inefficient administration.” In contrast, for question 3 pertaining to whether the aims were being met, many perceived significant improvement and efficiencies with administration, with the code phrased as, “improved administration.” The codes from question 3 were then placed against potential themes with those related to better administration coming under the theme of “ improved systems / processes ” for further analysis and discussion. If some points fell under two themes, the worksheet cell with the raw data was duplicated and each cell color-coded appropriately to ensure everything was recorded. Using the Excel sorting tool, the data was sorted by the color assigned to each cell, and therefore by thematic area. This sorting and collation approach brought together all the key points on each theme which determined the frequency of a theme raised by participants, which in turn assisted the researchers in determining the prominence of a theme (e.g., for the aims question, the frequency of respondents perceiving whether they believed all the aims were being met, versus whether they thought one or more were not being met was carefully considered in the analysis). After sorting and combining similar statements, the initial color-coded data analysis resulted in a list of comments sorted against potential codes/themes by each of the selected questions.

In phase three, the researchers analyzed and interpreted the data to make overall sense of it, rather than just paraphrasing or describing the data. Following the initial coding exercise, the data was copied for each question to a second Excel worksheet. This step involved a “first pass” over the data and involved grouping similar comments to consolidate the data. Every time the pass was performed for each thematic area per question, the data was moved to a new excel worksheet. The reason for the multiple worksheets was that the researchers could go back a step to the previous unconsolidated data set if needed.

To limit researcher bias and ensure the data was credible and accurate, phase four involved a two-researcher confirmation approach, in which each stage of the data analysis was reviewed. The first level involved reviewing at the level of the coded data extracts to determine if they formed a coherent pattern. If this was the case, the researcher then moved onto the second level of this phase to determine the validity of individual themes in relation to the data set. The primary researcher completed a re-read of the entire data set to firstly ascertain whether the themes worked in relation to the data set and secondly to code any additional data within the themes that had been missed in earlier coding stages. The data pass steps were repeated five times (constant comparative analysis) to finally generate the most prominent themes. This process generated a thematic map of the analysis to ensure the analysis and data matched each other. The primary researcher stopped this process once the refinements of the data did not add anything substantial and used two ways to arrange and analyze the data. The first being most prevalent theme to the least prevalent related to the frequency of the information being raised by participants. The second included the Rashomon effect whereby the same event is described from the perspective of more than one participant (Sandelowski 1998 ).

Phase five defined and named the themes, which started once both researchers were satisfied with the thematic map of the data. This involved the researchers defining and further refining the themes to identify the essence of what each theme was about and determining what aspect of the data each theme captured. This phase included reporting of the themes and presenting these to AHPs who had the opportunity to complete the anonymous survey and who volunteered to attend one of a series of confirmation meetings. These meetings clarified and corroborated the generated themes, which confirmed the final set of emergent themes. It is important to note that the aims, barriers, and solutions will be discussed next under four key themes in a combined approach due to many of the solutions being similar to the aims of the new structure and a reverse of the barriers. This avoided duplicating information throughout the results/discussion section.

Results and discussion

Theme 1: systems and processes.

The most prominent theme across the three years was that the centralized structure had greatly improved the systems and processes necessary for AHPs to operate their essential functions within hospital bed-based services. The findings about improvement in systems and processes are similar to the studies outlined in the literature that describe comparable benefits of a centralized allied health profession-based structure in public hospital settings (Law and Boyce 2003 ; Mickan et al 2019 ; Robinson and Compton 1996 ). The following comment sums up the general sentiment of the participants across the three years, “I think overall things are going really well for allied health and the new structure is delivering on the aims it set out to achieve, there is a real sense of hope for the future” (occupational therapist). The survey data indicated a high proportion of AHPs perceived the posited aims of the new structure were being achieved and that a centralized structure in bed-based services for AHPs worked well. This was also confirmed at the confirmatory meetings; however, it was highlighted at these meetings that each profession needed a governance structure that could accommodate their diverse professional requirements.

