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Writing A Case Study

Case Study Examples

Brilliant Case Study Examples and Templates For Your Help

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An Overview of Case Studies

A case study is a research method used to study a particular individual, group, or situation in depth. It involves analyzing and interpreting data from a variety of sources to gain insight into the subject being studied.

Case studies are often used in psychology, business, and education to explore complicated problems and find solutions. They usually have detailed descriptions of the subject, background info, and an analysis of the main issues.

The goal of a case study is to provide a comprehensive understanding of the subject. Typically, case studies can be divided into three parts, challenges, solutions, and results.

Here is a case study sample PDF so you can have a clearer understanding of what a case study actually is:

Case Study Sample PDF

How to Write a Case Study Examples

Learn how to write a case study with the help of our comprehensive case study guide.

Case Study Examples for Students

Quite often, students are asked to present case studies in their academic journeys. The reason instructors assign case studies is for students to sharpen their critical analysis skills, understand how companies make profits, etc.

Below are some case study examples in research, suitable for students:

Case Study Example in Software Engineering

Qualitative Research Case Study Sample

Software Quality Assurance Case Study

Social Work Case Study Example

Ethical Case Study

Case Study Example PDF

These examples can guide you on how to structure and format your own case studies.

Struggling with formatting your case study? Check this case study format guide and perfect your document’s structure today.

Business Case Study Examples

A business case study examines a business’s specific challenge or goal and how it should be solved. Business case studies usually focus on several details related to the initial challenge and proposed solution.

To help you out, here are some samples so you can create case studies that are related to businesses:

Here are some more business case study examples:

Business Case Studies PDF

Business Case Studies Example

Typically, a business case study discovers one of your customer's stories and how you solved a problem for them. It allows your prospects to see how your solutions address their needs.

Medical Case Study Examples

Medical case studies are an essential part of medical education. They help students to understand how to diagnose and treat patients.

Here are some medical case study examples to help you.

Medical Case Study Example

Nursing Case Study Example

Want to understand the various types of case studies? Check out our types of case study blog to select the perfect type.

Psychology Case Study Examples

Case studies are a great way of investigating individuals with psychological abnormalities. This is why it is a very common assignment in psychology courses.

By examining all the aspects of your subject’s life, you discover the possible causes of exhibiting such behavior.

For your help, here are some interesting psychology case study examples:

Psychology Case Study Example

Mental Health Case Study Example

Sales Case Study Examples

Case studies are important tools for sales teams’ performance improvement. By examining sales successes, teams can gain insights into effective strategies and create action plans to employ similar tactics.

By researching case studies of successful sales campaigns, sales teams can more accurately identify challenges and develop solutions.

Sales Case Study Example

Interview Case Study Examples

Interview case studies provide businesses with invaluable information. This data allows them to make informed decisions related to certain markets or subjects.

Interview Case Study Example

Marketing Case Study Examples

Marketing case studies are real-life stories that showcase how a business solves a problem. They typically discuss how a business achieves a goal using a specific marketing strategy or tactic.

They typically describe a challenge faced by a business, the solution implemented, and the results achieved.

This is a short sample marketing case study for you to get an idea of what an actual marketing case study looks like.

Here are some more popular marketing studies that show how companies use case studies as a means of marketing and promotion:

“Chevrolet Discover the Unexpected” by Carol H. Williams

This case study explores Chevrolet's “ DTU Journalism Fellows ” program. The case study uses the initials “DTU” to generate interest and encourage readers to learn more.

Multiple types of media, such as images and videos, are used to explain the challenges faced. The case study concludes with an overview of the achievements that were met.

Key points from the case study include:

Using a well-known brand name in the title can create interest.
Combining different media types, such as headings, images, and videos, can help engage readers and make the content more memorable.
Providing a summary of the key achievements at the end of the case study can help readers better understand the project's impact.

“The Met” by Fantasy

“ The Met ” by Fantasy is a fictional redesign of the Metropolitan Museum of Art in New York City, created by the design studio Fantasy. The case study clearly and simply showcases the museum's website redesign.

The Met emphasizes the website’s features and interface by showcasing each section of the interface individually, allowing the readers to concentrate on the significant elements.

For those who prefer text, each feature includes an objective description. The case study also includes a “Contact Us” call-to-action at the bottom of the page, inviting visitors to contact the company.

Key points from this “The Met” include:

Keeping the case study simple and clean can help readers focus on the most important aspects.
Presenting the features and solutions with a visual showcase can be more effective than writing a lot of text.
Including a clear call-to-action at the end of the case study can encourage visitors to contact the company for more information.

“Better Experiences for All” by Herman Miller

Herman Miller's minimalist approach to furniture design translates to their case study, “ Better Experiences for All ”, for a Dubai hospital. The page features a captivating video with closed-captioning and expandable text for accessibility.

The case study presents a wealth of information in a concise format, enabling users to grasp the complexities of the strategy with ease. It concludes with a client testimonial and a list of furniture items purchased from the brand.

Key points from the “Better Experiences” include:

Make sure your case study is user-friendly by including accessibility features like closed captioning and expandable text.
Include a list of products that were used in the project to guide potential customers.

