theory used in case study

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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• Open access
• Published: 27 June 2011

The case study approach

• Sarah Crowe 1 ,
• Kathrin Cresswell 2 ,
• Ann Robertson 2 ,
• Guro Huby 3 ,
• Anthony Avery 1 &
• Aziz Sheikh 2  

BMC Medical Research Methodology volume  11 , Article number:  100 ( 2011 ) Cite this article

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The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

Peer Review reports

Introduction

The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Our aim in writing this piece is to provide insights into when to consider employing this approach and an overview of key methodological considerations in relation to the design, planning, analysis, interpretation and reporting of case studies.

The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically of one or more patients, aims to provide insights into aspects of the clinical case and, in doing so, illustrate broader lessons that may be learnt. In research, the conceptually-related case study approach can be used, for example, to describe in detail a patient's episode of care, explore professional attitudes to and experiences of a new policy initiative or service development or more generally to 'investigate contemporary phenomena within its real-life context' [ 1 ]. Based on our experiences of conducting a range of case studies, we reflect on when to consider using this approach, discuss the key steps involved and illustrate, with examples, some of the practical challenges of attaining an in-depth understanding of a 'case' as an integrated whole. In keeping with previously published work, we acknowledge the importance of theory to underpin the design, selection, conduct and interpretation of case studies[ 2 ]. In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry.

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables 1 , 2 , 3 and 4 ) and those of others to illustrate our discussion[ 3 – 7 ].

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Stake's work has been particularly influential in defining the case study approach to scientific enquiry. He has helpfully characterised three main types of case study: intrinsic , instrumental and collective [ 8 ]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher should define the uniqueness of the phenomenon, which distinguishes it from all others. In contrast, the instrumental case study uses a particular case (some of which may be better than others) to gain a broader appreciation of an issue or phenomenon. The collective case study involves studying multiple cases simultaneously or sequentially in an attempt to generate a still broader appreciation of a particular issue.

These are however not necessarily mutually exclusive categories. In the first of our examples (Table 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables 2 , 3 and 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 – 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables 2 and 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

How are case studies conducted?

Here, we focus on the main stages of research activity when planning and undertaking a case study; the crucial stages are: defining the case; selecting the case(s); collecting and analysing the data; interpreting data; and reporting the findings.

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

For an instrumental case study, selecting a "typical" case can work well[ 8 ]. In contrast to the intrinsic case study, the particular case which is chosen is of less importance than selecting a case that allows the researcher to investigate an issue or phenomenon. For example, in order to gain an understanding of doctors' responses to health policy initiatives, Som undertook an instrumental case study interviewing clinicians who had a range of responsibilities for clinical governance in one NHS acute hospital trust[ 17 ]. Sampling a "deviant" or "atypical" case may however prove even more informative, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collective or multiple case studies, a number of cases are carefully selected. This offers the advantage of allowing comparisons to be made across several cases and/or replication. Choosing a "typical" case may enable the findings to be generalised to theory (i.e. analytical generalisation) or to test theory by replicating the findings in a second or even a third case (i.e. replication logic)[ 1 ]. Yin suggests two or three literal replications (i.e. predicting similar results) if the theory is straightforward and five or more if the theory is more subtle. However, critics might argue that selecting 'cases' in this way is insufficiently reflexive and ill-suited to the complexities of contemporary healthcare organisations.

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

It is also important to consider in advance the likely burden and risks associated with participation for those who (or the site(s) which) comprise the case study. Of particular importance is the obligation for the researcher to think through the ethical implications of the study (e.g. the risk of inadvertently breaching anonymity or confidentiality) and to ensure that potential participants/participating sites are provided with sufficient information to make an informed choice about joining the study. The outcome of providing this information might be that the emotive burden associated with participation, or the organisational disruption associated with supporting the fieldwork, is considered so high that the individuals or sites decide against participation.

In our example of evaluating implementations of electronic health record systems, given the restricted number of early adopter sites available to us, we sought purposively to select a diverse range of implementation cases among those that were available[ 5 ]. We chose a mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems procured centrally by the NPfIT. At one recruited site, it quickly became apparent that access was problematic because of competing demands on that organisation. Recognising the importance of full access and co-operative working for generating rich data, the research team decided not to pursue work at that site and instead to focus on other recruited sites.

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 – 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table 2 )[ 4 ].

Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ]. Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care. The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone.

In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed (e.g. the nature of different cancer care programmes), before considering the emerging similarities and differences in cross-case comparisons (e.g. to explore why one programme is more effective than another). It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth.

Analysing, interpreting and reporting case studies

Making sense and offering a coherent interpretation of the typically disparate sources of data (whether qualitative alone or together with quantitative) is far from straightforward. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases. Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage. An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package.

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table 4 )[ 6 ].

Case study findings can have implications both for theory development and theory testing. They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical (as opposed to statistical) generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

What are the potential pitfalls and how can these be avoided?

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8 )[ 8 , 18 – 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table 9 )[ 8 ].

Conclusions

The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake. Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers. Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery.

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Acknowledgements

We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. This work received no direct funding, but it has been informed by projects funded by Asthma UK, the NHS Service Delivery Organisation, NHS Connecting for Health Evaluation Programme, and Patient Safety Research Portfolio. We would also like to thank the expert reviewers for their insightful and constructive feedback. Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript.

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Home » Case Study – Methods, Examples and Guide

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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• Case Study | Definition, Examples & Methods

Case Study | Definition, Examples & Methods

Published on 5 May 2022 by Shona McCombes . Revised on 30 January 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organisation, 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 analyse the case.

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.

Prevent plagiarism, run a free check.

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

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.

If you find yourself aiming to simultaneously investigate and solve an issue, consider conducting action research . As its name suggests, action research conducts research and takes action at the same time, and is highly iterative and flexible. 

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

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 .

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 analyse 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.

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What Is a Case Study?

Weighing the pros and cons of this method of research

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Cara Lustik is a fact-checker and copywriter.

Verywell / Colleen Tighe

• Pros and Cons

What Types of Case Studies Are Out There?

Where do you find data for a case study, how do i write a psychology case study.

A case study is an in-depth study of one person, group, or event. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes of behavior. Case studies can be used in many different fields, including psychology, medicine, education, anthropology, political science, and social work.

The point of a case study is to learn as much as possible about an individual or group so that the information can be generalized to many others. Unfortunately, case studies tend to be highly subjective, and it is sometimes difficult to generalize results to a larger population.

While case studies focus on a single individual or group, they follow a format similar to other types of psychology writing. If you are writing a case study, we got you—here are some rules of APA format to reference.  

At a Glance

A case study, or an in-depth study of a person, group, or event, can be a useful research tool when used wisely. In many cases, case studies are best used in situations where it would be difficult or impossible for you to conduct an experiment. They are helpful for looking at unique situations and allow researchers to gather a lot of˜ information about a specific individual or group of people. However, it's important to be cautious of any bias we draw from them as they are highly subjective.

What Are the Benefits and Limitations of Case Studies?

A case study can have its strengths and weaknesses. Researchers must consider these pros and cons before deciding if this type of study is appropriate for their needs.

One of the greatest advantages of a case study is that it allows researchers to investigate things that are often difficult or impossible to replicate in a lab. Some other benefits of a case study:

• Allows researchers to capture information on the 'how,' 'what,' and 'why,' of something that's implemented
• Gives researchers the chance to collect information on why one strategy might be chosen over another
• Permits researchers to develop hypotheses that can be explored in experimental research

On the other hand, a case study can have some drawbacks:

• It cannot necessarily be generalized to the larger population
• Cannot demonstrate cause and effect
• It may not be scientifically rigorous
• It can lead to bias

Researchers may choose to perform a case study if they want to explore a unique or recently discovered phenomenon. Through their insights, researchers develop additional ideas and study questions that might be explored in future studies.

It's important to remember that the insights from case studies cannot be used to determine cause-and-effect relationships between variables. However, case studies may be used to develop hypotheses that can then be addressed in experimental research.

Case Study Examples

There have been a number of notable case studies in the history of psychology. Much of  Freud's work and theories were developed through individual case studies. Some great examples of case studies in psychology include:

• Anna O : Anna O. was a pseudonym of a woman named Bertha Pappenheim, a patient of a physician named Josef Breuer. While she was never a patient of Freud's, Freud and Breuer discussed her case extensively. The woman was experiencing symptoms of a condition that was then known as hysteria and found that talking about her problems helped relieve her symptoms. Her case played an important part in the development of talk therapy as an approach to mental health treatment.
• Phineas Gage : Phineas Gage was a railroad employee who experienced a terrible accident in which an explosion sent a metal rod through his skull, damaging important portions of his brain. Gage recovered from his accident but was left with serious changes in both personality and behavior.
• Genie : Genie was a young girl subjected to horrific abuse and isolation. The case study of Genie allowed researchers to study whether language learning was possible, even after missing critical periods for language development. Her case also served as an example of how scientific research may interfere with treatment and lead to further abuse of vulnerable individuals.

Such cases demonstrate how case research can be used to study things that researchers could not replicate in experimental settings. In Genie's case, her horrific abuse denied her the opportunity to learn a language at critical points in her development.

This is clearly not something researchers could ethically replicate, but conducting a case study on Genie allowed researchers to study phenomena that are otherwise impossible to reproduce.

There are a few different types of case studies that psychologists and other researchers might use:

• Collective case studies : These involve studying a group of individuals. Researchers might study a group of people in a certain setting or look at an entire community. For example, psychologists might explore how access to resources in a community has affected the collective mental well-being of those who live there.
• Descriptive case studies : These involve starting with a descriptive theory. The subjects are then observed, and the information gathered is compared to the pre-existing theory.
• Explanatory case studies : These   are often used to do causal investigations. In other words, researchers are interested in looking at factors that may have caused certain things to occur.
• Exploratory case studies : These are sometimes used as a prelude to further, more in-depth research. This allows researchers to gather more information before developing their research questions and hypotheses .
• Instrumental case studies : These occur when the individual or group allows researchers to understand more than what is initially obvious to observers.
• Intrinsic case studies : This type of case study is when the researcher has a personal interest in the case. Jean Piaget's observations of his own children are good examples of how an intrinsic case study can contribute to the development of a psychological theory.

The three main case study types often used are intrinsic, instrumental, and collective. Intrinsic case studies are useful for learning about unique cases. Instrumental case studies help look at an individual to learn more about a broader issue. A collective case study can be useful for looking at several cases simultaneously.

The type of case study that psychology researchers use depends on the unique characteristics of the situation and the case itself.

There are a number of different sources and methods that researchers can use to gather information about an individual or group. Six major sources that have been identified by researchers are:

• Archival records : Census records, survey records, and name lists are examples of archival records.
• Direct observation : This strategy involves observing the subject, often in a natural setting . While an individual observer is sometimes used, it is more common to utilize a group of observers.
• Documents : Letters, newspaper articles, administrative records, etc., are the types of documents often used as sources.
• Interviews : Interviews are one of the most important methods for gathering information in case studies. An interview can involve structured survey questions or more open-ended questions.
• Participant observation : When the researcher serves as a participant in events and observes the actions and outcomes, it is called participant observation.
• Physical artifacts : Tools, objects, instruments, and other artifacts are often observed during a direct observation of the subject.

If you have been directed to write a case study for a psychology course, be sure to check with your instructor for any specific guidelines you need to follow. If you are writing your case study for a professional publication, check with the publisher for their specific guidelines for submitting a case study.

Here is a general outline of what should be included in a case study.

Section 1: A Case History

This section will have the following structure and content:

Background information : The first section of your paper will present your client's background. Include factors such as age, gender, work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses.

Description of the presenting problem : In the next section of your case study, you will describe the problem or symptoms that the client presented with.

Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported.

Your diagnosis : Provide your diagnosis and give the appropriate Diagnostic and Statistical Manual code. Explain how you reached your diagnosis, how the client's symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Section 2: Treatment Plan

This portion of the paper will address the chosen treatment for the condition. This might also include the theoretical basis for the chosen treatment or any other evidence that might exist to support why this approach was chosen.