Thus, a prominent and positive structural feature highlighted by participants was the single point of accountability for each profession, which they believed improved processes by decreasing ambiguity and improving communication (Mickan et al 2019 ). Comments highlighting this included, “ the clear reporting lines and channels of communication improves the speed of response to service needs” (physiotherapist) and “ the new structure is a positive change with less confusion around reporting lines” (speech pathologist). Furthermore, one reporting line decreased the duplication of tasks and subsequently streamlined payroll and administration duties. This resulted in significantly less employees with multiple position numbers, reducing the time required to perform many related administrative tasks, which resulted in improved efficiencies. The following comments reinforced this view point, “the reporting lines are easier to navigate for operational and clinical needs” (social worker) and “ direct reporting lines via each profession means that administrative tasks are more streamlined” (psychologist) and “communication and the ability to implement new models of care appear to be more streamlined and better supported” (physiotherapist) and “the new structure is much more efficient from an admin and payroll perspective, I don’t need to spend hours correcting payroll errors, thank you” (administration staff member). These benefits had substantial implications for not only the AHPs but also the organization due to more streamlined and efficient processes. For example, the grouping of each profession enabled the director of each professional area to complete and approve actions more promptly, reducing duplication of resources and costly administration errors.

Another prominent benefit of single lines of accountability included each director’s ability to flexibly mobilize their staff more seamlessly. This created better delivery of prioritized clinical services due to less arduous negotiations with medical and nursing administrators. It also significantly improved the governance and accountability of staff within each profession. Moreover, the feedback from the participants suggested they believed this reduced patient risk by having an enhanced professional lens through high standards of professional supervision, skills training and support. The following comments sums up the general sentiment, “there is a sense of team, improved accountability and enhanced professional support and career opportunities with the new structure, as well as improved staff mobilization to cover emergent leave” (speech pathologist). Participants reported satisfaction with being able to rotate between clinical specialties which enhanced their career opportunities and succession planning.

One of the few related examples in the literature included research by Robinson and Compton ( 1996 ) which provided practical learnings from their re-structuring from a matrix to a centralized model for physiotherapy staff. Similar to the findings in this case study, they demonstrated for the physiotherapy profession multiple benefits of a centralized model in hospital bed-based services when compared to a matrix model in a very short period. One prominent similarity found not only for physiotherapy, but for all the professions included the operating improvements such as maintenance of staffing levels due to being able to have control of the budget. This resulted in savings being made very quickly due to streamlining processes, such as recruitment, rostering, backfill, ordering non-labor stock, etc. The following comment highlights this, “ we can take a whole of profession approach to movement of staffing into areas of higher need which is appreciated and effective especially throughout times of significant unplanned leave due to COVID and needing to isolate” (occupational therapist).

Many of the system and process efficiencies gained from each profession having control of budget was due to the in-depth understanding and knowledge the directors had about their profession and how best to govern, roster and manage the workforce seamlessly when compared to the previous structure in which the operational manager was not of the same profession, which often resulted in arduous communications between multiple stakeholders to manage clinical demand across the clinical units.

Theme 2: professional identity

The second prominent theme demonstrated that the identity of each profession developed very quickly within the centralized structure and the participants generally expressed they felt more supported and comfortable within their own profession. The data analyzed from the survey results (and confirmed at profession meetings) reported that many respondents perceived that returning to a profession-based structure was positive. A high proportion of participants indicated that operating as professional groups and being in an allied health centralized structure was a better person-environment fit in comparison to the change associated with working in a matrix structure. For many of the AHPs, they perceived a strong sense of familiarity and belonging to their profession and to allied health when compared to their sense of belonging to their clinical unit and the organization. The following comment supports the general sentiment, “ profession specific led teams is proven to work, and this is how other tertiary facilities in Queensland run. Having a different profession govern a discipline they know very little about is a recipe for disaster which we have proven in our previous structure” (dietitian).

This aligns to findings in research which has previously identified the importance of professional identity among AHPs (Braithwaite et al. 2006 ; Porter andWilton 2020 ). This is consistent with the multitude of comments from participants that the new structure was providing strong governance and accountability for each profession. The following comment highlights the general perception from participants, “ the centralized structure provides stronger accountability across the organization and uniform governance and consistency for allied health staff” (psychologist). This is particularly important in hospital bed-based services given the highly specialized skills required to work competently in this setting. In contrast, there was a small number of respondents that identified more positively with the matrix structure, describing a strong allegiance with their multidisciplinary team and/or clinical unit. Therefore, the findings reinforce the importance of managing professional identity of AHPs during structural change, given their experiences of the structural alignment can be perceived differently (Beasley et al. 2020 ; Porter andWilton 2020 ).