“NetApp” by Evisort

Evisort's case study on “ NetApp ” stands out for its informative and compelling approach. The study begins with a client-centric overview of NetApp, strategically directing attention to the client rather than the company or team involved.

The case study incorporates client quotes and explores NetApp’s challenges during COVID-19. Evisort showcases its value as a client partner by showing how its services supported NetApp through difficult times.

Provide an overview of the company in the client’s words, and put focus on the customer.
Highlight how your services can help clients during challenging times.
Make your case study accessible by providing it in various formats.

“Red Sox Season Campaign,” by CTP Boston

The “ Red Sox Season Campaign ” showcases a perfect blend of different media, such as video, text, and images. Upon visiting the page, the video plays automatically, there are videos of Red Sox players, their images, and print ads that can be enlarged with a click.

The page features an intuitive design and invites viewers to appreciate CTP's well-rounded campaign for Boston's beloved baseball team. There’s also a CTA that prompts viewers to learn how CTP can create a similar campaign for their brand.

Some key points to take away from the “Red Sox Season Campaign”:

Including a variety of media such as video, images, and text can make your case study more engaging and compelling.
Include a call-to-action at the end of your study that encourages viewers to take the next step towards becoming a customer or prospect.

“Airbnb + Zendesk” by Zendesk

The case study by Zendesk, titled “ Airbnb + Zendesk : Building a powerful solution together,” showcases a true partnership between Airbnb and Zendesk.

The article begins with an intriguing opening statement, “Halfway around the globe is a place to stay with your name on it. At least for a weekend,” and uses stunning images of beautiful Airbnb locations to captivate readers.

Instead of solely highlighting Zendesk's product, the case study is crafted to tell a good story and highlight Airbnb's service in detail. This strategy makes the case study more authentic and relatable.

Some key points to take away from this case study are:

Use client's offerings' images rather than just screenshots of your own product or service.
To begin the case study, it is recommended to include a distinct CTA. For instance, Zendesk presents two alternatives, namely to initiate a trial or seek a solution.

“Influencer Marketing” by Trend and WarbyParker

The case study "Influencer Marketing" by Trend and Warby Parker highlights the potential of influencer content marketing, even when working with a limited budget.

The “Wearing Warby” campaign involved influencers wearing Warby Parker glasses during their daily activities, providing a glimpse of the brand's products in use.

This strategy enhanced the brand's relatability with influencers' followers. While not detailing specific tactics, the case study effectively illustrates the impact of third-person case studies in showcasing campaign results.

Key points to take away from this case study are:

Influencer marketing can be effective even with a limited budget.
Showcasing products being used in everyday life can make a brand more approachable and relatable.
Third-person case studies can be useful in highlighting the success of a campaign.

Marketing Case Study Example

Marketing Case Study Template

Now that you have read multiple case study examples, hop on to our tips.

Tips to Write a Good Case Study

Here are some note-worthy tips to craft a winning case study

Define the purpose of the case study This will help you to focus on the most important aspects of the case. The case study objective helps to ensure that your finished product is concise and to the point.
Choose a real-life example. One of the best ways to write a successful case study is to choose a real-life example. This will give your readers a chance to see how the concepts apply in a real-world setting.
Keep it brief. This means that you should only include information that is directly relevant to your topic and avoid adding unnecessary details.
Use strong evidence. To make your case study convincing, you will need to use strong evidence. This can include statistics, data from research studies, or quotes from experts in the field.
Edit and proofread your work. Before you submit your case study, be sure to edit and proofread your work carefully. This will help to ensure that there are no errors and that your paper is clear and concise.

There you go!

We’re sure that now you have secrets to writing a great case study at your fingertips! This blog teaches the key guidelines of various case studies with samples. So grab your pen and start crafting a winning case study right away!

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22 Cases and Articles to Help Bring Diversity Issues into Class Discussions

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Course Materials
Diversity, Equity, and Inclusion

T he recent civic unrest in the United States following the death of George Floyd has elevated the urgency to recognize and study issues of diversity and the needs of underrepresented groups in all aspects of public life.

Business schools—and educational institutions across the spectrum—are no exception. It’s vital that educators facilitate safe and productive dialogue with students about issues of inclusion and diversity. To help, we’ve gathered a collection of case studies (all with teaching notes) and articles that can encourage and support these critical discussions.

These materials are listed across three broad topic areas: leadership and inclusion, cases featuring protagonists from historically underrepresented groups, and women and leadership around the world. This list is hardly exhaustive, but we hope it provides ways to think creatively and constructively about how educators can integrate these important topics in their classes. HBP will continue to curate and share content that addresses these equity issues and that features diverse protagonists.

Editors’ note: To access the full text of these articles, cases, and accompanying teaching notes, you must be registered with HBP Education. We invite you to sign up for a free educator account here . Verification may take a day; in the meantime, you can read all of our Inspiring Minds content .

Leadership and Inclusion

John Rogers, Jr.—Ariel Investments Co.