• Cognitive behavioral approach : Explain how a cognitive behavioral therapist would approach treatment. Offer background information on cognitive behavioral therapy and describe the treatment sessions, client response, and outcome of this type of treatment. Make note of any difficulties or successes encountered by your client during treatment.
• Humanistic approach : Describe a humanistic approach that could be used to treat your client, such as client-centered therapy . Provide information on the type of treatment you chose, the client's reaction to the treatment, and the end result of this approach. Explain why the treatment was successful or unsuccessful.
• Psychoanalytic approach : Describe how a psychoanalytic therapist would view the client's problem. Provide some background on the psychoanalytic approach and cite relevant references. Explain how psychoanalytic therapy would be used to treat the client, how the client would respond to therapy, and the effectiveness of this treatment approach.
• Pharmacological approach : If treatment primarily involves the use of medications, explain which medications were used and why. Provide background on the effectiveness of these medications and how monotherapy may compare with an approach that combines medications with therapy or other treatments.

This section of a case study should also include information about the treatment goals, process, and outcomes.

When you are writing a case study, you should also include a section where you discuss the case study itself, including the strengths and limitiations of the study. You should note how the findings of your case study might support previous research. 

In your discussion section, you should also describe some of the implications of your case study. What ideas or findings might require further exploration? How might researchers go about exploring some of these questions in additional studies?

Need More Tips?

Here are a few additional pointers to keep in mind when formatting your case study:

• Never refer to the subject of your case study as "the client." Instead, use their name or a pseudonym.
• Read examples of case studies to gain an idea about the style and format.
• Remember to use APA format when citing references .

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach .  BMC Med Res Methodol . 2011;11:100.

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach . BMC Med Res Methodol . 2011 Jun 27;11:100. doi:10.1186/1471-2288-11-100

Gagnon, Yves-Chantal.  The Case Study as Research Method: A Practical Handbook . Canada, Chicago Review Press Incorporated DBA Independent Pub Group, 2010.

Yin, Robert K. Case Study Research and Applications: Design and Methods . United States, SAGE Publications, 2017.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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What the Case Study Method Really Teaches

• Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

• Nitin Nohria is the George F. Baker Jr. and Distinguished Service University Professor. He served as the 10th dean of Harvard Business School, from 2010 to 2020.

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• Front Psychol

Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment

This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases.

Introduction

Psychoanalysis has always been, according to its inventor, both a research endeavor and a therapeutic endeavor. Furthermore it is clear from Freud's autobiography that he prioritized the research aspect; he did not become a doctor because he wished to cure people in ill health (Freud, 2001 [1925] ). His invention of the psychoanalytic approach to therapy, involving the patient lying down and associating freely, served a research purpose as much as a therapeutic purpose. Through free association, he would be able to gain unique insight in the human mind. Next, he had to find a format to report on his findings, and this would be the case study. The case study method already existed in medicine (Forrester, 2016 ), but Freud adjusted it considerably. Case studies in medical settings were more like case files, in which the patient was described or reduced to a number of medical categories: the patient became a case of some particular ailment (Forrester, 2016 ). In Freud's hands, the case study developed into Kranken Geschichten in which the current pathology of the patient is related to the whole of his life, sometimes even over generations.

Although Freud's case studies have demonstrably provided data for generations of research by analysts (Midgley, 2006a ) and various scholars (Pletsch, 1982 ; Sealey, 2011 ; Damousi et al., 2015 ), the method of the case study has become very controversial. According to Midgley ( 2006b ), objections against the case study method can be grouped into three arguments. First there is the data problem: case studies provide no objective clinical data (Widlöcher, 1994 ), they only report on what went right and disregard any confusion or mistakes (Spence, 2001 ). Second, there is the data analysis problem: the way in which the observations of the case study are analyzed lack validity; case studies confirm what we already know (Spence, 2001 ). Some go even so far to say that they are purely subjective: Michels calls case studies the “crystallization of the analyst's countertransference” (Michels, 2000 , p. 373). Thirdly, there is the generalizability problem: it is not possible to gain generalizable insight from case studies. Reading, writing and presenting case studies has been described as being a group ritual to affirm analysts in their professional identity, rather than a research method (Widlöcher, 1994 ).

These criticisms stand in contrast to the respect gained by the case study method in the last two decades. Since the 1990s there has been an increasing number of psychoanalytic and psychodynamic clinical case study and empirical case studies being published in scientific journals (Desmet et al., 2013 ; Cornelis et al., in press ). It has also been signaled that the case study method is being revived more broadly in the social sciences. In the most recent, fifth edition of his seminal book on case study research, Yinn ( 2014 ) includes a figure showing the steady increase of the frequency with which the term “case study research” appears in published books in the period from 1980 to 2008.

KEY CONCEPT 1

Clinical case study.

A clinical case study is a narrative report by the therapist of what happened during a therapy together with the therapist's interpretations of what happened. It is possible that certain (semi)-structured assessment instruments, such as a questionnaire or a diagnostic interview are included in clinical case studies, yet it is still the therapist that uses these, interprets and discusses them.

KEY CONCEPT 2

Empirical case studies.

In an empirical case study data are gathered from different sources (e.g., self-report, observation,…) and there is a research team involved in the analyses of the data. This study can take place either in a naturalistic setting (systematic case study) or in a controlled experimental environment (single-case experiment).

In addition to the controversy about the case study method, psychoanalysis has developed into a fragmented discipline. The different psychoanalytic schools share Freud's idea of the unconscious mind, but they focus on different aspects in his theoretical work. Some of the schools still operate under the wings of the International Psychoanalytic Association, while others have established their own global association. Each school is linked to one or several key psychoanalysts who have developed their own version of psychoanalysis. Each psychoanalytic school has a different set of theories but there are also differences in the training of new psychoanalysts and in the therapeutic techniques that are applied by its proponents.

Based on this heterogeneity of perspectives in psychoanalysis, a research group around the Single Case Archive investigated the current status of case study research in psychoanalysis (Willemsen et al., 2015a ). They were particularly interested to know more about the output and methodology of case studies within the different psychoanalytic schools.

KEY CONCEPT 3

Single case archive.

The Single Case Archive is an online archive of published clinical and empirical case studies in the field of psychotherapy ( http://www.singlecasearchive.com ). The objective of this archive is to facilitate the study of case studies for research, clinical, and teaching purposes. The online search engine allows the identification of sets of cases in function of specific clinical or research questions.

Our survey among case study authors about their psychoanalytic school

In order to investigate and compare case studies from different psychoanalytic schools, we first had to find a way of identifying to which school the case studies belonged. This is very difficult to judge straightforwardly on the basis of the published case study: the fact that someone cites Winnicott or makes transference interpretations doesn't place him or her firmly within a particular psychoanalytic school. The best approach was to ask the authors themselves. Therefore, we contacted all case study authors included in the Single Case Archive (since the time of our original study in 2013, the archive has expanded). We sent emails and letters in different languages to 445 authors and received 200 replies (45% response rate). We asked them the following question: “ At the time you were working on this specific case, to which psychoanalytic school(s) did you feel most attached? ” Each author was given 10 options: (1) Self Psychology (1.a Theory of Heinz Kohut, 1.b Post-Kohutian Theories, 1.c Intersubjective psychoanalysis), (2) Relational psychoanalysis, (3) Interpersonal psychoanalysis, (4) Object relational psychoanalysis (4.a Theory of Melanie Klein, 4.b Theory of Donald W. Winnicott, 4.c Theory of Wilfred R. Bion, 4.d Theory of Otto F. Kernberg), (5) Ego psychology (or) “Classic psychoanalysis” (5.a Theories of Sigmund Freud, 5.b Ego psychology, 5.c Post-Ego psychology), (6) Lacanian psychoanalysis, (7) Jungian psychoanalysis, (8) National Psychological Association for Psychoanalysis (NPAP) related theory, (9) Modern psychoanalysis related to the Boston or New York Graduate School of Psychoanalysis (BGSP/NYGSP), (10) Other. Respondents could indicate one or more options.

Analysis of the responses indicated that the two oldest schools in psychoanalysis, Object-relations psychoanalysis and Ego psychology, dominate the field in relation to case studies that are published in scientific journals. More than three quarters of all case study authors (77%) reported these schools of thought to be the ones with which they considered themselves most affiliated. Three more recent schools were also well-represented among case studies: Self Psychology, Relational Psychoanalysis, and Interpersonal Psychoanalysis. Lacanian Psychoanalysis, Jungian Psychoanalysis, NPAP related Theory and Modern Psychoanalysis related to the BGSP/NYGSP were only rarely mentioned by case study authors as their school of thought. This does not mean that clinicians or researchers within these latter schools do not write any case studies. It only means that they publish few case studies in the scientific journals included in ISI-ranked journals indexed in Web of Science. But they might have their own journals in which they publish clinical material.

Our survey demonstrated that the majority of case study authors (59%) feel attached to more than one psychoanalytic school. This was in fact one of the surprising findings in our study. It seems that theoretical pluralism is more rule than exception among case study authors. There were some differences between the psychoanalytic schools though in terms of pluralism. Case study authors who feel attached to Self Psychology and Interpersonal Psychoanalysis are the most pluralistic: 92 and 86%, respectively also affiliate with one or more other psychoanalytic schools. Case study authors who feel attached to Object Relations Psychoanalysis are the “purest” group: only 69% of them affiliate with one or more other psychoanalytic schools.

KEY CONCEPT 4

Theoretical pluralism.

A situation in which several, potentially contradicting, theories coexist. It is sometimes interpreted as a sign of the immaturity of a science, under the assumption that a mature science should arrive at one single coherent truth. Others see theoretical pluralism as unavoidable for any applied discipline, as each theory can highlight only part of reality.

Psychoanalytic pluralism and the case study method

We were not really surprised to find that Object Relations psychoanalysis and Ego psychology were the most dominant schools in the field of psychoanalytic case studies, as they are very present in European, Latin-American and North-American psychoanalytic institutes. We were more surprised to find such a high degree of pluralism among these case study authors, given the fact that disputes between analysts from different schools can be quite ardent (Green, 2005 ; Summers, 2008 ). Others have compared the situation of psychoanalytic schools with the Tower of Babel (Steiner, 1994 ).

It has been argued that the case study method contributes to the degree of theoretical pluralism within psychoanalysis. The reason for this is situated in the reasoning style at the basis of case study research (Chiesa, 2010 ; Fonagy, 2015 ). The author of a psychoanalytic case study makes a number of observations about the patient within the context of the treatment, and then moves to a conclusion about the patient's psychodynamics in general. The conclusion he or she arrives at inductively gains its “truth value” from the number and quality of observations it is based on. This style of reasoning in case study research is very similar to how clinicians reason in general. Clinicians look for patterns within patients and across patients. If they make similar observations in different patients, or if other psychoanalysts make similar observations in their patients, the weight of the conclusion becomes greater and greater. The problem with this reasoning style is that one can never arrive at definite conclusions: even if a conclusion is based on a large number of observations, it is always possible that the next observation disconfirms the conclusion. Therefore, it could be said, it is impossible to attain “true” knowledge.

The above argument is basically similar to objections against any kind of qualitative research. To this, we argue with Rustin ( 2003 ) that there is not one science and no hierarchy of research methods. Each method comes with strengths and weaknesses, and what one gains in terms of control and certainty in a conventional experimental setup is lost in terms of external validity and clinical applicability. Numerous researchers have pleaded for the case study approach as one method among a whole range of research methods in the field of psychoanalysis (Rustin, 2003 ; Luyten et al., 2006 ; Midgley, 2006b ; Colombo and Michels, 2007 ; Vanheule, 2009 ; Hinshelwood, 2013 ). Leuzinger-Bohleber makes a distinction between clinical research and extra-clinical research (Leuzinger-Bohleber, 2015 ). Clinical research is the idiographic type of research conducted by a psychoanalyst who is working with a patient. Unconscious phantasies and conflicts are symbolized and put into words at different levels of abstraction. This understanding then molds the perception of the analyst in subsequent clinical situations; even though the basic psychoanalytic attitude of “not knowing” is maintained. The clinical case study is clinical research par excellence . Extra-clinical research consists in the application of different methodologies developed in the natural and human sciences, to the study of the unconscious mind. Leuzinger-Bohleber refers to empirical psychotherapy research, experimental research, literature, cultural studies, etc. We believe that the clinical case study method should step up and claim its place in psychoanalytic research, although we agree that the method should be developed further. This paper and a number of others such as Midgley ( 2006b ) should facilitate this methodological improvement. The clinical research method is very well-suited to address any research question related to the description of phenomena and sequences in psychotherapy (e.g., manifestation and evolution of symptoms and therapeutic relationship over time). It is not suitable for questions related to causality and outcome.