This can be explained through Social Identity Theory in which an individual identifies with social groups partly to enhance self-esteem, which is probably why, in this case some of the AHPs did not adjust well to the new structure, even though transitioning to being a member of their own professional group would have been familiar to them (Ashforth and Mael 1989 ). Some AHPs felt a sense of loss for their multidisciplinary leader who provided them with positive reinforcement. The following comment highlights this, “I am concerned that the profession specific model loses the importance of multidisciplinary care and fails to acknowledge how this profession-based change impacts service delivery. I think we need to have the multidisciplinary allied health lead in each clinical unit like before we re-structured to ensure we don’t silo into professions when delivering care to patients” (Physiotherapist).

This case study highlights that any type of structural change in healthcare is likely to impact professional identity in allied health due to the diversity of professions and that this needs to be managed accordingly. Beasley et al. ( 2020 ) recommended organizations recognize that AHPs are autonomous clinicians, who are members of several groups (i.e., own profession, healthcare teams and the organization), with all of these diverse roles influencing both their response and adaption to change. They stated that clear communication and affording opportunities to make decisions and provide feedback can improve employees’ perceptions of change and positively impact their wellbeing (Beasley et al. 2020 ; Byers 2017 ). Furthermore, Braithewaite et al. ( 2005 ) recommended organizations concurrently consider both the previous and the new identities throughout a re-structure by explaining the change initiative and supporting employees to transition from the old to the new identity. This approach can help to ensure security for employees, whose group status is threatened by the change process, as well as broaden perceptions of the ingroup, thereby assisting their acceptance of the new, post-change structure. This point flows into the third prominent theme pertaining to staff morale and wellbeing.

Theme 3: morale and wellbeing

Although the written responses analyzed from the survey questions indicated that a high proportion of participants believed the centralized allied health structure was a positive change, the findings also demonstrated that staff perceived morale and wellbeing to be an issue and was negatively impacted across the time the matrix structure was in place. This case study found low morale and wellbeing before re-structuring AHPs working in hospital bed-based services into a centralized allied health structure. This was suggested to be more inherent in broader change that was occurring and associated with several years of ongoing budget cuts and organizational change in adjusting to a new tertiary facility. While there were many supporting statements the following comment expresses the general perception, “there has been many years of incessant change and a lack of support and resourcing for clinical practitioners, with an expectation to just keep doing more with less due to the ongoing issues with the organizations budget” (social worker).

Another influencing factor that occurred a few months following the re-structure was the COVID-19 pandemic, which participants perceived impacted morale and wellbeing. Literature describes the impact of the COVID-19 pandemic, which overwhelmed and stretched healthcare systems past their limits in terms of capacity and resources, while striving to continue to deliver quality care (Søvold et al. 2021 ). This resulted in significant impacts on the mental health and psychosocial wellbeing of frontline healthcare workers (including AHPs) and increased risk of depression and burnout (Søvold et al. 2021 ; Willis et al. 2021 ). The following comment supports this view, “the workloads are unrelenting and leading to both overt and silent burnout. Increasing patient complexity and volume is beyond that which allied health staff can meet discharge planning and patient care demands” (occupational therapist).

Within the narrative feedback, many comments were made that staff were thankful of being in a profession-based structure at the time the pandemic started. Participants believed the one line of accountability and professional expertise allowed immediate decision-making such as being able to mobilize staff quickly to the areas of most need. The following comment highlights this point, “the new structure brought each profession together as a cohesive team which was invaluable during the pandemic where we needed the support from colleagues in our profession to cope and meet the demands” (physiotherapist). During the pandemic, it became very clear that having a flexible and adaptable workforce and an overall professional director that understood the complexities and skill sets of their professional group was extremely important due to managing higher numbers of emergent sick leave.

