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4.1 Taking a case study approach
The main purpose of this research is to build a better understanding of the concept
of modularity in the setting of long-term care for the elderly. In this way, we can
characterize this study as theory building, rather than theory testing. Although we
do not expect to develop a complete theory on the use and application of modularity
in order to advance long-term care for the elderly towards the goal of demand-based
care provision, this study aims to be part of the process that eventually leads to such
a theory.
We selected the case study method as the appropriate research method for our empirical
study. Case study research has been identified as a good way to develop theory
when compared to other research methods such as survey research, experiments, or
quantitative modeling (Eisenhardt, 1989, Meredith, 1998, Voss et al., 2002, Yin, 2003,
Zomerdijk, 2005). More specifically, we identified the following strengths of the case
study approach:
Case study research is particularly appropriate for areas where research
and theory are at their early, formative stages (Benbasat et al., 1987,
Meredith, 1998). This particularly applied to our focus on increasing
the understanding of modularity beyond manufacturing and advancing
knowledge on modularity in long-term care for the elderly. Moreover,
it fitted our focus on understanding how demand-based care can be
brought into practice through modularity.
Case study methodology is specifically suitable for addressing research
questions regarding the ‘how’, ‘what’, and ‘why’ aspects of a phenomenon
(Benbasat et al., 1987, Voss, 2009). Since our aim is to more fully
understand how modularity manifests itself in a particular service
context, this was particularly relevant to our research focus. By focusing
on the ‘how’, ‘what’, and ‘why’, the cases would allow us to concentrate
on operational links (over time) rather than frequencies or incidence
(Yin, 2003). We expected this to increase our understanding of how
modularity relates to the provision of demand-based care in all stages
of long-term care provision.
Case study research allows a phenomenon to be studied holistically
(Yin, 2003), which leads to a relatively full understanding of the nature
and complexity of the complete phenomenon (Meredith, 1998). Various
dimensions and aspects are related to the study of modularity in general.
We therefore expected that the use of modularity in care for the elderly
will result from several of these variables and relations between them.
Modular
Care Provision
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As such, it was important to study modularity holistically rather than in
its individual dimensions. In addition, the holistic approach facilitated
the recognition of variables related to demand-based care, as well as
relations between modularity dimensions and demand-based care
that are not yet part of our conceptual operationalization as presented
in Chapter 2. Since we might not have a complete operationalization
or a comprehensive view of how modularity dimensions can advance
demand-based care, enabling additional concepts to emerge from
practice was desirable.
The case method allows the phenomenon of interest to be studied in
its natural setting (Benbasat et al., 1987, Meredith, 1998). Thereby, it is
particularly appropriate for sticky, practice based problems where the
context of action is critical (Benbasat et al., 1987). The trend towards
demand-based care is unique to the health care environment. In
addition, we expected the use of modularity practices to be related to or
influenced by the specific context of long-term care - its complex political
environment, wide range of providers and health care professionals
and largely heterogeneous elderly clients. However, how modularity is
influenced by the characteristics and trends that are particular to this
sector is unknown. It therefore was important to study modularity in
close relation to our context of interest.
Case research is widely used to take into account both the physical
or ‘hard’ elements of organizations as well as the more human or
‘soft’ elements of the productive system (Voss, 2009). Our research
environment, the sector for long-term care for the elderly, is
characterized by a high incidence of client involvement and intensive
interaction between client and professional. At the same time, strict
adherence to structural elements of the area, such as budgets, planning
schemes, and execution protocols is highly prevalent. The case research
allowed us to take both sides of our research context into account and
thus enabled us to develop knowledge that truly reflects reality, which
will also increase its validity with practitioners – the ultimate users of
research (Voss, 2009).
To design and execute our case research in an appropriate and rigorous manner,
we went through several research stages. Table 4.1 provides a summary of the main
methodological choices in this study that we made to design each of the research
stages. We will address each research stage and research activities involved in more
detail in the coming sections.
Resear
ch desig
n
and methods
Chapt
er 4