—by Steven S. Rogers and Greg White

Gender and Free Speech at Google (A)

—by Nien-hê Hsieh, Martha J. Crawford, and Sarah Mehta

The Massport Model: Integrating Diversity and Inclusion into Public-Private Partnerships

—by Laura Winig and Robert Livingston

“Numbers Take Us Only So Far”

—by Maxine Williams

For Women and Minorities to Get Ahead, Managers Must Assign Work Fairly

—by Joan C. Williams and Marina Multhaup

How Organizations Are Failing Black Workers—and How to Do Better

—by Adia Harvey Wingfield

To Retain Employees, Focus on Inclusion—Not Just Diversity

—by Karen Brown

From HBR 's The Big Idea:

Toward a Racially Just Workplace: Diversity efforts are failing black employees. Here’s a better approach.

—by Laura Morgan Roberts and Anthony J. Mayo

Cases with Protagonists from Historically Underrepresented Groups

Arlan Hamilton and Backstage Capital

—by Laura Huang and Sarah Mehta

United Housing—Otis Gates

—by Steven Rogers and Mercer Cook

Eve Hall: The African American Investment Fund in Milwaukee

—by Steven Rogers and Alterrell Mills

Dylan Pierce at Peninsula Industries

—by Karthik Ramanna

Maggie Lena Walker and the Independent Order of St. Luke

—by Anthony J. Mayo and Shandi O. Smith

Multimedia Cases:

Enterprise Risk Management at Hydro One, Multimedia Case

—by Anette Mikes

Women and Leadership Around the World

Monique Leroux: Leading Change at Desjardins

—by Rosabeth Moss Kanter and Ai-Ling Jamila Malone

Kaweyan: Female Entrepreneurship and the Past and Future of Afghanistan

—by Geoffrey G. Jones and Gayle Tzemach Lemmon

Womenomics in Japan

—by Boris Groysberg, Mayuka Yamazaki, Nobuo Sato, and David Lane

Women MBAs at Harvard Business School: 1962-2012

—by Boris Groysberg, Kerry Herman, and Annelena Lobb

Beating the Odds

—by Laura Morgan Roberts, Anthony J. Mayo, Robin J. Ely, and David A. Thomas

Rethink What You “Know” About High-Achieving Women

—by Robin J. Ely, Pamela Stone, and Colleen Ammerman

“I Try to Spark New Ideas”

—by Christine Lagarde and Adi Ignatius

How Women Manage the Gendered Norms of Leadership

—by Wei Zheng, Ronit Kark, and Alyson Meister

Is this list helpful to you? What other topics or materials would you like to see featured in our next curated list? Let us know .

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Case Study At-A-Glance

A case study is a way to let students interact with material in an open-ended manner. the goal is not to find solutions, but to explore possibilities and options of a real-life scenario..

Want examples of a Case-Study? Check out the ABLConnect Activity Database Want to read research supporting the Case-Study method? Click here

Why should you facilitate a Case Study?

Want to facilitate a case-study in your class .

How-To Run a Case-Study

Before class pick the case study topic/scenario. You can either generate a fictional situation or can use a real-world example.
Clearly let students know how they should prepare. Will the information be given to them in class or do they need to do readings/research before coming to class?
Have a list of questions prepared to help guide discussion (see below)
Sessions work best when the group size is between 5-20 people so that everyone has an opportunity to participate. You may choose to have one large whole-class discussion or break into sub-groups and have smaller discussions. If you break into groups, make sure to leave extra time at the end to bring the whole class back together to discuss the key points from each group and to highlight any differences.
What is the problem?
What is the cause of the problem?
Who are the key players in the situation? What is their position?
What are the relevant data?
What are possible solutions – both short-term and long-term?
What are alternate solutions? – Play (or have the students play) Devil’s Advocate and consider alternate view points
What are potential outcomes of each solution?
What other information do you want to see?
What can we learn from the scenario?
Be flexible. While you may have a set of questions prepared, don’t be afraid to go where the discussion naturally takes you. However, be conscious of time and re-focus the group if key points are being missed
Role-playing can be an effective strategy to showcase alternate viewpoints and resolve any conflicts
Involve as many students as possible. Teamwork and communication are key aspects of this exercise. If needed, call on students who haven’t spoken yet or instigate another rule to encourage participation.
Write out key facts on the board for reference. It is also helpful to write out possible solutions and list the pros/cons discussed.
Having the information written out makes it easier for students to reference during the discussion and helps maintain everyone on the same page.
Keep an eye on the clock and make sure students are moving through the scenario at a reasonable pace. If needed, prompt students with guided questions to help them move faster.
Either give or have the students give a concluding statement that highlights the goals and key points from the discussion. Make sure to compare and contrast alternate viewpoints that came up during the discussion and emphasize the take-home messages that can be applied to future situations.
Inform students (either individually or the group) how they did during the case study. What worked? What didn’t work? Did everyone participate equally?
Taking time to reflect on the process is just as important to emphasize and help students learn the importance of teamwork and communication.