The negative impact of the pandemic on staff morale and wellbeing was a prominent theme in both the 2021 and 2022 survey results due to workforce shortages and staff feeling significant pressure to do more with less with comments like, “ although overall I agree the new allied health structure has improved a number of parameters, the projected benefits have been clouded by other variables notably budget constraints and ongoing emergent leave due to the pandemic impacting resources” (social worker). Even though the structure was considered positive, the pandemic added another layer of complexity that impacted staff morale negatively within the new structure. The pandemic placed added strain on staffing levels across allied health, nursing, medicine, operational and administration. The staff shortages impacted the organization’s budget as shifts needed to be replaced or staff paid overtime to ensure there were adequate levels of staffing on the inpatient units. Many staff commented, “staff morale could have been much worse in allied health if the matrix structure had still been in place as we would not have been able to be so adaptable and flexible within in our professions” (speech pathologist). Therefore, even with the pressures described, the perception from AHPs was that morale had improved because of the new structure due to increased collaboration and support within each profession. Even though improvement in morale was evident within the allied health workforce, many of the participants perceived low morale was still an issue that required a targeted approach by the allied health leaders, which is discussed next.

Theme 4: Leadership training and resources to support the change

The final prominent theme from the data analysis was extrapolated from the open-ended question pertaining to the enablers that could improve the re-structure. The most prominent were resources and leadership, with many respondents reporting a perceived lack of project support in implementing the new structure. Even though many of the respondents believed the new structure had improved the operating systems, they perceived there was not enough resourcing to support the leaders to implement the change effectively with comments like, “the structure is much better from an operating perspective, however more project resources are needed to help the leaders embed the new structure, particularly business, administration and human resource support for team building and helping staff to accept the change” (physiotherapist). Across the three years, the feedback continued to have a strong theme around lack of resourcing and the need to provide a dedicated project or workforce development officer role(s) so the professional directors could meet all the requirements to implement the change. There was the perception from participants that the under resourcing may have impacted the potential benefits of the re-structure.

Furthermore, the participants described concerns over the professional directors being reactive and that there was a lack of consistency between professions that was reinforcing the perception by participants that the professions were siloing and doing their own thing. The following comment sums up the general sentiment of the survey feedback, “ the professional directors need to establish consistency across the professions in relation to portfolios, expectations, accountability and workloads” (psychologist).

A related theme raised by some participants was the lack of perceived capability and competence pertaining to management and leadership. The director roles were new positions created as part of the re-structure, with some being new incumbents to the organization. It was suggested the directors were not provided with the training they needed to lead and manage complex change. Many participants reinforced this point by providing feedback that for the allied health culture to improve more training was required for some of the professional directors to gain the necessary skills to do this effectively. Comments that reinforce this include, “strong directorship is required to ensure a positive culture, and to support staff to provide safe clinical care, managers need to be empathetic, visible and connect with their staff” (physiotherapist) and “leadership and management training for some professional directors on how to effectively conduct strategic planning, communicate change, lead teams etc. is needed” (social worker).

Mickan et al. ( 2019 ) supported these findings, concluding from their study of allied health managers and employees that for a structure to be successful credible, skilled, and respected allied health leaders were required to enact the systems and processes between AHPs and clinical service managers to ensure the necessary integration within clinical teams. Turato et al. ( 2022 ) findings emphasized the importance of allied health leaders developing the necessary skills in human resource management in hospitals to effectively manage relationships among people. They concluded this would improve morale and wellbeing as allied health managers and leaders would be better equipped to manage incivility through complex change. The following comments emphasize this theme, “ the professional directors should be trained in advanced communication and management skills and they must have a sense of empathy which is almost always overlooked when appointing someone into a management position however, I believe it is a key attribute in managing a large team” (dietitian) and “the allied health leaders need to better understand the needs of clinical practitioners and make an effort to plan collaboratively, in a way that supports direct clinical care” (occupational therapist) .

Conclusions

This study reports on the perceptions, thoughts, and insights of AHPs working in hospital bed-based services that have re-structured from a matrix to a centralized allied health profession-based structure and the consequential impacts on the workforce. The results from the experiences and insights of participants in this case study demonstrated that within public hospital bed-based services, a centralized allied health structure was considered superior to a matrix structure (Boyce 2001 , 2006 ; Mickan et al. 2019 ; Robinson and Compton 1996 ).

The reasons why the centralized structure was superior for AHPs working in bed-based services can be explained through the theory of organizational design, which not only highlights the importance of context, but also in taking a systematic approach to aligning structures, processes, leadership, culture, people, practices, and metrics to enable optimal performance (Burton and Obel 2018 ). Ultimately, the centralized allied health structure was a better person-context fit than the matrix structure. The main reasons being that the centralized structure supported AHPs to operate both administration and clinical practices efficiently through single lines of accountability that could effectively govern and support each profession, all of which improved the culture and morale of AHPs in bed-based services.