We also want to point out that there is a new evolution in the field of psychotherapy case study research, which consists in the development of methodologies for meta-studies of clinical case studies (Iwakabe and Gazzola, 2009 ). The evolution builds on the broader tendency in the field of qualitative research to work toward integration or synthesis of qualitative findings (Finfgeld, 2003 ; Zimmer, 2006 ). The first studies which use this methodology have been published recently: Widdowson ( 2016 ) developed a treatment manual for depression, Rabinovich ( 2016 ) studied the integration of behavioral and psychoanalytic treatment interventions, and Willemsen et al. ( 2015b ) investigated patterns of transference in perversion. The rich variety of research aims demonstrates the potential of these meta-studies of case studies.

KEY CONCEPT 5

Meta-studies of clinical case studies.

A meta-study of clinical case studies is a research approach in which findings from cases are aggregated and more general patterns in psychotherapeutic processes are described. Several methodologies for meta-studies have been described, including cross-case analysis of raw data, meta-analysis, meta-synthesis, case comparisons, and review studies in general.

Lack of basic information in psychoanalytic case studies

The second research question of our study (Willemsen et al., 2015a ) concerned the methodological, patient, therapist, and treatment characteristics of published psychoanalytic case studies. All studies included in the Single Case Archive are screened by means of a coding sheet for basic information, the Inventory of Basic Information in Single Cases (IBISC). The IBISC was designed to assess the presence of basic information on patient (e.g., age, gender, reasons to consult), therapist (e.g., age, gender, level of experience), treatment (e.g., duration, frequency, outcome), and the methodology (e.g., therapy notes or audio recoding of sessions). The IBISC coding revealed that a lot of basic information is simply missing in psychoanalytic case studies (Desmet et al., 2013 ). Patient information is fairly well-reported, but information about therapist, treatment and methodology are often totally absent. Training and years of experience are not mentioned in 84 and 94% of the cases, respectively. The setting of the treatment is not mentioned in 61% of the case studies. In 80% of the cases, it was not mentioned whether the writing of the case studies was on the basis of therapy notes, or audiotapes. In 91% of the cases, it was not mentioned whether informed consent was obtained.

Using variables on which we had more comprehensive information, we compared basic information of case studies from different psychoanalytic schools. This gave us a more detailed insight in the type of case studies that have been generated within each psychoanalytic school, and into the difference between these schools in terms of the kind of case study they generate. We found only minimal differences. Case studies in Relational Psychoanalysis stand out because they involve older patients and longer treatments. Case studies in Interpersonal Psychoanalysis tend to involve young, female patients and male therapists. Case study authors from both these schools tend to report on intensive psychoanalysis in terms of session frequency. But for the rest, it seems that the publication of case studies throughout the different psychoanalytic schools has intensified quite recently.

Guidelines for writing clinical case studies

One of the main problems in using psychoanalytic case studies for research purposes is the enormous variability in quality of reporting and inconsistency in the provision of basic information about the case. This prevents the reader from contextualizing the case study and it obstructs the comparison of one case study with another. There have been attempts to provide guidelines for the writing of case studies, especially in the context of analytic training within the American Psychoanalytic Association (Klumpner and Frank, 1991 ; Bernstein, 2008 ). However, these guidelines were never enforced for case study authors by the editors from the main psychoanalytic journals. Therefore, the impact of these guidelines on the field of case study research has remained limited.

Here at the end of our focused review, we would like to provide guidelines for future case study authors. Our guidelines are based on the literature and on our experience with reading, writing, and doing research with clinical case studies. We will include fragments of existing case studies to clarify our guidelines. These guidelines do not provide a structure or framework for the case study; they set out basic principles about what should be included in a case study.

Basic information

First of all, we think that a clinical case study needs to contain basic information about the patient, the therapist, the treatment, and the research method. In relation to the patient , it is relevant to report on gender, age (or an age range in which to situate the patient), and ethnicity or cultural background. The reader needs to know these characteristics in order to orientate themselves as to who the patient is and what brings them to therapy. In relation to the therapist , it is important to provide information about professional training, level of professional experience, and theoretical orientation. Tuckett ( 2008 ) emphasizes the importance for clinicians to be explicit about the theory they are using and about their way of practicing. It is not sufficient to state membership of a particular group or school, because most groups have a wide range of different ways of practicing. In relation to the treatment itself, it is important to be explicit about the kind of setting, the duration of treatment, the frequency of sessions, and details about separate sequences in the treatment (diagnostic phase, follow-up etc.). These are essential features to share, especially at a time when public sector mental health treatment is being subjected to tight time restrictions and particular ways of practising are favored over others. For example short-term psychotherapies are being implemented in public services for social and economic reasons. While case studies carried out in the public sector can give us information on those short-term therapies, private practice can offer details about the patient's progress on a long-term basis. Moreover, it is important to report whether the treatment is completed. To our astonishment, there are a considerable number of published case studies on therapies that were not finished (Desmet et al., 2013 ). As Freud ( 2001 [1909] , p. 132) already advised, it is best to wait till completion of the treatment before one starts to work on a case study. Finally, in relation to the research method , it is crucial to mention which type of data were collected (therapy notes taken after each session, audio-recordings, questionnaires, etc.), whether informed consent was given, and in what way the treatment was supervised. Clinicians who would like to have help with checking whether they included all necessary basic information case use the Inventory for Basic Information in Single Cases (IBISC), which is freely available on http://www.singlecasearchive.com/resources .

Motivation to select a particular patient

First of all, it is crucial to know what the motivation for writing about a particular case comes from. Some of the following questions should be kept in mind and made explicit from the beginning of the case presentation. Why is it interesting to look at this case? What is it about this case or the psychotherapist's work that can contribute to the already existing knowledge or technique?

“This treatment resulted in the amelioration of his [obsessive-compulsive] symptoms, which remained stable eight years after treatment ended. Because the standard of care in such cases has become largely behavioral and pharmacological, I will discuss some questions about our current understanding of obsessive-compulsive phenomena that are raised by this case, and some of the factors that likely contributed to the success of psychoanalytic treatment for this child (McGehee, 2005 , p. 213–214).”

This quotation refers to a case that has been selected on the basis of its successful outcome. The author is then interested to find out what made this case successful.

Informed consent and disguise

As regulations on privacy and ethics are becoming tighter, psychotherapists find themselves with a real problem in deciding what is publishable and what is not. Winship ( 2007 ) points out that there is a potential negative effect of research overregulation as clinicians may be discouraged from reporting ordinary and everyday findings from their clinical practice. But he also offers very good guidelines for approaching the issue of informed consent. A good practice is asking for consent either at the start of the treatment or after completion of the treatment: preferably not during treatment. It is inadvisable to complete the case study before the treatment has ended. It is also advisable that the process of negotiating consent with the patient is reported in the case study.

“To be sure that Belle's anonymity was preserved, I contacted her while writing this book and told her it would not be published without her complete approval. To do this, I asked if she would review every word of every draft. She has (Stoller, 1986 , p. 217).”

In relation to disguise, one has to strike a balance between thin and thick disguise. Gabbard ( 2000 ) suggests different useful approaches to disguising the identity of the patient.

Patient background and context of referral or self-referral

It is important to include relevant facts about the patient's childhood, family history, siblings, any trauma or losses and relationship history (social and romantic) and the current context of the patient's life (family, working, financial). The context of referral is also key to understanding how and why the patient has come to therapy. Was the patient encouraged to come or had wanted to come? Has there been a recent crisis which prompted the intervention or an on-going problem which the patient had wanted to address for some time?

“Michael was one of the youngest children in his family of origin. He had older brothers and sisters who had been received into care before his birth. His parents separated before he was born. There had been some history of violence between them and Michael was received into care on a place of safety order when he was an infant because his mother had been unable to show consistent care toward him (Lykins Trevatt, 1999 , p. 267).”

Patient's narrative, therapist's observations, and interpretations

A case study should contain detailed accounts of key moments or central topics, such as a literal transcription of an interaction between patient and therapist, the narration of a dream, a detailed account of associations, etc. This will increase the fidelity of the case studied, especially when both patient's and therapist's speech are reported as carefully as possible.

“Martha spoke in a high-pitched voice which sounded even more tense than usual. She explained that her best friend's mum had shouted at her for being so withdrawn; this made her angry and left her feeling that she wanted to leave their home for good. I told Martha that she often tried to undo her bad feelings by acting quickly on her instincts, as she did not feel able to hold her feelings in her mind and bring them to her therapy to think about with me. Martha nodded but it was not clear whether she could really think about what I just said to her. She then said that she was being held in the hospital until a new foster placement could be found. “In the meantime,” she said in a pleased tone, “I have to be under constant supervision” (Della Rosa, 2015 , p. 168).”

In this example, observations of nonverbal behavior and tonality are also included, which helps to render a lively picture of the interaction.

Interpretative heuristics

In which frame of reference is the writer operating? It is important to know what theories are guiding the therapist's thinking and what strategies he employs in order to deal with the clinical situation he is encountering. Tuckett ( 1993 ) writes about the importance of knowing what “explanatory model” is used by the therapist in order to make sense of the patient and to relate his own thinking to a wider public for the purpose of research. This idea is also supported by Colombo and Michels ( 2007 ) who believe that making theoretical orientations as explicit as possible would make the case studies intelligible and more easily employed by the research community. This can be done by the therapists explaining why they have interpreted a particular situation in the way they have. For example, Kegerreis in her paper on time and lateness (2013) stresses throughout how she is working within the object-relations framework and looking out for the patient's use of projective mechanisms.

“She was 10 minutes late. Smiling rather smugly to herself she told me that the wood supplied for her new floor had been wrongly cut. The suppliers were supposed to come and collect it and hadn't done so, so she had told them she was going to sell it to a friend, and they are now all anxious and in a hurry to get it. I said she now feels as if she has become more powerful, able to get a response. She agrees, grinning more, telling me she does have friends who would want it, that it was not just a ploy. She said she had found it easier to get up today but was still late. I wondered if she had a sense of what the lateness was about. She said it was trying to fit too much in. She had been held up by discussing the disposal of rubble with her neighbors. I said I thought there was a link here with the story about the wood. In that she had turned the situation around. She had something that just didn't work, had a need for something, but it was turned around into something that was the suppliers' problem. They were made to feel the urgency and the need. Maybe when she is late here she is turning it around, so it is me who is to be uncertain and waiting, not her waiting for her time to come. We maybe learn here something of her early object relationships, in which being in need is felt to be unbearable, might lead to an awful awareness of lack and therefore has to be exported into someone else. One could go further and surmise that in her early experience she felt teased and exploited by the person who has the power to withhold what you need (Kegerreis, 2013 , p. 458).”

There can be no doubt reading this extract about the theoretical framework which is being used by the therapist.

Reflexivity and counter-transference

A good case study contains a high degree of reflexivity, whereby the therapist is able to show his feelings and reactions to the patient's communication in the session and an ability to think about it later with hindsight, by himself or in supervision. This reflexivity needs to show the pattern of the therapist's thinking and how this is related to his school of thought and to his counter-transferential experiences. How has the counter-transference been dealt with in a professional context? One can also consider whether the treatment has been influenced by supervision or discussion with colleagues.

“Recently for a period of a few days I found I was doing bad work. I made mistakes in respect of each one of my patients. The difficulty was in myself and it was partly personal but chiefly associated with a climax that I had reached in my relation to one particular psychotic (research) patient. The difficulty cleared up when I had what is sometimes called a ‘healing’ dream. […] Whatever other interpretations might be made in respect of this dream the result of my having dreamed it and remembered it was that I was able to take up this analysis again and even to heal the harm done to it by my irritability which had its origin in a reactive anxiety of a quality that was appropriate to my contact with a patient with no body (Winnicott, 1949 , p. 70).”

Leaving room for interpretation

A case study is the therapist's perspective on what happened. A case study becomes richer if the author can acknowledge aspects of the story that remain unclear to him. This means that not every bit of reported clinical material should be interpreted and fitted within the framework of the research. There should be some loose ends. Britton and Steiner ( 1994 ) refer to the use of interpretations where there is no room for doubt as “soul murder.” A level of uncertainty and confusion make a case study scientifically fruitful (Colombo and Michels, 2007 ). The writer can include with hindsight what he thinks he has not considered during the treatment and what he thinks could have changed the course for the treatment if he had been aware or included other aspects. This can be seen as an encouragement to continue to be curious and maintain an open research mind.

Answering the research question, and comparison with other cases

As in any research report, the author has to answer the research question and relate the findings to the existing literature. Of particular interest is the comparison with other similar cases. Through comparing, aggregating, and contrasting case studies, one can discover to what degree and under what conditions, the findings are valid. In other words, the comparison of cases is the start of a process of generalization of knowledge.