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Harvard Business School: Teaching By the Case-Study Method

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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."

case study examples for group discussion

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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Structuring the Case Discussion

Well-designed cases are intentionally complex. Therefore, presenting an entire case to students all at once has the potential to overwhelm student groups and lead them to overlook key details or analytic steps. Accordingly, Barbara Cockrill asks students to review key case concepts the night before, and then presents the case in digestible “chunks” during a CBCL session. Structuring the case discussion around key in-depth questions, Cockrill creates a thoughtful interplay between small group work and whole group discussion that makes for more systematic forays into the case at hand.

Barbara Cockrill , Harold Amos Academy Associate Professor of Medicine

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Harvard Medical School

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CBCL provides students the opportunity to apply course material in new ways. For this reason, you might consider not sharing the case with students beforehand and having them experience it in class with fresh eyes.
Chunk cases so students can focus on case specifics and gradually build-up to greater complexity and understanding.
Introduce variety into case-based discussions. Integrate a mix of independent work, small group discussion, and whole group share outs to keep students engaged and provide multiple junctures for students to get feedback on their understanding.
Instructor scaffolding is critical for effective case-based learning ( Ramaekers et al., 2011 )
This resource from the Harvard Business School provides suggestions for questioning, listening, and responding during a case discussion .
This comprehensive resource on “The ABCs of Case Teaching” provides helpful tips for planning and “running” your case .

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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 .

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.

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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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Section 4. Techniques for Leading Group Discussions

Chapter 16 Sections

Section 1. Conducting Effective Meetings
Section 2. Developing Facilitation Skills
Section 3. Capturing What People Say: Tips for Recording a Meeting
Main Section

A local coalition forms a task force to address the rising HIV rate among teens in the community. A group of parents meets to wrestle with their feeling that their school district is shortchanging its students. A college class in human services approaches the topic of dealing with reluctant participants. Members of an environmental group attend a workshop on the effects of global warming. A politician convenes a “town hall meeting” of constituents to brainstorm ideas for the economic development of the region. A community health educator facilitates a smoking cessation support group.

All of these might be examples of group discussions, although they have different purposes, take place in different locations, and probably run in different ways. Group discussions are common in a democratic society, and, as a community builder, it’s more than likely that you have been and will continue to be involved in many of them. You also may be in a position to lead one, and that’s what this section is about. In this last section of a chapter on group facilitation, we’ll examine what it takes to lead a discussion group well, and how you can go about doing it.

What is an effective group discussion?

The literal definition of a group discussion is obvious: a critical conversation about a particular topic, or perhaps a range of topics, conducted in a group of a size that allows participation by all members. A group of two or three generally doesn’t need a leader to have a good discussion, but once the number reaches five or six, a leader or facilitator can often be helpful. When the group numbers eight or more, a leader or facilitator, whether formal or informal, is almost always helpful in ensuring an effective discussion.

A group discussion is a type of meeting, but it differs from the formal meetings in a number of ways: It may not have a specific goal – many group discussions are just that: a group kicking around ideas on a particular topic. That may lead to a goal ultimately...but it may not. It’s less formal, and may have no time constraints, or structured order, or agenda. Its leadership is usually less directive than that of a meeting. It emphasizes process (the consideration of ideas) over product (specific tasks to be accomplished within the confines of the meeting itself. Leading a discussion group is not the same as running a meeting. It’s much closer to acting as a facilitator, but not exactly the same as that either.

An effective group discussion generally has a number of elements:

All members of the group have a chance to speak, expressing their own ideas and feelings freely, and to pursue and finish out their thoughts
All members of the group can hear others’ ideas and feelings stated openly
Group members can safely test out ideas that are not yet fully formed
Group members can receive and respond to respectful but honest and constructive feedback. Feedback could be positive, negative, or merely clarifying or correcting factual questions or errors, but is in all cases delivered respectfully.
A variety of points of view are put forward and discussed
The discussion is not dominated by any one person
Arguments, while they may be spirited, are based on the content of ideas and opinions, not on personalities
Even in disagreement, there’s an understanding that the group is working together to resolve a dispute, solve a problem, create a plan, make a decision, find principles all can agree on, or come to a conclusion from which it can move on to further discussion

Many group discussions have no specific purpose except the exchange of ideas and opinions. Ultimately, an effective group discussion is one in which many different ideas and viewpoints are heard and considered. This allows the group to accomplish its purpose if it has one, or to establish a basis either for ongoing discussion or for further contact and collaboration among its members.

There are many possible purposes for a group discussion, such as:

Create a new situation – form a coalition, start an initiative, etc.
Explore cooperative or collaborative arrangements among groups or organizations
Discuss and/or analyze an issue, with no specific goal in mind but understanding
Create a strategic plan – for an initiative, an advocacy campaign, an intervention, etc.
Discuss policy and policy change
Air concerns and differences among individuals or groups
Hold public hearings on proposed laws or regulations, development, etc.
Decide on an action
Provide mutual support
Solve a problem
Resolve a conflict
Plan your work or an event

Possible leadership styles of a group discussion also vary. A group leader or facilitator might be directive or non-directive; that is, she might try to control what goes on to a large extent; or she might assume that the group should be in control, and that her job is to facilitate the process. In most group discussions, leaders who are relatively non-directive make for a more broad-ranging outlay of ideas, and a more satisfying experience for participants.