In contrast, the previous matrix structure was described by AHPs in this context as complex and confusing, which is reinforced by past research regarding the tell-tale signs of when a matrix structure is failing. The signs included the operational managers not having the necessary knowledge to effectively solve problems being raised by the professional managers. The operations were not coordinated, resource utilization was inefficient and costly, the clinical units were spending excessive time trying to coordinate and negotiate with each other, all of which resulted in staff feeling unhappy and confused (Burton and Obel 2018 ). Further issues described in literature and found in this case study were loss of professional identity, ambiguity, inconsistency, and frequent disagreements which further contributed to lower staff morale among AHPs (Robinson and Compton 1996 ; Turato et al 2023 ).

Hence, this case study demonstrates that an acute and sub-acute bed-based setting is different to other environments in which AHPs work, such as community and primary care settings, outside of the hospital context. In community and primary care settings, staff work autonomously as case managers with a caseload of predominantly medically stable patients that are managed by their local doctor. The pace is slower with minimal pressure to discharge patients quickly from doctors, nurses and administrators that need access to inpatient beds. Therefore, the systems, processes and people can be managed more effectively to cope with sudden changes such as emergent leave, etc. Furthermore, staff who work in these contexts are often more senior AHPs who require less supervision, training, and governance due to having years of experience and expertise. Hence, the structural issues experienced in a fast-paced dynamic hospital setting do not appear to have the same impacts in settings where AHPs work as case managers.

In this case study, the matrix structure did not deliver on the anticipated outcomes for AHPs because the systems, processes and lines of authority required for AHPs to work effectively in this context were not appropriately executed and maintained. Moreover, the climate, leadership, knowledge sharing and decision-making processes at each junction point were not clearly defined or performing (Burton and Obel 2018 ). Further, the findings demonstrate for a matrix structure to work effectively, highly competent allied health managers who have good interpersonal communication, conflict management, negotiation, and political skills to manage up and down the organization is essential (Burton and Obel 2018 ).

This is also true for the centralized structure, even with single lines of accountability, the findings highlighted that leadership/management preparation and training for each professional manager is crucial before, during and after implementation to embed the new structure, manage complex change and ensure efficient performance. The findings demonstrated that this could have done better, including the provision of skilled project resources to support the professional managers to embed the new structure. Finally, the change in professional identity for AHPs is important to consider and manage to ensure consistency within and across professions, particularly in relation to the multidisciplinary team (i.e., individual professional identity versus the overall allied health identities at the clinical unit and management level). Even though the AHPs were returning to a familiar professional identity, it became clear that this needed to be more clearly defined, particularly for those clinicians who had an overall allied health leadership role within the multidisciplinary team.

This case study provides learnings that would be worth further investigation. The first being the importance of considering the evidence and theory of organizational design during the planning phase of a new structure so that all contingencies are considered in relation to AHPs working in contexts such as bed-based services. A number of factors may have contributed to this not being done in this case study, one of which included AHPs not having an allied health role on executive that could inform and provide counsel to administrators about the potential negative outcomes of the matrix structure for AHPs working in bed-based services. Another included the transitioning from regional to tertiary level services and the commissioning team not having a good understanding of what AHPs required to function, but rather taking a global organizational design perspective (i.e., one size fits all approach), which did not consider the specific needs of each professional group and what would be required for a matrix structure to be successful.

The findings in this case study add to the literature and emphasize that the context of public hospital bed-based services is not the same as other contexts and that the way AHPs are structured does have significant impact on their functioning. AHPs in this fast-paced setting need highly specialized skills and clearly defined operational and professional governance structures, systems, and processes in place to function optimally. Furthermore, competent profession-based management and leadership is required to ensure the unique and diverse requirements of each profession is being governed appropriately so AHPs can deliver high quality and prioritized clinical care. Additionally, both executive and professional director organizational representation and advocacy for AHPs in this context is vital so AHPs can contribute positively to the organization’s objectives and performance. In conclusion, there is a need for further research that investigates and reports upon AHPs unique and dynamic professional contexts in which they operate, their position in the healthcare system and the ways in which they respond and adapt to change during organizational re-structures, including the external impacts imposed upon them (Boyce 2001 ; Callan et al. 2007 ; Porter and Wilton 2020 ; Turato et al. 2023 ). Specifically, further research regarding hospital system organizational design components pertaining to AHPs is encouraged, such as resource availability, training, staff turnover, morale, creation of a shared identity, representation, and system efficiencies, such as cost reduction.