“Although based on a single case study, the results of my research appear to concur with the few case studies already in the field. In reviewing the literature on adolescent bereavement, it was the case studies that had particular resonance with my own work, and offered some of the most illuminating accounts of adolescent bereavement. Of special significance was Laufer's ( 1966 ) case study that described the narcissistic identifications of ‘Michael’, a patient whose mother had died in adolescence. Both Laufer's research and my own were conducted using the clinical setting as a basis and so are reflective of day-to-day psychotherapy practice (Keenan, 2014 , p. 33).”

As Yinn ( 2014 ) has argued for the social sciences, the case study method is the method of choice when one wants to study a phenomenon in context, especially when the boundaries between the phenomenon and the context are fussy. We are convinced that the same is true for case study methodology in the fields of psychoanalysis and psychotherapy. The current focused review has positioned the research method within these fields, and has given a number of guidelines for future case study researchers. The authors are fully aware that giving guidelines is a very tricky business, because while it can channel and stimulate research efforts it can as well-limit creativity and originality in research. Moreover, guidelines for good research change over time and have to be negotiated over and over again in the literature. A similar dilemma is often pondered when it comes to qualitative research (Tracy, 2010 ). However, our first impetus for providing these guidelines is pedagogical. The three authors of this piece are experienced psychotherapists who also work in academia. A lot of our students are interested in doing case study research with their own patients, but they struggle with the methodology. Our second impetus is to improve the scientific credibility of the case study method. Our guidelines for what to include in the written account of a case study, should contribute to the improvement of the quality of the case study literature. The next step in the field of case study research is to increase the accessibility of case studies for researchers, students and practitioners, and to develop methods for comparing or synthesizing case studies. As we have described above, efforts in that direction are being undertaken within the context of the Single Case Archive.

Author contributions

JW has written paragraphs 1–4; ER and JW have written paragraph 5 together; SK has contributed to paragraph 5 and revised the whole manuscript.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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A Real Case Application of Game Theoretical Concepts in a Complex Decision-Making Process: Case Study ERTMS

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• Published: 18 October 2021
• Volume 31 , pages 153–185, ( 2022 )

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• Femke Bekius   ORCID: orcid.org/0000-0003-4357-7371 1 ,
• Sebastiaan Meijer 2 &
• Hugo Thomassen 3  

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Engineering systems are complex, amongst others due to the interdependencies between actor and technical aspects. This complexity has consequences for the way of designing such systems and, in particular, for the decision-making process. Recognizing the impossibility of having an optimal system design in such complex systems, this article explores how a game theoretical characterization of a decision-making process assists in the organization and design of the process itself. In contrast to a game theoretical analysis, which results in optimal outcomes, the characterization is fed back to the designers of the decision-making process during the course of the process. The study analyses how the game concept characterization was used, i.e., which strategies were defined during the game theory interventions, and what the consequences of these strategies were for the design of the decision-making process. The design of a new safety system ERTMS for the Dutch railway sector is the context in which the study was performed. The contribution is a successful approach to complex decision-making in multi-actor systems by identification of multiple game concepts over time, with periodic feedback into the designing system, and not the actual decision-making itself. In short, it supported adapting to an actor focus on the process, it affected the role and responsibilities of the program management, it contributed to (de)coupling of issues, and it influenced the capability of creating awareness amongst actors of the urgency of the decision window. The paper ends with reflections on the experience of intervening in a decision-making process with game theoretical concepts.

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1 Introduction

Large scale infrastructures in our society are associated with complex stakeholder constellations and equally complex technological challenges and interdependencies. It is well-known that an integrated management of both aspects is essential for the success of infrastructures and society at large.

Different perspectives on engineering systems exist, as they can be interpreted as a large technological system (Hughes 1987 ), as a Socio-Technical System (STS) (Trist and Bamforth 1951 ), as a System-of-Systems (SoS) (DeLaurentis 2005 ) or as a Complex Adaptive System (CAS) (Holland 1995 ; Miller and Page 2007 ).

Considering this evolution of system theories, we observe an increase in focus on the interactions between actor and technical aspects. According to a CAS perspective, systems consist of interdependent subsystems that need to be aligned to let the entire system function. The relations between subsystems are dynamic and evolving over time and, as a result, systems show emergent and chaotic behavior (Holland 1992 ). The increased understanding of the complexity of systems has consequences for the designing function. In traditional engineering design, one actor could decide on an optimal solution. Nowadays, multiple actors are involved, each responsible for their own subsystem with disjoint perspectives on optimality and incentives. This is embodied in the concept of Engineering Systems (De Weck et al. 2011 ).

To capture and address the uncertainties in decision-making processes, several types or levels of complexity have been proposed. System complexity is rooted in the engineering sciences (Hughes 1987 ) and actor complexity has its origins in the social sciences (Thissen and Walker 2013 ). This distinction provides insight into the different elements of the process, but the real complexity is represented by the interdependencies within and between complexity levels (De Bruijn and Herder 2009 ). According to De Bruijn and Ten Heuvelhof ( 2018 ), decision-making processes are complex due to three main characteristics: (i) unstructured problems: there are many technological uncertainties, problems and solutions; (ii) networks: multiple stakeholders with different incentives are interdependent; (iii) dynamics: context and environment continuously change. Therefore, we distinguish three levels of complexity: technical, actor and context complexity. Moreover, the theory on complex decision-making and multi-actor systems talks about games (Kickert et al. 1997 ; Scharpf 1997 ; Axelrod 1984 ).

Game concepts describe the behavior of and interaction between actors who have to make a decision. The concepts originate from different disciplines - ranging from formal game theory to public administration (Bekius et al. 2016 ; Rasmusen 2007 ). The game concept approach provides structure in the ill-structured decision-making process by making the game elements, such as actors, actions and strategies, precise and specify the type of game. Moreover, the game concepts allow for an analysis of different scenarios and possible outcomes which creates a perspective of action. Different from formal game theory the approach does not make the assumption of rationality explicit or specifies an optimal or right-versus-wrong outcome. Rather, the game concept approach focuses on incentive structures, responsibility and ownership of actors, i.e., actors’ agency, and dilemmas existing in the decision-making process (Bekius 2019 ).

In this paper, we explore how a game theoretical characterization of a decision-making process assists in the organization and design of the process itself. Describing decision-making situations in game theoretical terms is not new. This paper goes one step further: theoretical models are used to assist in the continuous design of a complex negotiation process. The exploratory nature of the paper allows us to assess the value of descriptive insights for a process without being prescriptive.

The objectives of this paper are (i) to apply game theoretical concepts in a real complex decision-making process, (ii) to give back the game theoretical characterization to the designers of the decision-making process and observe the impact on the process, and (iii) to provide lessons learned from the experience (intervening in a decision-making process with game theoretical concepts) for both researchers and practitioners. Our research question is: What are the effects of giving back a game theoretical characterization of a decision-making process to the designers of the process on the process itself?

The paper contributes to the theoretical framework on complex decision-making in multi-actor systems [among others De Bruijn et al. ( 2010 ); De Bruijn and Ten Heuvelhof ( 2018 ); Kickert et al. ( 1997 )]. We identify multiple game concepts, show how they interact and characterize the situation instead of finding an optimal outcome and defining the rules of the game. Moreover, we extend the framework by specifying particular game concepts instead of talking about the decision-making game in general terms.

Moreover, the paper contributes to the use of game theoretical models and formal models in general. It yields an example in which theoretical models are used to assist in a complex decision-making process. Opposed to the classical use of game theoretical concepts in a multi-actor setting which aims at an optimal outcome of a particular decision moment, the game theoretical characterization in this process describes a running process. Additionally, the characterization was given back to the designers of the process while the process was still going on. We explore the effects of periodic feedback to designers of the decision-making process on the process. In particular, we describe how the characterization is translated into strategies and present the consequences of these strategies for the design of the decision-making process.

The focus of this paper is to intervene in the design of the decision-making process without actively intervening in the behavior of actors. This is different from gaming simulation which is an active intervention in actor behavior and in which players are taken out of their usual context to play a game in a so-called safe environment. The use and effect of such interventions have been assessed in different studies (Bekebrede and Meijer 2009 ; Meijer 2012b ; Mayer et al. 2005 ; De Caluwé 1997 ), but an evaluation of the interventions in the design of decision-making processes is missing (Grogan and Meijer 2017 ).

Finally, we contribute to the decision support field by outlining lessons learned from the experience. In several interventions the game theoretical characterization is presented to and discussed with senior program managers. An analysis of the interventions provides insight into the consequences of giving back such information for the process of decision-making. Moreover, apart from a descriptive value at process level, the analysis resulted in learning points for us as researchers. The learning points are framed as points to consider when repeating this study in different organizations or domains to overcome the exploratory character of the current study.

1.1 Case Study: Railways

The European Rail Traffic Management System (ERTMS) is a European project to standardize control and improve safety of the railway system. The aim of the project is to “enhance cross-border interoperability and signaling procurement by creating a single Europe-wide standard for railways with the final aim of improving competitiveness of the rail sector” (Schuitemaker et al. 2018 ). For the Netherlands, it entails a major systems transition from an analogue to a digital system for the entire country. We will introduce the context of the case study using three complexity levels.

The technical complexity consists of the difficult content of the technical aspects and the multiple interdependencies that exist between theses technical aspects. For example, implementation strategies in the Netherlands have immediate consequences for the timing of replacing trains. There is uncertainty whether program goals regarding interoperability, capacity, speed, safety and reliability can be reached. The complexity of and interdependence between these goals makes it nearly impossible to translate them to technical specifications for all subsystems.

The complex multi-actor setting with many formal and informal rules, diffuse responsibilities towards the systems results in a complicated governance and is captured by the actor complexity . The actors (passenger and freight train operators, contractors, leasing companies, infrastructure manager, ministries, the Parliament, and European Union) have different incentives, are not hierarchically organized, but are mutually dependent and responsible for different parts of the system. The main actors, ProRail, NS, the Ministry of Infrastructure and Water management (I&W), and freight operators, have different perspectives on time lines.

The context complexity comprises different dynamics: other decisions made on the railway system such as storage of trains overnight are coupled to ERTMS decision-making, historical decisions which assume the implementation of ERTMS influence the current decision-making; political pressure from European Union requirements exists as well as decisions made by other European Union countries regarding ERTMS. Moreover, the technology is new and developing. Hence, the status of the technology today is not the status at the moment of implementation.

The complexities and interdependencies create an ill-structured, and sometimes messy, decision-making process with many uncertainties. The program management of ERTMS, responsible for the design of the decision-making process and advising on the decisions to be made, can impossibly oversee the entire process. There is thus a need to gain insight into the strategic behavior of actors, actors’ power and responsibilities and how both evolve in a dynamic environment. More understanding of the decision-making process and a perspective of action could help the program management in the design of the decision-making process. To address both points we propose the use of game theoretical concepts as further explored in this paper.

The paper is structured as follows: in Sect.  2 , we introduce the game concept approach and position the approach in the broader field of decision support methods. The methodology for this paper is outlined in Sect.  3 where we distinguish between a characterization of the decision-making process and returning the characterization into the designing system. In Sect.  4 , we present a timeline of events capturing the main elements of the decision-making process together with the game concept elements and interventions. The analysis of the four interventions is shown in Sect.  5 . Finally, we provide lessons learned from the series of interventions in Sect.  6 before we conclude the paper and discuss the results in Sect.  7 .

2 Game Concept Approach

In this paper, we use game concepts to characterize a complex decision-making process. Subsequently, the characterization is given to designers of the decision-making process in interventions to support the process. The game concept approach is introduced by presenting the theoretical framework in which the approach fits and positioning the approach in the broader field of decision support methods. Finally, we introduce the seven game concepts that are central in this paper.

2.1 Theoretical Framework

Complex decision-making in multi-actor systems is a broad field that has been studied by many researchers (among others De Bruijn et al. ( 2010 ); De Bruijn and Ten Heuvelhof ( 2018 ); Kickert et al. ( 1997 )). It goes beyond the scope of this paper to give a detailed overview of this literature. We have restricted ourselves to a couple of features that explain why decision-making processes in multi-actor systems are complex. They include: networks of multiple interdependent actors, wicked or unstructured problems, and a dynamic environment.