Directive leaders can be necessary in some situations. If a goal must be reached in a short time period, a directive leader might help to keep the group focused. If the situation is particularly difficult, a directive leader might be needed to keep control of the discussion and make

Why would you lead a group discussion?

There are two ways to look at this question: “What’s the point of group discussion?” and “Why would you, as opposed to someone else, lead a group discussion?” Let’s examine both.

What’s the point of group discussion?

As explained in the opening paragraphs of this section, group discussions are common in a democratic society. There are a number of reasons for this, some practical and some philosophical.

A group discussion:

G ives everyone involved a voice . Whether the discussion is meant to form a basis for action, or just to play with ideas, it gives all members of the group a chance to speak their opinions, to agree or disagree with others, and to have their thoughts heard. In many community-building situations, the members of the group might be chosen specifically because they represent a cross-section of the community, or a diversity of points of view.
Allows for a variety of ideas to be expressed and discussed . A group is much more likely to come to a good conclusion if a mix of ideas is on the table, and if all members have the opportunity to think about and respond to them.
Is generally a democratic, egalitarian process . It reflects the ideals of most grassroots and community groups, and encourages a diversity of views.
Leads to group ownership of whatever conclusions, plans, or action the group decides upon . Because everyone has a chance to contribute to the discussion and to be heard, the final result feels like it was arrived at by and belongs to everyone.
Encourages those who might normally be reluctant to speak their minds . Often, quiet people have important things to contribute, but aren’t assertive enough to make themselves heard. A good group discussion will bring them out and support them.
Can often open communication channels among people who might not communicate in any other way . People from very different backgrounds, from opposite ends of the political spectrum, from different cultures, who may, under most circumstances, either never make contact or never trust one another enough to try to communicate, might, in a group discussion, find more common ground than they expected.
Is sometimes simply the obvious, or even the only, way to proceed. Several of the examples given at the beginning of the section – the group of parents concerned about their school system, for instance, or the college class – fall into this category, as do public hearings and similar gatherings.

Why would you specifically lead a group discussion?

You might choose to lead a group discussion, or you might find yourself drafted for the task. Some of the most common reasons that you might be in that situation:

It’s part of your job . As a mental health counselor, a youth worker, a coalition coordinator, a teacher, the president of a board of directors, etc. you might be expected to lead group discussions regularly.
You’ve been asked to . Because of your reputation for objectivity or integrity, because of your position in the community, or because of your skill at leading group discussions, you might be the obvious choice to lead a particular discussion.
A discussion is necessary, and you’re the logical choice to lead it . If you’re the chair of a task force to address substance use in the community, for instance, it’s likely that you’ll be expected to conduct that task force’s meetings, and to lead discussion of the issue.
It was your idea in the first place . The group discussion, or its purpose, was your idea, and the organization of the process falls to you.

You might find yourself in one of these situations if you fall into one of the categories of people who are often tapped to lead group discussions. These categories include (but aren’t limited to):

Directors of organizations
Public officials
Coalition coordinators
Professionals with group-leading skills – counselors, social workers, therapists, etc.
Health professionals and health educators
Respected community members. These folks may be respected for their leadership – president of the Rotary Club, spokesperson for an environmental movement – for their positions in the community – bank president, clergyman – or simply for their personal qualities – integrity, fairness, ability to communicate with all sectors of the community.
Community activists. This category could include anyone from “professional” community organizers to average citizens who care about an issue or have an idea they want to pursue.

When might you lead a group discussion?

The need or desire for a group discussion might of course arise anytime, but there are some times when it’s particularly necessary.

At the start of something new . Whether you’re designing an intervention, starting an initiative, creating a new program, building a coalition, or embarking on an advocacy or other campaign, inclusive discussion is likely to be crucial in generating the best possible plan, and creating community support for and ownership of it.
When an issue can no longer be ignored . When youth violence reaches a critical point, when the community’s drinking water is declared unsafe, when the HIV infection rate climbs – these are times when groups need to convene to discuss the issue and develop action plans to swing the pendulum in the other direction.
When groups need to be brought together . One way to deal with racial or ethnic hostility, for instance, is to convene groups made up of representatives of all the factions involved. The resulting discussions – and the opportunity for people from different backgrounds to make personal connections with one another – can go far to address everyone’s concerns, and to reduce tensions.
When an existing group is considering its next step or seeking to address an issue of importance to it . The staff of a community service organization, for instance, may want to plan its work for the next few months, or to work out how to deal with people with particular quirks or problems.

How do you lead a group discussion?

In some cases, the opportunity to lead a group discussion can arise on the spur of the moment; in others, it’s a more formal arrangement, planned and expected. In the latter case, you may have the chance to choose a space and otherwise structure the situation. In less formal circumstances, you’ll have to make the best of existing conditions.

We’ll begin by looking at what you might consider if you have time to prepare. Then we’ll examine what it takes to make an effective discussion leader or facilitator, regardless of external circumstances.

Set the stage

If you have time to prepare beforehand, there are a number of things you may be able to do to make the participants more comfortable, and thus to make discussion easier.