Practical implications

This case study warns against organizations re-structuring AHPs in hospital bed-based services without considering the diverse requirements for AHPs to operate successfully in this context. Lack of due diligence in the planning phases of a new or modified organizational design can have substantial detrimental impacts on professional identity, morale and wellbeing and productivity, all of which can lead to poor or delayed outcomes for professional groups such as allied health. Furthermore, Braithewaite (2005) suggests allied health service restructurings would benefit from a combination of process and outcome evaluation measures (e.g., professional identity, retention, staff satisfaction and clinical outcomes). Hence, the findings highlight the importance of considering an evidence-based approach when proposing a new structure in healthcare organizations so critical discussions about how organizational designs can be utilized to enhance service provision by AHPs within particular contexts are prominent. This approach would provide comprehensive evidence for healthcare administrators and commissioning teams to consider before they embark on widespread organizational change (Braithwaite et al. 2005 ; Turato et al. 2023 ).

Data availability

All data have been de-identified and is stored in a workplace drive that is protected by username and password, which can be made available upon request.

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Acknowledgements

The first author would like to acknowledge the support given by the Sunshine Coast Hospital and Health Service with administrative and in-kind provisions.

Institutional review board statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of The Prince Charles Hospital, Queensland Health Human Research (HREC 18/QPCH/238 on 5 July 2018 with an additional approval letter received by TPCH HREC to complete a follow-up survey on 30/08/2021).

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G.T. designed the study and drafted the initial manuscript, which was reviewed and edited by J.W. & R.O. All the authors were equally involved in the analysis of the results and the discussions that led to G.T. finalising the manuscript, which J.W. and R.O reviewed / edited before G.T. submitted to the journal.

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Allied health survey

The new centralized allied health structure for hospital bed-based services went live on 28 January 2020. It was decided the best way to gain feedback about how the new structure is progressing was by an annual confidential survey and follow-up meetings with each profession. We are now asking for your feedback as your opinion is highly valued and very important. The survey will take about 15–20 min to complete; thank you very much for taking the time to answer the following questions:

Do you consent for the confidential data you input into this survey be utilized for research?

Yes, I give consent.

No, I would rather not give consent.

What is your discipline?

Administration.

Allied Health Assistant.

Nutrition & Dietetics.

Occupational Therapy.

Physiotherapy.

Psychology.

Social Work.

Speech Pathology.

Below are the aims and reasons for implementing the change. Please provide your feedback on which of the aims you believe the new structure is achieving and which require more work. Please be specific and provide as much detail as you can about why an aim is being achieved or not achieved.

Reduced patient risk through an enhanced discipline lens

Decreased confusion over reporting lines and improved communication to allied health staff

Decreased duplication of tasks for allied health staff within each service group, e.g., quality, education and training programs, supervision, rostering, mandatory training, and workforce planning tasks such as leave management

Improved flexibility to mobilize the allied health workforce based on clinical priority

Improved governance and accountability of allied health staff

Decreased administration time required to maintain the centralized allied health structure when comparted to the previous matrix (dispersed) structure: i.e., payroll tasks, maintaining rosters, workforce planning

Improved support to the facilities outside of the tertiary facility

Improved ability to implement new models of care, innovation, and research

Please provide as much detail as to whether you believe the reasons/aims for implementation are being achieved (or not achieved) and why.

Please list any barriers or issues you perceive regarding the new structure, providing as much detail as you can about the barrier and/or issue.

Please add any enablers or suggestions that would improve the new structure, providing as much detail as you can about the enabler or suggestion.

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Turato, G., Whiteoak, J. & Oprescu, F. The insights of allied health professionals transitioning from a matrix structure to a centralized profession-based structure within a public hospital setting. J Org Design (2024). https://doi.org/10.1007/s41469-024-00178-w

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DOI : https://doi.org/10.1007/s41469-024-00178-w

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