71
This implies that from the population of providers in the field of long-term care we
selected research units that represented certain characteristics (Boeije, 2006). Because
of this selection, it would be likely that we would be able to replicate or extend a
developing theory (Eisenhardt, 1989). Yin (2003) advocates following a replication
logic for case sampling and distinguishes between literal replication (i.e. cases are
selected to provide similar results) and theoretical replication (i.e. cases are selected to
provide contrasting results but for predictable reasons). We chose to follow a sampling
strategy that allowed for literal replication, which means that we selected cases because
they demonstrated the same phenomenon under study, i.e. modularity in long-term
care for the elderly. Because little is known about the application and use of various
dimensions related to modularity in this field and its relation to demand-based care
provision, it was extremely valuable to observe the same phenomenon a number of
times to gain general insights.
To bring about literal replication we had to ensure homogeneity among the cases.
Therefore, we controlled for certain variables, as such preserving unity within our
sample and promoting meaningful comparison. For all case organizations, elderly
clients were the main client population. In addition, all cases provided a wide range
of heterogeneous care and service parts to be combined into a single package for each
client. Finally, all organizations were certified with the Dutch care-related ISO9000
certificate (HKZ-certificate), meaning that their products and processes were registered
and implemented in an established manner.
In addition, we selected for maximum variation by deliberately varying the context of
the cases. To see whether a common pattern could be identified regarding modularity
(Miles and Huberman, 1994) we decided to include cases with differing organizational
backgrounds. Even though all cases selected provided care and services to elderly
people living independently at the time of our data collection, this was a recent
development and their background was either in home care or residential care. Both
types of organizations are highly prevalent in the Dutch sector for long-term care for
the elderly. Since we aimed to gain insight into various dimensions related to modularity
in this sector, data collection in both types of organizations was essential for our
research. The differences in organizational background will be likely to influence the
current working practices of the case organizations. In particular, we expected that
the organizational background might influence the range of care and service parts
supplied, as well as the way in which these were provided. Details on the differences
in relation to our research questions are provided in the following chapters of this
dissertation. In addition to different organizational backgrounds, the way in which
the organizations made the total range of supply available to their clients varied from
having all domains in-house, to different types of cooperation with other providers.
Different types of strategies to make the service domains available might influence the
Resear
ch desig
n
and methods
Chapt
er 4
72
way in which modularity dimensions were effectuated, for example in how modular
packages were specified and configured. Finally, cases were also selected on basis of
their ease of accessibility for the researchers. According to Miles and Huberman (1994)
convenience sampling is an acceptable reason for case selection, when combined with
other reasons for case selection. In summary, by selecting organizations from different
backgrounds and with different strategies concerning the availability of supply, we
aimed to acquire a comprehensive and exhaustive image of all aspects related to
modularity and demand-based care.
The final sample of long-term care providers consisted of four cases. Ideally, it is time
to stop adding cases when theoretical saturation in reached. This is the point at which
incremental learning is minimal because the researchers are observing phenomena seen
before (Glaser and Strauss, 1967). In practice, theoretical saturation often combines
with pragmatic considerations such as time, money, or the need to plan cases well
in advance (Eisenhardt, 1989). For reasons of practical feasibility, we could not do
more than four case studies. We expected that four cases would be sufficient to gain
an adequate degree of depth to derive insight in various dimensions of modularity as
well as in its relation with demand-based care. Furthermore, four cases were enough
to satisfy our criteria for maximum variation in case history and accessibility strategy.
Table 4.2 summarizes the relevant characteristics of the four organizations included
in this case research.
In preparation for each case investigation, we first contacted the board of directors. In
a meeting with each board, we presented the aims and intentions of our study as well
as the set-up of our case research. After we gained the commitment of the board of
directors concerning the issues to be investigated, a principle informant was appointed
Modular
Care Provision
Table 4.2 Case summary
Case K
Case R
Case T
Case V
Main client population
Elderly
clients
Service range
Home care, home nursing, welfare, domestic services,
leisure activities, social
support, safety services,
comfort services, residential care and services
Product and process
stability
Certified with care related ISO-9000 (HKZ-certificate)
History in
Home
care and
residential care
Residential care
Home care
Home care and
residential care
Strategy to make
all
service domains
available
Cooperative
agreement among
organizations in both
types of care, welfare
and
housing
All services in-
house
Initiatives for
cooperation
with organizations
in
welfare and
housing
All services
in-house