Choose the space

If you have the luxury of choosing your space, you might look for someplace that’s comfortable and informal. Usually, that means comfortable furniture that can be moved around (so that, for instance, the group can form a circle, allowing everyone to see and hear everyone else easily). It may also mean a space away from the ordinary.

One organization often held discussions on the terrace of an old mill that had been turned into a bookstore and café. The sound of water from the mill stream rushing by put everyone at ease, and encouraged creative thought.

Provide food and drink

The ultimate comfort, and one that breaks down barriers among people, is that of eating and drinking.

Bring materials to help the discussion along

Most discussions are aided by the use of newsprint and markers to record ideas, for example.

Become familiar with the purpose and content of the discussion

If you have the opportunity, learn as much as possible about the topic under discussion. This is not meant to make you the expert, but rather to allow you to ask good questions that will help the group generate ideas.

Make sure everyone gets any necessary information, readings, or other material beforehand

If participants are asked to read something, consider questions, complete a task, or otherwise prepare for the discussion, make sure that the assignment is attended to and used. Don’t ask people to do something, and then ignore it.

Lead the discussion

Think about leadership style

The first thing you need to think about is leadership style, which we mentioned briefly earlier in the section. Are you a directive or non-directive leader? The chances are that, like most of us, you fall somewhere in between the extremes of the leader who sets the agenda and dominates the group completely, and the leader who essentially leads not at all. The point is made that many good group or meeting leaders are, in fact, facilitators, whose main concern is supporting and maintaining the process of the group’s work. This is particularly true when it comes to group discussion, where the process is, in fact, the purpose of the group’s coming together.

A good facilitator helps the group set rules for itself, makes sure that everyone participates and that no one dominates, encourages the development and expression of all ideas, including “odd” ones, and safeguards an open process, where there are no foregone conclusions and everyone’s ideas are respected. Facilitators are non-directive, and try to keep themselves out of the discussion, except to ask questions or make statements that advance it. For most group discussions, the facilitator role is probably a good ideal to strive for.

It’s important to think about what you’re most comfortable with philosophically, and how that fits what you’re comfortable with personally. If you’re committed to a non-directive style, but you tend to want to control everything in a situation, you may have to learn some new behaviors in order to act on your beliefs.

Put people at ease

Especially if most people in the group don’t know one another, it’s your job as leader to establish a comfortable atmosphere and set the tone for the discussion.

Help the group establish ground rules

The ground rules of a group discussion are the guidelines that help to keep the discussion on track, and prevent it from deteriorating into namecalling or simply argument. Some you might suggest, if the group has trouble coming up with the first one or two:

Everyone should treat everyone else with respect : no name-calling, no emotional outbursts, no accusations.
No arguments directed at people – only at ideas and opinions . Disagreement should be respectful – no ridicule.
Don’t interrupt . Listen to the whole of others’ thoughts – actually listen, rather than just running over your own response in your head.
Respect the group’s time . Try to keep your comments reasonably short and to the point, so that others have a chance to respond.
Consider all comments seriously, and try to evaluate them fairly . Others’ ideas and comments may change your mind, or vice versa: it’s important to be open to that.
Don’t be defensive if someone disagrees with you . Evaluate both positions, and only continue to argue for yours if you continue to believe it’s right.
Everyone is responsible for following and upholding the ground rules .

Ground rules may also be a place to discuss recording the session. Who will take notes, record important points, questions for further discussion, areas of agreement or disagreement? If the recorder is a group member, the group and/or leader should come up with a strategy that allows her to participate fully in the discussion.

Generate an agenda or goals for the session

You might present an agenda for approval, and change it as the group requires, or you and the group can create one together. There may actually be no need for one, in that the goal may simply be to discuss an issue or idea. If that’s the case, it should be agreed upon at the outset.

How active you are might depend on your leadership style, but you definitely have some responsibilities here. They include setting, or helping the group to set the discussion topic; fostering the open process; involving all participants; asking questions or offering ideas to advance the discussion; summarizing or clarifying important points, arguments, and ideas; and wrapping up the session. Let’s look at these, as well as some do’s and don’t’s for discussion group leaders.

Setting the topic . If the group is meeting to discuss a specific issue or to plan something, the discussion topic is already set. If the topic is unclear, then someone needs to help the group define it. The leader – through asking the right questions, defining the problem, and encouraging ideas from the group – can play that role.
Fostering the open process . Nurturing the open process means paying attention to the process, content, and interpersonal dynamics of the discussion all at the same time – not a simple matter. As leader, your task is not to tell the group what to do, or to force particular conclusions, but rather to make sure that the group chooses an appropriate topic that meets its needs, that there are no “right” answers to start with (no foregone conclusions), that no one person or small group dominates the discussion, that everyone follows the ground rules, that discussion is civil and organized, and that all ideas are subjected to careful critical analysis. You might comment on the process of the discussion or on interpersonal issues when it seems helpful (“We all seem to be picking on John here – what’s going on?”), or make reference to the open process itself (“We seem to be assuming that we’re supposed to believe X – is that true?”). Most of your actions as leader should be in the service of modeling or furthering the open process.

