Thinking about Case Studies in 3-D: Researching the NHS Clinical Commissioning Landscape in England

Abstract

What is our unit of analysis and by implication what are the boundaries of our cases? This is a question we grapple with at the start of every new project. We observe that case studies are often referred to in an unreflective manner and are often conflated with geographical location. Neat units of analysis and clearly bounded cases usually do not reflect the messiness encountered during qualitative fieldwork. Others have puzzled over these questions. We briefly discuss work to problematise the use of households as units of analysis in the context of apartheid South Africa and then consider work of other anthropologists engaged in multi-site ethnography. We have found the notion of ‘following’ chains, paths and threads across sites to be particularly insightful.

We present two examples from our work studying commissioning in the English National Health Service (NHS) to illustrate our struggles with case studies. The first is a study of Practice-based Commissioning groups and the second is a study of the early workings of Clinical Commissioning Groups. In both instances we show how ideas of what constituted our unit of analysis and the boundaries of our cases became less clear as our research progressed. We also discuss pressures we experienced to add more case studies to our projects. These examples illustrate the primacy for us of understanding interactions between place, local history and rapidly developing policy initiatives. Understanding cases in this way can be challenging in a context where research funders hold different views of what constitutes a case.

Citation

Segar, J., Checkland, K., Coleman, A. and McDermott, I. (2015), "Thinking about Case Studies in 3-D: Researching the NHS Clinical Commissioning Landscape in England", Case Study Evaluation: Past, Present and Future Challenges (Advances in Program Evaluation, Vol. 15), Emerald Group Publishing Limited, Leeds, pp. 85-105. https://doi.org/10.1108/S1474-786320140000015004