Actors perform strategies to deal with the complexity of a decision-making process. This can take place at (at least) two levels. First, at the level of individual actors and their strategies, for example, wait-and-see behavior or keeping-options-open. Second, at the process level actors develop strategies or interventions to deal with the unstructured process itself. For instance, share or hide information, or introduce new issues as an attempt to structure the process.

We consider the following three elements of the theoretical framework on complex decision-making in multi-actor systems to be relevant for the game concept approach: First, the decision-making process can be seen as a game. Actors perform strategic behavior and follow the rules of the game to reach an (optimal) outcome or consensus. Second, descriptive analysis of the decision-making process in terms of game elements takes into account the dynamics and context of the process. Third, the analysis of the decision-making process forms the basis for interventions in the behavior of actors.

In the remainder of this paper, we show how the game concept approach used in multiple interventions extends the theoretical framework by addressing the above mentioned elements.

2.2 Decision Support Methods

As the game concept approach is used to support decision-making processes, more precisely to support the design of the process, we present a selection of approaches and decision support methods applied in cases on large infrastructure systems. We show for each method how the game concept approach is different or complementary.

Many examples of formal applications of game theoretical models to support decision-making exist (Chen et al. 2012 ; Cantarelli et al. 2013 ; Hollander and Prashker 2006 ; Osman and Nikbakht 2014 ). Game theoretic modeling often simplifies the situation to one game and therefore explains only a small part of the process (Cohen 2015 ). In contrast, we identify multiple game concepts in a decision-making process and are interested in the interactions between identified game concepts to represent the dynamics of the process more accurately. Another feature of formal game theoretical modeling is that it usually aims at finding an optimal or stable outcome and thereby assumes the rationality of actors (Howard 1994 ). This assumption is quite strong, especially when we consider the fact that actors have different responsibilities and thus perceive an outcome differently. The game concept approach rather presents different scenarios and outcomes with potential risks. Moreover, game theoretical models are rarely presented to decision makers in their formal way (Camerer 1991 ). The game concept approach does not use the formal presentation of games which makes it suitable for use in interventions with decision makers.

Several design theory frameworks are available which aim to describe the design process of (engineering) systems (Reich 1995 ; Reich et al. 1996 ; Meijer et al. 2014 ). Such frameworks suggest that the components (e.g. product, actor, institution) need to be connected to or reflecting upon one another (Geels 2004 ; Hermans et al. 2013 ; Geyer and Davies 2000 ; Hardy et al. 2005 ). However, the problem with those methods, which is why they are less suitable for application to support decision-making, is that they either do not involve all components (Pluchinotta et al. 2019 ) or the framework is not fully operationalized. The game concept approach is applied to design processes to explain misalignments between different components in the process (Bekius and Meijer 2018 ).

Some well-known decision support models are Multi Criteria Decision Analysis (MCDA) (Ishizaka and Nemery 2013 ; Nikas et al. 2018 ), Cost-Benefit Analysis (CBA) (Flyvbjerg et al. 2008 ) and Analytical Hierarchy Process (AHP) (Ossadnik et al. 2016 ). The models compare different alternatives, or variants, based upon various evaluation criteria that can have different weights (Dodgson et al. 2009 ; Corsair et al. 2009 ). Group Decision Support Systems (GDSS) are specific Information and Communications Technology (ICT) applications for the support of group interaction and decision-making (Mayer and De Jong 2004 ; Eden 1992 ). De Vreede and Dickson ( 2000 ) use a Group Support System (GSS) to develop and evaluate a participatory design process. Their research approach to support the design of organizational processes relates to our study. However, the game concept approach particularly focuses on interactions between actors with selected game theoretical models. Moreover, we evaluate the use of the game concept approach in a running process compared to a complete redesign of a process. The context elements of a decision-making process, such as the impact of the political environment on the decision, are difficult to quantify and these elements are usually not covered by the decision-based models (Mayer et al. 2005 ). The game concept approach is able to reflect the political dimensions of a decision-making process by focusing on incentive structures of actors as shown in two case studies of the Dutch railway sector (Bekius et al. 2018 ).

Gaming simulations have been used in various studies to support decision-making on infrastructure systems (Mayer et al. 2004 ; Bekebrede and Meijer 2009 ), including the Dutch railway sector (Meijer 2012a , 2015 ; Lo et al. 2013 ). Which elements of the process to include in the game design is crucial for the success of a gaming simulation (Salen and Zimmerman 2004 ). The game concept approach helps in identifying the strategic games being played in the decision-making process in terms of actor constellation, its responsibilities and power relations and how the constellation evolves over time (Roungas et al. 2019 ). Gaming simulation is an active intervention in the behavior of actors. Participants are taken out of their usual context to participate in a game. The game concept approach targets a different type of participants and does not intervene directly in the decision-making process, but more indirectly in the design of the process.

Operational research is a discipline which has developed a plethora of methods and tools to support decision-making processes (De Gooyert 2016 ). Problem Structuring Methods (PSM) , and as subcategory Game Structuring Methods (GSM), are a collection of techniques to model a situation one want to change (Cunningham et al. 2014 ; Rouwette et al. 2009 ). Usually the model is applied by a group of people to structure a situation, to facilitate reaching consensus or to negotiate on what needs to change instead of making a decision (Mingers and Rosenhead 2001 ). Hermans and Thissen ( 2009 ) present an overview of actor analysis methods and their limitations and potentials by focusing on the trade-off between analytic quality and practical usability. Although features of the various stakeholder and actor analysis methods overlap with the game concept approach there are three important characteristics that distinguish them: (i) game concepts focus on the behavior of actors and interactions between them, including actor’s agency, i.e., responsibility and ownership of the system resulting in power relations; (ii) game concepts characterize the process of decision-making and thereby include the dynamics; and (iii) game concepts are developed in such a way that they can be used by decision makers themselves and eventually create a ‘perspective of action’ in the form of strategies.

So far, we introduced the theoretical framework in which we position the game concept approach and showed how the game concept approach relates to other methods investigating and supporting decision-making processes. In short, the game concept approach adds a structured way to address the constellation of actors including their responsibilities and power relations and the dynamics. Moreover, the approach is not only theoretical, but can be used with and by decision makers as we will show later in the paper. Next, we introduce the selection of game concepts which are central in this paper.

2.3 Game Concepts

In this paper, we use seven different game concepts to characterize a complex decision-making process. The selection of game concepts is based on characteristics of complex decision-making processes such as multiple actors forming a network of interdependencies and where reaching a collective decision is the aim of the process. A taxonomy of game concepts is provided in an earlier paper, and we refer to Bekius ( 2019 ) and Bekius and Meijer ( 2020 ) for a detailed explanation of the selection criteria. The game concepts are illustrated by an example and defined in terms of the context in which they appear, the process they characterize, their possible results, and potential risks in Table  1 .

The Multi-Issue game (M-I game) characterizes a situation with multiple actors having different incentives aim to reach consensus in a decision-making process that was in a deadlock in the first place (Winter 1997 ; De Bruijn and Ten Heuvelhof 2018 ; De Bruijn and Ten Heuvelhof 2002 ; Sebenius 1983 ).

Imagine you are part of a family (father, mother and three children) and the father sees the opportunity to have a summer holiday together. He decides on a destination and period in summer, but not everyone likes his idea. The family members have different preferences regarding the summer holiday issue and the situation gets stuck in a deadlock. How could the father resolve it? An option is to take control over the agenda and introduce new issues that matter to the family members, such as a skiing holiday during winter or having a pet. The new agenda creates a broadened solution space which enables the forming of coalitions within the family, the exchanging of issues, and the creation of a give-and-take game. As a result, the deadlock could be resolved and the family members could reach consensus on the larger set of issues. A serious risk is that too many issues are added to the agenda such that the game becomes over-complex.

The Principal-Agent game (P-A game) represents a hierarchical relation between a principal and an agent. The principal is dependent on the agent because of its knowledge and expertise regarding a certain decision. The game explains the power position of the subordinate, i.e., the agent (Stauvermann 2004 ; Gintis 2000 ; Braun and Guston 2003 ; Laffont and Martimort 2002 ; Cantarelli et al. 2013 ; Dodgson et al. 2009 ; Cole et al. 2014 ).

Suppose you are an employee in a company and your boss asks you to deliver a report before the deadline on the feasibility of a certain technique for measuring the well-being of elderly people (Roungas et al. 2019 ). Apart from the content of the report, you know it is important for the company to be able to report good results in order to be chosen by the regional government for implementing the technique. As employee, you are the agent in a principal-agent relation with your boss, i.e., the principal. The relation is asymmetrical since your boss puts pressure on the deadline and the content of the report, i.e., the principal has more power. On the other hand, you have more information and know the details of the technique. The information is the agent’s power to argue with or convince the principal.

The Cascade Game (CG) shows the tendency of intelligent actors, in case of uncertainties, to follow the decisions of others independently of the quality of the content of the decisions (Bikhchandani et al. 1992 ; Easley and Kleinberg 2010 ; Anderson and Holt 1996 ; Conradie et al. 2015 ).

Imagine you are in a new place and you want to make a roundtrip. Based on your own research you intent to go for operator A. However, when you arrive at the departure point you notice that it is completely empty, and operator B has a line of people waiting for tickets. At this point, it would make sense to have your private information, decide for operator A, to be outweighed by the public information you infer from others’ decision for operator B. The decision has an either-or character, it is either A or B, players make the decision sequentially, and each player can observe the choices made by those who acted earlier. The Cascade game makes clear that players tend to follow others and this creates a cascade-effect. It has an important implication: the actors who made their choice first have an impact on the following actors.

The Hub-Spoke game (H-S game) describes a situation with multiple actors (spokes) having different incentives who are steered by one actor (hub) via command-and-control. The game creates an incentive for inflated claims, the spokes can reach agreements among each other and create strategic issues for the hub (Elrod and Fortenberry 2017 ; Adler 2005 ; Adler and Smilowitz 2007 ; Adler et al. 2010 ; Takebayashi 2015 ; Markusen 1996 ; De Bruijn et al. 2010 ).

Suppose there is a company, called the hub, which wants to found a business unit in a certain area. To succeed it needs to deal with several parties, called the spokes, for example local companies and municipalities. The hub initiates the plan and starts negotiating with the spokes. The negotiations follow a plan and it can enact several strategies. The hub can make agreements with each spoke separately and propose a unique deal to each. Alternatively, it can propose the same deal to each of the spokes. A local company can try to block the plan of the hub by performing a wait-and-see strategy or exchanging information with other spokes. The communication between spokes can create strategic issues for the hub.

The Volunteers Dilemma (VD) explains why one or more actors take the responsibility for the group to prevent a worst-case scenario from happening. Performing wait-and-see behavior is beneficial, but increases the risk of a bad outcome of the decision-making process (Archetti 2009 ; Goeree and Holt 2000 ; Diekmann 1985 ).

Imagine a situation in which you live in a flat and suddenly the electricity fails. There are many people in your flat, but no one calls an electrician. Performing wait-and-see behavior, not calling the electrician, is beneficial, since it requires no effort and thus no cost. Moreover, there are so many others, why would you be the volunteer? No volunteer acting increases the time of being without electricity. A very bad outcome no one wants. The longer this dilemma, calling or not calling, is present, the higher the risk, and thus the more pressure exists for a volunteer to take action.

The Diners Dilemma (DD) represents a situation in which multiple actors come to an agreement about the process of decision-making, e.g. collaboration and mutual interaction. Due to the agreements made it becomes attractive to be the first one to violate the agreements (Teng et al. 2013 ; Gneezy et al. 2004 ; O’Donovan et al. 2013 ; De Bruijn and Ten Heuvelhof 2018 ).

Suppose you decide to have dinner with a group of people in a restaurant. You agree in advance that the costs of the dinner will be divided equally among the participants. Upon arrival, there appear to be two options: there is a cheap menu and an expensive menu. The participants come to an additional agreement to order the cheap menu. However, there is an incentive to be the first one to violate the collective agreement and order the expensive menu. The profit for this person is high, and there are limited additional costs for the other group members. However, the other group members seeing the bill will understand that the agreement has been violated. It becomes attractive for others to join the first mover and, in the end, the agreement will erode.

The Battle of the Sexes (BS) describes a case in which two actors are completely dependent upon each other. Moreover, they share the same goal, but have different incentives. In order to reach a decision one of the two actors needs to adopt the others’ idea (Shoham and Leyton-Brown 2008 ; Van Benthem 2014 ; Easley and Kleinberg 2010 ; Vollmer 2013 ; Goeree and Holt 1999 ; Camerer 1997 ; Binmore 2007 ; Rasmusen 2007 ).