Part of your job here is to protect “minority rights,” i.e., unpopular or unusual ideas. That doesn’t mean you have to agree with them, but that you have to make sure that they can be expressed, and that discussion of them is respectful, even in disagreement. (The exceptions are opinions or ideas that are discriminatory or downright false.) Odd ideas often turn out to be correct, and shouldn’t be stifled.

Involving all participants . This is part of fostering the open process, but is important enough to deserve its own mention. To involve those who are less assertive or shy, or who simply can’t speak up quickly enough, you might ask directly for their opinion, encourage them with body language (smile when they say anything, lean and look toward them often), and be aware of when they want to speak and can’t break in. It’s important both for process and for the exchange of ideas that everyone have plenty of opportunity to communicate their thoughts.
Asking questions or offering ideas to advance the discussion . The leader should be aware of the progress of the discussion, and should be able to ask questions or provide information or arguments that stimulate thinking or take the discussion to the next step when necessary. If participants are having trouble grappling with the topic, getting sidetracked by trivial issues, or simply running out of steam, it’s the leader’s job to carry the discussion forward.

This is especially true when the group is stuck, either because two opposing ideas or factions are at an impasse, or because no one is able or willing to say anything. In these circumstances, the leader’s ability to identify points of agreement, or to ask the question that will get discussion moving again is crucial to the group’s effectiveness.

Summarizing or clarifying important points, arguments, or ideas . This task entails making sure that everyone understands a point that was just made, or the two sides of an argument. It can include restating a conclusion the group has reached, or clarifying a particular idea or point made by an individual (“What I think I heard you say was…”). The point is to make sure that everyone understands what the individual or group actually meant.
Wrapping up the session . As the session ends, the leader should help the group review the discussion and make plans for next steps (more discussion sessions, action, involving other people or groups, etc.). He should also go over any assignments or tasks that were agreed to, make sure that every member knows what her responsibilities are, and review the deadlines for those responsibilities. Other wrap-up steps include getting feedback on the session – including suggestions for making it better – pointing out the group’s accomplishments, and thanking it for its work.

Even after you’ve wrapped up the discussion, you’re not necessarily through. If you’ve been the recorder, you might want to put the notes from the session in order, type them up, and send them to participants. The notes might also include a summary of conclusions that were reached, as well as any assignments or follow-up activities that were agreed on.

If the session was one-time, or was the last of a series, your job may now be done. If it was the beginning, however, or part of an ongoing discussion, you may have a lot to do before the next session, including contacting people to make sure they’ve done what they promised, and preparing the newsprint notes to be posted at the next session so everyone can remember the discussion.

Leading an effective group discussion takes preparation (if you have the opportunity for it), an understanding of and commitment to an open process, and a willingness to let go of your ego and biases. If you can do these things, the chances are you can become a discussion leader that can help groups achieve the results they want.

Do’s and don’ts for discussion leaders

Model the behavior and attitudes you want group members to employ . That includes respecting all group members equally; advancing the open process; demonstrating what it means to be a learner (admitting when you’re wrong, or don’t know a fact or an answer, and suggesting ways to find out); asking questions based on others’ statements; focusing on positions rather than on the speaker; listening carefully; restating others’ points; supporting your arguments with fact or logic; acceding when someone else has a good point; accepting criticism; thinking critically; giving up the floor when appropriate; being inclusive and culturally sensitive, etc.
Use encouraging body language and tone of voice, as well as words . Lean forward when people are talking, for example, keep your body position open and approachable, smile when appropriate, and attend carefully to everyone, not just to those who are most articulate.
Give positive feedback for joining the discussion . Smile, repeat group members’ points, and otherwise show that you value participation.
Be aware of people’s reactions and feelings, and try to respond appropriately . If a group member is hurt by others’ comments, seems puzzled or confused, is becoming angry or defensive, it’s up to you as discussion leader to use the ground rules or your own sensitivity to deal with the situation. If someone’s hurt, for instance, it may be important to point that out and discuss how to make arguments without getting personal. If group members are confused, revisiting the comments or points that caused the confusion, or restating them more clearly, may be helpful. Being aware of the reactions of individuals and of the group as a whole can make it possible to expose and use conflict, or to head off unnecessary emotional situations and misunderstandings.
Ask open-ended questions . In advancing the discussion, use questions that can’t be answered with a simple yes or no. Instead, questions should require some thought from group members, and should ask for answers that include reasons or analysis. The difference between “Do you think the President’s decision was right?” and “Why do you think the President’s decision was or wasn’t right?” is huge. Where the first question can be answered with a yes or no, the second requires an analysis supporting the speaker’s opinion, as well as discussion of the context and reasons for the decision.
Control your own biases . While you should point out factual errors or ideas that are inaccurate and disrespectful of others, an open process demands that you not impose your views on the group, and that you keep others from doing the same. Group members should be asked to make rational decisions about the positions or views they want to agree with, and ultimately the ideas that the group agrees on should be those that make the most sense to them – whether they coincide with yours or not. Pointing out bias – including your own – and discussing it helps both you and group members try to be objective.

