only for Dutch providers of long-term care and their members or researchers: we did
not confine ourselves to literature regarding the Dutch care-for-the elderly sector and
we used universally applicable language and constructs instead of care-for-the-elderly
jargon in developing our insights. Even though we expect that because of this, the
results and insights provided by this study will be broadly applicable to other health
care
and service environments, we have no empirical evidence for this.
One difficulty we encountered in our empirical research was the unfamiliarity of the
interviewees with the concepts under research in this study. A modular way of working
was not deliberately chosen by the case organizations, rather the set-up of the financial
system and resulting organizational choices brought the case organizations into a state
of modularity. Although interviewees did recognize the aspects and practices related
to modularity in their way of working, normally, they would not express themselves
using modularity concepts nor think about their processes and products as being
modular. Therefore we had to develop a common language. The modularity terms
and labels used in this study are our well-considered interpretations of sector-related
denominations as phrased by the interviewees. Even though we took measures in
our data collection and analysis to warrant the quality of this research and prevent
researcher bias and misinterpretations of the data collected, differences in language
used could have influenced the study results.
Another limitation concerns the breadth of our findings. The difficulties described
above that we encountered during data collection influenced the selection of modularity
aspects and practices on which we chose to focus. In general, we can say that the
modularity dimensions that we investigated in detail concern those that are most easily
understandable and most obvious from a user/interviewee perspective. We studied
these dimensions by focusing on that phase of the total care process that provided most
insight into a particular modularity aspect. So, each research question was studied from
a different modularity angle and was addressed by using a different part of the total
dataset. Our study, therefore, does not provide an all-embracing and integrated theory
on modularity in long-term care. Rather, it provides cross sections on various important
dimensions related to modularity that can eventually be part of such a theory.
9.6.3 Research methodology
We consider our research method as appropriate, considering the status of theory
in our area of interest. Easton (2007) argues that when little theory is available even
one case can be enough to start the theory-building process. To be able to draw solid
conclusions on our rather novel subject (care modularity) we selected cases for literal
replication only. Thereby, we focused on only one group of rather similar organizations
which might have colored our findings. In addition, other case selection strategies might
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Care Provision
have resulted in stronger or more in-depth research findings. Our case selection has
been parallel, and as such this research has drawn on a single design in which we have
mapped and analyzed modularity in the four cases at the same time. Sequential case
research (conducting one study, analyzing the findings and based on these, conducting
another case study) might have led to increasingly focused data collection as well as
a larger depth of data collected.
A final reflection concerns the validation of our findings in relation to wrong
conceptualization and incomplete information. As explained in Chapter 4, we
employed various tactics to sustain and support the validity of our findings such as data
triangulation, member checks, expert meetings and the use of multiple coders. Still,
a critical comment may be raised with regard to the data collected and analyzed. The
interviewees indicated their unfamiliarity with modularity. Still, we deemed it necessary
to provide the interviewees with only limited background knowledge to make sure that
they would give us information based on actual working processes and procedures
rather than statements colored by explanations of modularity theory. However, it
should be noted that these difficulties may be the cause of discrepancies between the
researcher’ interpretation of the data and the expressions used by interviewees.
9.7 Future research
As mentioned before, our study has focused on the organization perspective. It would be
both interesting and necessary to direct future research towards different perspectives.
We would especially recommend further research from the client perspective in order to
develop a full picture of the concept of modularity in care and service settings. Looking
through the lens of the client/customer is undertaken mainly in management and
marketing research (Johnston, 2008). Taking such a perspective towards modularity
would provide insight into the aspects of care and service provision that are deemed
important from a client point-of-view. Moreover, bringing together research from
both an organization and a client perspective may enable the generation of some
deeper insights as how to better understand and bring about improvement to the
quality of services delivered (Johnston, 2008). It would thereby provide an interesting
and important addition to the body of knowledge concerning modularity in care and
services. To explore modularity from a client point-of-view, a research project started
in April 2010 at the department of Tranzo at Tilburg University. This research project,
then, is complementary to this Ph.D. research and the aim is to ultimately combine
the insights and results of both studies.
In this research, we focused on a selection of aspects and practices related to modularity.
To develop a full picture of modularity in long-term care, research is required on other
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Discussion and c
onclusions
Chapt
er 9