A man and a woman share the same goal of going out together, but prefer a different destination. The woman prefers a baseball match and the man prefers the opera. The different preferences result in different strategies and create a ‘battle’. To reach a decision and achieve the shared goal they need to anticipate each other’s strategy. One of the two actors needs to adopt the other’s viewpoint and go to the baseball game instead of the opera or the other way around. However, given the complete dependency of actors and the fact that no one can overrule the other by using power or information this is unlikely to happen. The battle will thus continue, probably delay the process, and eventually one of the actors will be the winner and the other the loser, which results in sub-optimal decision-making.

3 Methodology

Action research was the research approach employed in this study. It aligned with the general definition that says “research leading to action” (Lewin 1946 ) and was intended to have a dual outcome of action (in the design of the decision-making process) and research (exploring how the game concept approach was used) (Argyris and Schön 1989 ). The game theoretical characterization of the decision-making process came about as an interplay between researchers and participants in interventions. In the interventions, the participants used the game concept characterization to reflect on the situation and formulated strategies. Moreover, we assessed the uptake from the formulated strategies for the design of the decision-making process.

In this study, we performed an iterative process from data collection to data structuring, data analysis and data validation through various methods such as participatory interventions, interviews and reconciliation meetings.

Important to mention is the dichotomy in this research between (i) characterizing the decision-making process using game concepts, and (ii) giving back the characterization to designers of the decision-making process. The latter always happened during the interventions and, apart from intervention 1, by the researcher. The first point, however, was sometimes performed by researchers beforehand, other times by participants during interventions, and at times by both researchers and participants. In Table  3 , we specified the role of researchers and participants during the interventions.

3.1 Data Collection

In this study, we collected different types of data. The reason why the data was collected varied.

Creation of an overview of decision-making process to understand the context, the actors involved and the issues present.

Identification of game concepts to characterize the decision-making process.

Presentation and discussion of game concepts with and by participants to come to strategies .

Estimate the uptake of defined strategies and its consequences for the design of the decision-making process.

Validation of results, in particular, validation of the overview and identification.

Table  2 lists the types of data collected and the above mentioned purposes. The order of the table does not correspond to the order in which data was collected. Since the interventions were an important part of this research we specify the details of the interventions in Table  3 .

3.2 Data Structuring, Analysis and Validation

To explain how we structured and analyzed the data we use the different purposes of data collection.

An overview of the decision-making process was created by a timeline of events. The timeline contained the important decision moments, the actors and their incentives, and the issues present. Both researchers and program managers contributed to the timeline. Program managers did this during intervention 2 and intervention 3. Researchers provided a timeline, based on documentation, interviews, memos of meetings and recordings of interventions, before interventions 3 and 4 and adapted these afterwards. The interventions together with the validation sessions served to check the details of the process overview.

Identification of game concepts was performed by both program managers and researchers. In intervention 1 program members identified the game concepts using a game concept identification tool (Bekius 2019 ). The tool consists of characteristics of the game concepts. These characteristics were translated to questions regarding the process of decision-making. By answering a sequence of questions the tool presented one or more game concepts. In intervention 3, the game concepts were identified using the descriptions of the game concepts (see Sect.  2 ). In interventions 2, 3 and 4, researchers identified the game concepts before the intervention based on data collected in interviews, meetings, and from documentation. Hence, those interventions were also a validation session for the game concept identification performed by the researchers. Moreover, during these interventions the identified game concepts were connected to the events on the timeline.

Formulation of strategies took place during the interventions. After the game concept characterization was presented to the participants, they discussed its meaning for the process of decision-making. The participants thought of ways to steer the game(s) identified and prevent the potential worst case scenarios from happening. More precisely, they defined strategies to (re)design the decision-making process. Researchers made notes during the interventions or coded the transcripts of the discussion afterwards.

Assessing the uptake from strategies formulated during the interventions happened both directly and indirectly. During validation sessions and meetings with program members we asked them which strategies were implemented and how they worked out. The program members formulated the strategies during the interventions and were able to assess to which extent these actions steered, changed, or contributed to the design of the decision-making process. Additionally, we questioned the consequences of strategies in an indirect way by interviewing different actors involved in the decision-making process. Questions during interviews concerned the quality of the decision-making process, the preparation of the decision weeks, the essential moments in the process, information and time available, and collaboration with other actors. Moreover, we followed the development of the process of decision-making using documentation and reconsolidation meetings with program members. In intervention 4, we described potential future game concept dynamics and interactions based on the previous collected information. Afterwards, we evaluated whether the dynamics and interactions of game concepts happened as expected by interviewing different program members. The interview questions concerned elements of the game concepts, and for each of these elements we questioned which strategies were performed to deal with that situation or what context prevented this situation from happening.

The methodology explained so far described how we accomplished the iterative process of collecting, analyzing, structuring and validating data. It showed how we applied game theoretical concepts in a real complex decision-making process, and returned the game theoretical characterization to the designers of the decision-making process and observed the impact on the process. The third objective, to provide lessons learned from the experience (interventions), is based on a reflection of the researchers and practitioners on the process afterwards.

4 Case Study ERTMS and Game Concepts

The case description considers a specific part of the decision-making process regarding the roll-out of ERTMS starting from the beginning of 2018, when preparations for a first decision week started, until mid-2019, when the Parliament decided on the implementation of ERTMS. This section gives an overview of the important moments in the decision-making process and highlights the elements and strategies of the game concepts present. Figure  1 provides an overview of the game concepts present throughout the decision-making process. Details about the role of the actors and strategies played in the game can be found in the text description.

Game concepts present throughout the decision-making process

Beginning 2018: Letter from freight operators to the Parliament The roll-out of ERTMS needed a timely and technically coordinated refurbishment of trains and infrastructure. Freight operators sent (separate) letters to the Parliament (a principal in the Principal-Agent game) about their worries regarding the process of introducing ERTMS. For the freight operators it was unclear which costs they needed to cover and no agreements were made regarding this issue. The need for investment in new trains by freight operators created a deadlock in the decision-making process (Multi-Issue game). Moreover, contractors wanted to confirm their position. As a result, freight and regional passenger operators started participating in the steering group of ERTMS which brought new perspectives to the decision table. New actors were introduced in the Multi-Issue game.

April 2018: Decision to start preparation phase of program ERTMS The first decision week concerned the approval of the ERTMS dossier for starting a BIT (Bureau ICT-Toetsing) test. Footnote 1 In preparation of this week, the actors of the steering group made process agreements which included finalizing the ERTMS dossier and investigating, and solving, a list of issues. The process agreements were an element of a Diners Dilemma. Final decisions regarding the list of issues needed to be made before summer 2018. The focus of the process so far had been mainly on content issues and new issues arose constantly because of the complexity of the system transition and the many uncertainties present. Content and context issues were on the agenda of the Multi-Issue game. The focus on content issues explained the over-complexity of the decision-making process. Moreover, technical uncertainties influenced the hierarchical relation between the Ministry (principal) and the railway sector: ProRail as infrastructure provider, NS as main operator, regional and freight operators (agents) in a Principal-Agent game.

Mid-May 2018: Intervention 1 “Workshop session Patterns in decision-making processes” Members of the central program management organization ERTMS (in Dutch: programmadirectie ERTMS) identified game concepts for the current stage of the decision-making process and discussed their different views. Moreover, they discussed a possible design of the decision-making process.

Beginning June 2018: Intervention 2 “Follow-up workshop session” Building on Intervention 1, a timeline of events, including actors involved, their incentives, and the main issues was constructed. The participants recognized a Multi-Issue game and discussed its potential effects on the process of decision-making.

End June 2018: Final preparations of the first decision week At this point in time, two main issues were present. The first issue concerned a discussion between the Ministry and freight operators about the Masterplan freight transport. Exchange of issues, such as track access charges and noise pollution, took place in return for freight operators being committed to ERTMS. It influenced their position in the decision-making process. The exchange of issues to broaden the solution space was a Multi-Issue game strategy performed by the Ministry. Moreover, agreements between freight operators and the Ministry in the Masterplan were an element of a Diners Dilemma. The second issue reflected the following situation: there was asymmetry of information between the Ministry (principal) and the ProRail (agent). The Ministry did not have sufficient railway knowledge to fully steer the technical part of the program. Given its knowledge and position, ProRail was the best candidate to take a larger responsibility in the governance of the ERTMS program by being responsible for the program management. Moreover, the principal assigned to the agent the role of referee in conflict situations and distributed its power to close information gaps. This was a Principal-Agent strategy and concerned the positioning of ProRail, and especially the program management, as hub in a Hub-Spoke game. Therefore, one of the main questions to be answered in the decision week was: do the other main actors agree with the steering of the program ERTMS by ProRail?

The decision week was prepared in a very short time, resulting in limited time for reflections on the decisions to be made and late communication of information. This affected the pressure on and quality of the decisions to be made. The program management and the Ministry put pressure on deadlines, heading for a freeze of the dossier for the BIT test. Its aim was to decide on the list of issues prepared and finally decide on starting the BIT test after summer 2018. Pressure to start the BIT test was forced by European Union agreements. The pressure from the European Union (principal) was part of another Principal-Agent game in which the Parliament, and indirectly the Ministry, was one of the agents.

9-13 July 2018: The first decision week The main goal of the first decision week was to decide on the readiness of the ERTMS dossier to start the BIT test. The decision week was set-up as a ‘cascade’ of decisions which needed to be made by the different layers of the organizations. First, the different organizations discussed the decisions internally within their own organization. Then, the actors met at the Director meeting (in Dutch: Directeuren Overleg (DO)) and discussed the list of decisions again. Subsequently, the DO-meetings provided input for the Board of Directors (in Dutch: Raad van Bestuur (RvB)) before the final decisions were made by the ERTMS steering committee at the end of the week. The decision week was organized as a Cascade game and as an effect the entire process before and after the decision week converged to and built on a Cascade game structure. The decisions needed to be adopted by the various predefined decision levels involving representatives of different organizations.

Decisions present in the decision week were connected to one another which is an element of a Multi-Issue game. For example, the issue concerning one or two system suppliers for implementing ERTMS was connected to the number of corridors which could be equipped with ERTMS given the available budget. Moreover, investing in a test corridor affected the number of corridors that could be included in the roll-out strategy. Starting the roll-out with corridor Kijfhoek-Roosendaal would give freight operators the burden of dealing with first-time issues. However, connecting this decision to the decision of assuring a test corridor resolved the issue. For the ATB-NG issue (an old safety system that needs to be replaced before ERTMS is implemented) no solution was found yet. ProRail as infrastructure provider wanted to introduce ERTMS immediately. However, this raised several new issues, contributing to the over-complexity of the process (Multi-Issue game), concerning the roll-out strategy that was decided upon and the need for investments in new trains earlier than expected.

Everyone was committed to provide clarity to the steering committee at the end of the week and postponing decisions until after summer was not challenged. The commitment showed that an agreement on the list of decisions and the shared goal to start the BIT test after summer was made (Diners Dilemma). Moreover, the Cascade game was not blocked by any actor at this point. After the decision week, the starting point for the introduction of ERTMS was clear, but certainly not everything was set. For instance, there were still no (formal) agreements with freight operators about the exact costs and the train specifications. Moreover, many issues remained and new issues were expected, therefore no consensus was reached in the Multi-Issue game.

End July 2018: Intervention 3 “Construct timeline of game concepts” The earlier constructed timeline was adapted and a game concept characterization was added to the timeline based on the dynamics of the first decision week.

Summer 2018: Completion of tasks after the first decision week Although freight operators agreed during the decision week on the list of decisions, afterwards they claimed that they needed more time and they actually disagreed with some decisions made. The freight operators, leasing companies, and contractors had different perspectives and were thus split-up. Additionally, ProRail, NS, and the Ministry sent letters to the program management with additional wishes and issues. The objections of actors after the decision week, due to the fact that time was limited and information was late, could be seen as a sub-optimal results of the Cascade game.

Some actors organized themselves and consulted political parties to influence the political level. This is an example of actors who were ‘freeriding’ (Diners Dilemma). It was in the freight operators’ interest to delay the process since investments in the future were necessary anyway. NS did not have an incentive to delay the process, but they wanted to have sufficient time to prepare the operation before introducing ERTMS and they wished to maintain their autonomy. This situation could eventually result in actors violating the agreements made (Diners Dilemma) and blocking the Cascade game or at least delaying the process. The program management was positioned as independent actor (the hub), i.e., separate from the organization ProRail itself (one of the spokes). Its role was to challenge project plans from different actors and departments (other spokes). The spokes in the Hub-Spoke game were not aligned, moreover, the exact responsibilities of the hub were not fully clear and if they were clear they were not fully accepted by the spokes. The result was that spokes created strategic issues easily which delayed the process and created chaos (Hub-Spoke strategy).

The period after the decision week and before the start of the BIT test appeared to be too short to address all remaining aspects of the decision week. NS was worried about aspects concerning the planning of infrastructure and the readiness of the test corridor. Both situations could lead to a blockade of the Cascade game.

October 2018: The BIT test officially started.

January 2019: Results BIT test The advice from the BIT test arrived and its main point concerned the position of the program management in the process of decision-making. The program should conduct a system engineering approach and provide guidance on technical content towards the main actors. The advice suggested to use additional methods for managing this program. It said to change the role of the hub (program management) to a more strict and controlling role that did not leave room for conflicts and issues between spokes to occur (following a client-contractor model), this was a Hub-Spoke game strategy.

An example of such a conflict was the technological issue of where to build an antenna: on the train (preferred by ProRail) or into the infrastructure (preferred by NS). Both actors shared a common goal of introducing ERMTS in a feasible and good way, however, on this issue their preferences were in conflict. Since no one could overrule the other actor with power or information and no compromise was possible the conflict appeared (Battle of the Sexes). The fact that institutional uncertainty existed, i.e., no one could decide on the issue alone, this resulted in a delay of the process and affected the (trust) relations between actors. A solution (Battle of the Sexes strategy) was to involve a referee, in this case the hub (program management), who decided upon the issue and resolved the conflict.

February 2019: Intervention 4 “Potential future game concepts” A timeline including the period until mid-2019 was presented to participants based on the previous constructed timelines (including events, actors and issues) and a game concept characterization of the process. The timeline also described potential future activation of and interaction between game concepts. Participants validated the timeline and discussed how to deal with the game concept dynamics in the process of decision-making.

March/April 2019: Towards the second decision week In preparation of the second decision week, the program management organized several meetings with directors to make sure that urgent issues were covered. The main issues were the delayed tendering process concerning the infrastructure, the connection of the budget of the high speed line (HSL) and ERTMS, and the fact that freight train operators searched for support from the political level.

Moreover, technical briefings with the Ministry were held to discuss the details of the dossier ERTMS and the role of freight train operators in the process. This was a Principal-Agent strategy to minimize information asymmetry between the Ministry (principal) and the program management (agent).

April 2019: The second decision week The goal of the second decision week was to decide whether the ERTMS program could move from the planning phase to the realization phase. Hence, the decision to be made was: Is the ERTMS dossier ready for the decision by the Council of Ministers in May 2019? Depending on their decision, the decision would be reconsidered by the Parliament. If the Parliament’s decision was positive, the tender process for new rolling stock and infrastructure could start, but only after an independent review approved that the recommendations of the BIT test were adequately implemented, as the Ministry promised to the Parliament. A third Principal-Agent game, the Parliament being the principal and the Ministry being the agent, was present.

During the second decision week the remainder of the decisions from the previous decision week and final points for finalizing the dossier were discussed. The decision week was organized similar to the first decision week starting with decision-making at the DO-level, then decision-making at the RvB level, and finally the steering committee ERTMS decided. Again a Cascade game was present since decisions needed to be adopted by the various predefined decision levels.

May 2019: Council of Ministers decision The Ministry of Infrastructure and Water management decided positively on the start of the implementation of ERTMS on 17th of May 2019.

June 2019: Parliament decision Despite the large budget allocated by the Parliament for implementation of ERTMS, the number of motions was relatively low and the decision of the Council of Ministers was adopted. Hereby, the principal in the second Principal-Agent game, i.e., the Parliament, finalized the cascade of decisions. During the process information asymmetry was minimized by the Ministry (agent) providing access to documentation, technical briefings, and progress reports (a Principal-Agent strategy). As a result, the principal and the agent shared the same incentives which meant that pressure for a certain outcome from the principal was not necessary.

5 Analysis of Interventions With Game Concepts

The previous section presented an overview of the ERTMS decision-making process and highlighted the elements of and strategies performed by actors in terms of game concepts. This section analyses the four intervention moments in which the game concept characterization was given back to designers of the decision-making process, i.e., program management ERTMS. For each intervention, we describe the main observation points by the participants of the intervention and explicate the strategies they formulated during the intervention. Subsequently, we present the consequences of those strategies for the design of the decision-making process. Notice that this section discusses game concept strategies at another level compared to the previous section. Where Sect.  4 characterized game concept strategies performed by actors in the decision-making process, in Sect.  5 , we discuss the game concept strategies (to be) performed by participants of the interventions as a result of the intervention.

5.1 Intervention 1: Workshop “Patterns in Decision-Making Processes”

Short summary: Participants identified the game concepts individually using a game concept identification tool (Bekius 2019 ). They discussed their view on which game concepts were present and reached consensus on two game concepts: the Multi-Issue game and the Cascade game. Additionally, they discussed potential next steps in the process of decision-making given the game concept context.

5.1.1 Observations and Strategies

Actors involved in the decision-making process brought up new content issues continuously, but most new issues were not that much relevant with respect to the overall program goals. There was a risk of creating an over-complex process (Multi-Issue game). The over-complexity could have resulted in no decision being made in the first decision week. Extension of the decision was an undesirable outcome and seen as a worst case scenario due to the planned external BIT-audit. It was unlikely that after all the engineering work new insights would occur. Strategy (1): Change the focus of the process, from content to actors, their incentives, and the process of decision-making.

The incentives of the different actors were not always clear, or at least not made transparent. Some actors could have retained the decision. This was something to pay attention to and affirmed that trust between actors played an important role. Strategy (2): Create an overview of actors’ preferences towards the issues of the Multi-Issue game. Focus on strengthening the trust relation with actors who can block the decision.

The aim of the decision-making process, consensus among actors (Multi-Issue game outcome) or sufficient actors on board regarding the weight of the program goals and design of solutions, changed over time due to politics. Strategy (3): Aim for sufficient support of actors, i.e., their agreement with the main or sufficient decisions, and particularly focus on the interests of potential blocking actors. More specifically, give actors the opportunity to put their final points on paper and discuss them in the steering group.

The process was not about one decision, but a sequence of decisions to be made in the coming years (Cascade game). The program management was part of a much larger game playing at different decision levels. Strategy (4): Create an overview for actors of those decision levels (Cascade game) and how the sequence of decisions evolves over time.

5.1.2 Consequences for the Design of the Decision-Making Process

Strategy (1) led to a focus on actors and the larger context in the process of decision-making. Together with strategies (2), (3) and (4) this resulted in the following: incentives of actors involved in the process were planned to be made explicit in the program plan, the next decision week as extension to make decisions was framed as no option, the number of issues was limited with support of actors, and the program specified a decision-making process as a sequence of decisions rather than as one decision.

In general, awareness of the Multi-Issue game and Cascade game, and how to use them explicitly in the decision-making process, increased. Based on these insights there was a need to further develop and investigate the game concepts identified. This was the motivation for a follow-up session on how to approach and organize the first decision week based on the Cascade game and the Multi-Issue game.

5.2 Intervention 2: Follow up “Patterns in Decision-Making Processes”

Short summary: Participants created a timeline of important events in the decision-making process. Attached to the events we specified the actors involved, their incentives and the main issues present. The discussion then focused on the Multi-Issue game and the Cascade game: How could the program management steer these games and thereby manage the process of decision-making, in particular, towards the first decision week?

5.2.1 Observations and Strategies

The program management had to manage the Multi-Issue game and the Cascade game to reach the desired outcome. Two risks were observed: i) an over-complex Multi-Issue game (more and more issues on the table) and ii) a Cascade game blocked by one or more actors.

There were two main issues: Masterplan freight train operators and the governance of the program ERTMS. Moreover, these two issues influenced decisions on other issues in the Multi-Issues game. In the decision week, decision makers needed to decide over the totality of issues. Strategy (1): Create an overview of the totality of issues and collect actors’ opinions on these issues.

The desired outcome of the process was a decision supported by the actors involved, i.e., consensus reached in the Multi-Issue game. An undesired outcome was no decision since this would delay the process. Strategy (2): Focus on actors who can potentially block the Multi-Issue game. Which issues can be added to the agenda to stimulate exchange of issues?

5.2.2 Consequences for the Design of the Decision-Making Process

Strategy (1) led to a collection of opinions (in favor, neutral, or against) of the actors regarding the issues (decisions) planned for the decision week. It resulted in a categorization of the decisions: decisions that were not ready and would be postponed to a later stage, decisions not objected to by any actor, content decisions with objections from at least one actor, financial decisions, and decisions regarding the roll out of ERTMS in the Netherlands. The categorization provided the basis for the agenda, i.e., the sequence of topics and issues, of the decision week. Apart from collecting opinions on single decisions, the program management questioned the dependencies between the two main issues and preferences for the other decisions. This provided an idea on how potential blocking actors could be kept in the game to support the total set of issues (strategy 2).

The program management used the information to decide on the order of decisions on the agenda and balance decisions that would take short time (since everyone agreed) with decisions that would need more time for discussion (since actors had opposing opinions). This process steered the way in which the cascade of decisions in the decision week was structured (Cascade game) while taking into account the multiple issues that played a role in the context (Multi-Issue game).

Actors involved in the decision-making process were informed about the agenda and the structure of the decision week by the program management before the decision week started. This helped in giving the program management a neutral position (as hub in the Hub-Spoke game) during the decision week in which the actors involved should come to an agreement. The position of the program management as such contributed to the level of trust between actors. It had been reported that the decision week was structured and well prepared, the right issues were discussed and there was room for all actors to present their opinions. Moreover, actors involved in the decision week reported a high level of trust.

5.3 Intervention 3: Analysis of Game Concepts Over Time

Short summary: Participants adapted and extended the timeline of events from Intervention 2 with future events, actors and issues. They were able to identify and describe the game concepts themselves in the process of decision-making. The intervention included the total set of game concepts instead of only focusing on the Multi-Issue and Cascade game. Moreover, the scope was broader since it considered future decisions until the year 2025 and its potential dynamics.

5.3.1 Observations and Strategies

The position and coordination role of the program management was crucial for the continuation of the process. There was an increased focus by the Ministry to strengthen the position of the program direction ERTMS in legal terms. Strategy (1): The Ministry positioned the program management as hub in the Hub-Spoke game and agent in the Principal-Agent game.

One could not change decisions at a later stage without risking a lot of budget to be spend. This is called the convergence of decisions in the Cascade game. Strategy (2): Create awareness of this aspect to prevent sub-optimal outcomes of the Cascade game.

Actors violating agreements (Diners Dilemma) or creating deadlocks (Multi-Issue game) would delay the process. Strategy (3): The Ministry connected ERTMS issues to context issues, i.e., they created a support package for freight train companies (Maatregelenpakket) and thereby broadened the agenda of the Multi-Issue game. Strategy (4): Moreover, the Ministry wanted to stimulate cooperation between operators to prevent violation of agreements in the Diners Dilemma.

5.3.2 Consequences for the Design of the Decision-Making Process

Positioning the program management as a hub (strategy 1) aimed at minimizing information asymmetry and confusion about incentives. The program management functioned as an intermediate actor between the other actors and the Ministry. As a result, the Ministry did not need to be involved in all technical discussions. Moreover, in case of conflicts between actors (the spokes) about system integration aspects, the program management (hub) had the power to decide in favor of one actor and provided the other actor with compensation. The Ministry had limited knowledge of these system aspects and could not make an objective decision. The formulation of the hub-position in legal terms in the governance led to situations in which conflict situations could be dealt with easier and faster.

To prevent sub-optimal outcomes of the decision week (strategy 2), the cascade of decisions was taking place in one week. During the decision week, both internal decision-making within organizations and decision-making between organizations was performed iteratively. The fact that decisions were made consecutively in a short time decreased the risk of forgetting or ignoring what had been decided upon previously and alerted decision makers to inconsistencies among decisions.

The connection between ERTMS issues and context issues (strategy 3) led to a broader agenda. The discussion between freight operators, program management and the Ministry created room for a give-and-take of issues eventually preventing a deadlock in the decision-making process. Together with stimulation of cooperation between operators (strategy 4) this reduced opposition during the decision week.

5.4 Intervention 4: Forecasting Future Game Concepts

Short summary: Participants discussed a characterization of the decision-making process based on Intervention 3. Researchers included a preview of the decision-making process and described potential future game concepts and their dynamics. The total set of game concepts was included. Participants explored options and solutions to prevent situations which could be destructive for or delay the process of decision-making.

5.4.1 Observations and Strategies

Given the game concept characterization over time of Intervention 3 we expected the multiple Principal-Agent games, Multi-Issue game, Cascade game and Hub-Spoke game to continue towards the second decision week. Moreover, a Battle of the Sexes, Volunteers Dilemma and Diners Dilemma could appear and be destructive for the process and its outcome. The program management recognized the game concepts presented and their potential risks. A worst-case scenario for them was the final decision being postponed by the Parliament which could happen for several reasons.

Actors who disagreed with the set of decisions started lobbying by the Parliament. Strategy (1): Show actors that cooperation is key for this process with financial incentives (prevent a Diners Dilemma), and invest in the trust relation between actors by recognizing their worries and providing solutions.

New issues emerged at the table and opened up a new area of issues to be resolved (over-complex Multi-Issue game). Strategy (2): Create a context in which actors are aware that this is the only moment for a decision by the Parliament to go from ERTMS plan to implementation. Focus on actors’ incentives instead of technical issues they bring up.

Actors could leave the process or block the cascade of decisions (Cascade game). Strategy (3): Provide information regarding the second decision week on time and give sufficient time for internal decision-making within organizations. Moreover, focus on the importance of the decision moment at the level of directors of organizations.

Pressure from European Union due to time, budget, and cooperation with other countries increased. Strategy (4): Manage the multiple Principal-Agent games by reducing information asymmetry and differences in incentives. This is crucial to prevent misalignment of actors, in particular between the Ministry and the Parliament.

Conflicts and dilemmas between actors on content issues delayed the process (Battle of the Sexes). Strategy (5): Position the program management as mediator and objective actor in conflict situations between actors (to resolve a Battle of the Sexes). Moreover, introduce an extra condition in the subsidy arrangements such that the program management has the mandate to decide on technical issues.

5.4.2 Consequences for the Design of the Decision-Making Process

In meetings with directors of organizations prior to the second decision week the decision makers accommodated to the message of the program management: “there is a single chance to get the ERTMS dossier from plan to implementation and the chance is now” (strategy 2 and 3). Decision makers came to a common understanding of this situation which helped the discussions and decreased the number of issues coming up. This prevented an over-complex Multi-Issue game. Moreover, it set the basis for actors not performing unexpected behavior in the final stage close to the decision week. For example, blocking a Cascade game or acting as a volunteer in a Volunteers Dilemma.

The Ministry took its role in decreasing the information asymmetry and minimizing power play with the Parliament (strategy 4). This helped in dealing with the limited number of motions and during technical briefing with the Ministry. Moreover, they addressed the urgent issues in the final stage and permitted the actors involved to negotiate about it. These issues therefore did not complicate the decision week or decision-making at the Parliament level.

In case of conflicts or issues such as with the HSL, the program management formulated one consistent answer. Its role as mediator and objective decision maker was to a certain extent accepted by the actors involved (strategy 5). The acceptance was caused by the shared understanding that a decision was needed (strategy 2) and thus actors kept their opinion to themselves and did not bring it up with others.

Freight train operators did not try to block the decision of the Parliament, since they realized that a broad support across the Parliament had emerged and wanted in an upcoming stage to fight again for more budget. The program management acknowledged the position of the freight operators and promised extra support for their issues (strategy 1).

To conclude this section, we summarize the main consequences for the design of the decision-making process as a result of the formulation of strategies based on the game concept characterization.

The program management shifted towards a focus on actors and their incentives instead of on new issues, and they adapted the decision-making process accordingly. A result was the implementation of two separate decision weeks. To prepare for the decision weeks the program management identified the incentive structures of actors. Moreover, the program management adapted its role and responsibility to resemble a client-contractor model in which they became the neutral organizer of the decision-making process. It had been reported that decision weeks were well structured with decisions clustered around themes and the ordering dependent on the incentive structures of actors. This contributed to the level of trust between actors.

We observed a strengthening of the program management to better deal with conflicts in and prevent delays of the decision-making process. As a neutral actor, close to the technical system integration issues, they were better able to make objective decisions than the Ministry. In the final stages, the initiated coupling of issues was prevented by the program management being more secure in its role.

Coupling of issues by the Ministry for the freight train operators resulted in a broader decision-making process. Due to this strategy, smaller freight train operators got involved, which had historically proven difficult. Moreover, the program management invested in the relation with freight train operators, all to prevent them from blocking the decisions.

The game concepts assisted in supporting a consistent communication of the main message: there is a single chance for a decision by Parliament and that is now. This consistency decreased the number of new issues and set the basis for actors not enacting unexpected behavior in the final stage close to the decision week.

Finally, we observed an effect in minimizing the information asymmetry between principal and agent when multiple Principal-Agent games were present. It has been reported that the decision by the Parliament after the decision of the Ministry went quite fast. Due to minimizing the information asymmetry and sharing the incentives a level of trust was created which helped adopting the final decision.

In the next section, we take a step back and provide lessons learned from the experience of intervening in a decision-making process with game concepts.

6 Reflection on Methodology

Pursuing a project like this brings with it a number of challenges, as is common for action research. This section provides some reflections from the experience of intervening in a decision-making process with game concepts. Initially, the lessons are framed as points to consider when repeating this study in different organizations or domains to overcome the exploratory character of the current study. However, these lessons could even be valuable for practitioners who are interested in approaches that assist in the design of a decision-making process.

The research design can be seen as a cycle: process analysis \(\rightarrow \) intervention with designers \(\rightarrow \) evaluation of strategies, and back to process analysis. Zuber-Skerritt ( 1991 ) distinguishes four phases: plan (analysis), act and observe (intervention), and reflect (evaluation). In this study, we performed the cycle four times. However, the phases (analysis, intervention, evaluation) are not always distinct. During interventions, so when one acts and observers, analysis as well as evaluation can take place.

Lesson 1: A rigid design of steps and cycles provides clarity, but requires flexible adjustment during the process.

As with the nature of action research, the role of researchers and participants in the research cycle is dynamic (Robertson 2000 ). The role of researchers and participants can vary between the phases of the cycle and can differ across cycles. In our study, the role of researchers and participants in the interventions was made explicit in Table  3 . We observed that participants had a larger role in the characterization of the process and game concepts in the earlier interventions and researchers were more dominant in giving the information in the later interventions. An explanation for the shift in roles could be that researchers gained more insight in the decision-making during the process and were therefore better able to characterize, and even forecast future dynamics of, the decision-making process. Given the information asymmetry between researchers and process designers, we experienced several moments of tension between roles.

Lesson 2: Be explicit about the role of researchers and participants in the different phases of the research cycles. In particular, regarding the use of game concepts. Questions to clarify are: Who identifies the game concepts? Who validates the identification? (process analysis); Who presents the game concept characterization? Who interprets the game concept characterization? (intervention); Who assesses the effect of the formulated strategies of the intervention? (evaluation).

Although the interventions took place at the level of the design of the decision-making process, i.e., with designers of the process, the perspectives of the other actors at different levels involved in the process needed to be included. This was necessary to obtain an overview of the process itself, but most importantly to evaluate the consequences of strategies formulated for the design of the decision-making process.

Lesson 3: Include information from actors involved at different levels of the decision-making process. This can be done in two ways: Indirectly, by asking the designers of the process to introduce the perspectives of different actors; and directly, by interviews with, observations of, or documentation from actors themselves.

It was crucial to be aware of the changing dynamics of the decision-making process to prevent the game theoretical characterization being inaccurate (or just wrong). Assuming a constant actor constellation is not reasonable for such processes.

Lesson 4: Find a way to keep track of changing dynamics between intervention cycles. There are a couple of solutions here: (i) let participants characterize the process themselves during the intervention; (ii) start the intervention with validating the characterization, or do this beforehand; (iii) have at least one linking actor, part of the design team, who can provide updates about the process and changing dynamics.

Similar strategies were formulated in different interventions. For example, strategy 2 of intervention 1 and strategy 1 of intervention 2 overlap. An explanation could be that different participants were involved in the interventions, but also that the observation of the situation preceding the formulated strategy was still present. During interventions, participants did not always come up with new strategies, but also re-articulated strategies that were formulated before. Sometimes the moment to put the strategy into action was not directly after the current intervention, but only after the next intervention.

Lesson 5: A suggestion for further research is to not only consider the interventions separately, but to view them as a whole and examine how strategies developed over time as well as the consequences of these strategies for the design of the decision-making process.

In all interventions, the participants used the game concepts, but the way in which they used them was different. In this study, the way in which game concepts were used was dependent on (i) the size and constellation of the group, (ii) previous experience with and thus existing knowledge of the game concepts, (iii) the time available for the intervention, and (iv) the information researchers had about the decision-making process beforehand.

Lesson 6: When repeating this study on a larger scale, align a number of those points such that the value of the way in which the game concept approach is used by participants can be better assessed.

7 Conclusion and Discussion

The objective of this paper was to explore the value of descriptive insights from game-theoretic analysis for dynamic interventions in the design of a process. The study applied game theoretical models to characterize a complex decision-making process and gave back the information to the designers of the process. The experience showed that the effects of such an approach could potentially make game theoretical models relevant to practical decision-making in a new way. Moreover, we provided lessons learned based on the experience for both researchers and practitioners. The context in which this research took place is the case of ERTMS in the Dutch railway sector.

First, we described the process of decision-making and highlighted the game concept elements. Second, we analyzed the four interventions with designers of the decision-making process. They used the game concept characterization to formulate strategies. Subsequently, we investigated the consequences of the strategies for the design of the decision-making process. The consequences for the process can be summarized as follows: an actively supported adaptation of an actor focus in the process, it affected the role and responsibilities of the program management, it contributed to the (de)coupling of issues, and it influenced the capability of creating awareness amongst actors of the urgency of the decision window. It also avoided the expected actor behavior of complicating the final stage of the decision-making process. Finally, we reflected upon the study as action research and drew six lessons learned for both researchers and practitioners.

The paper contributed to the theoretical framework on complex decision-making in multi-actor systems. We characterized the process by multiple game concepts instead of talking about a (single) game and an optimal outcome. Parallel interacting game concepts existed in the decision-making process which played at different levels of the organizations involved.

We showed how game theoretical models can assist in a complex decision-making process by giving back the game theoretical characterization to designers of the process. We provided a successful example of a case where a descriptive analysis led to the formulation of strategies instead of using the normative value of game theoretic models. This point is of interest for the broader use of game theory, or formal models in general, in the area of participatory decision-making and design of organizational processes.

Moreover, instead of actively intervening in behavior of actors outside their real context, these interventions targeted the design of the decision-making process. By investigation of the consequences of the formulated strategies in interventions, we contributed to the area of evaluation of participatory interventions. The game concept approach proved to be flexible in aligning with an ongoing process, and did not overtake the process as, for instance, decision-support systems do and to a certain extent also gaming does.

Finally, the paper contributed to the field of decision support and action research by providing methodological reflections on the use of the game concept approach as presented in the paper. The exploratory nature of the study makes it impossible to draw firm conclusions and shows its limitations, however, the reflections provide a starting point for further research in this area.

The BIT test is a necessary gateway test conducted by the Ministry of Internal Affairs for all major ICT programs of governmental organizations in the Netherlands.

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Acknowledgements

This research was funded by ProRail (Dutch Railway Infrastructure Manager) and Delft University of Technology. The authors especially thank Peter Scheffel for his input and time during this study. Moreover, we thank the editor and reviewers for the valuable comments which definitely improved the paper.

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Nijmegen School of Management, Department of Methodology, Radboud University, Heyendaalseweg 141, Nijmegen, The Netherlands

Femke Bekius

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Sebastiaan Meijer

Director Airport Coordination Netherlands, Former Director Program ERTMS, Ministry of Infrastructure and Watermanagement, Schiphol, The Netherlands

Hugo Thomassen

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Bekius, F., Meijer, S. & Thomassen, H. A Real Case Application of Game Theoretical Concepts in a Complex Decision-Making Process: Case Study ERTMS. Group Decis Negot 31 , 153–185 (2022). https://doi.org/10.1007/s10726-021-09762-x

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Accepted : 25 September 2021

Published : 18 October 2021

Issue Date : February 2022

DOI : https://doi.org/10.1007/s10726-021-09762-x

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