A constant question that leaders – and members – of any group have is what to do about racist, sexist, or homophobic remarks, especially in a homogeneous group where most or all of the members except the leader may agree with them. There is no clear-cut answer, although if they pass unchallenged, it may appear you condone the attitude expressed. How you challenge prejudice is the real question. The ideal here is that other members of the group do the challenging, and it may be worth waiting long enough before you jump in to see if that’s going to happen. If it doesn’t, you can essentially say, “That’s wrong, and I won’t allow that kind of talk here,” which may well put an end to the remarks, but isn’t likely to change anyone’s mind. You can express your strong disagreement or discomfort with such remarks and leave it at that, or follow up with “Let’s talk about it after the group,” which could generate some real discussion about prejudice and stereotypes, and actually change some thinking over time. Your ground rules – the issue of respecting everyone – should address this issue, and it probably won’t come up…but there are no guarantees. It won’t hurt to think beforehand about how you want to handle it.

Encourage disagreement, and help the group use it creatively . Disagreement is not to be smoothed over, but rather to be analyzed and used. When there are conflicting opinions – especially when both can be backed up by reasonable arguments – the real discussion starts. If everyone agrees on every point, there’s really no discussion at all. Disagreement makes people think. It may not be resolved in one session, or at all, but it’s the key to discussion that means something.

All too often, conflict – whether conflicting opinions, conflicting world views, or conflicting personalities – is so frightening to people that they do their best to ignore it or gloss it over. That reaction not only leaves the conflict unresolved – and therefore growing, so that it will be much stronger when it surfaces later– but fails to examine the issues that it raises. If those are brought out in the open and discussed reasonably, the two sides often find that they have as much agreement as disagreement, and can resolve their differences by putting their ideas together. Even where that’s not the case, facing the conflict reasonably, and looking at the roots of the ideas on each side, can help to focus on the issue at hand and provide solutions far better than if one side or the other simply operated alone.

Keep your mouth shut as much as possible . By and large, discussion groups are for the group members. You may be a member of the group and have been asked by the others to act as leader, in which case you certainly have a right to be part of the discussion (although not to dominate). If you’re an outside facilitator, or leader by position, it’s best to confine your contributions to observations on process, statements of fact, questions to help propel the discussion, and clarification and summarization. The simple fact that you’re identified as leader or facilitator gives your comments more force than those of other group members. If you’re in a position of authority or seen as an expert, that force becomes even greater. The more active you are in the discussion, the more the group will take your positions and ideas as “right,” and the less it will come to its own conclusions.
Don’t let one or a small group of individuals dominate the discussion . People who are particularly articulate or assertive, who have strong feelings that they urgently want to express, or who simply feel the need – and have the ability – to dominate can take up far more than their fair share of a discussion. This often means that quieter people have little or no chance to speak, and that those who disagree with the dominant individual(s) are shouted down and cease trying to make points. It’s up to the leader to cut off individuals who take far more than their share of time, or who try to limit discussion. This can be done in a relatively non-threatening way (“This is an interesting point, and it’s certainly worth the time we’ve spent on it, but there are other points of view that need to be heard as well. I think Alice has been waiting to speak…”), but it’s crucial to the open process and to the comfort and effectiveness of the group.
Don’t let one point of view override others , unless it’s based on facts and logic, and is actually convincing group members to change their minds. If a point of view dominates because of its merits, its appeal to participants’ intellectual and ethical sensibilities, that’s fine. It’s in fact what you hope will happen in a good group discussion. If a point of view dominates because of the aggressiveness of its supporters, or because it’s presented as something it’s wrong to oppose (“People who disagree with the President are unpatriotic and hate their country”), that’s intellectual bullying or blackmail, and is the opposite of an open discussion. As leader, you should point it out when that’s happening, and make sure other points of view are aired and examined.

Sometimes individuals or factions that are trying to dominate can disrupt the process of the group. Both Sections 1 and 2 of this chapter contain some guidelines for dealing with this type of situation.

Don’t assume that anyone holds particular opinions or positions because of his culture, background, race, personal style, etc . People are individuals, and can’t be judged by their exteriors. You can find out what someone thinks by asking, or by listening when he speaks.
Don’t assume that someone from a particular culture, race, or background speaks for everyone else from that situation . She may or may not represent the general opinion of people from situations similar to hers…or there may not be a general opinion among them. In a group discussion, no one should be asked or assumed to represent anything more than herself.

The exception here is when someone has been chosen by her community or group to represent its point of view in a multi-sector discussion. Even in that situation, the individual may find herself swayed by others’ arguments, or may have ideas of her own. She may have agreed to sponsor particular ideas that are important to her group, but she may still have her own opinions as well, especially in other areas.

Don’t be the font of all wisdom . Even if you know more about the discussion topic than most others in the group (if you’re the teacher of a class, for instance), presenting yourself as the intellectual authority denies group members the chance to discuss the topic freely and without pressure. Furthermore, some of them may have ideas you haven’t considered, or experiences that give them insights into the topic that you’re never likely to have. Model learning behavior, not teaching behavior.

If you’re asked your opinion directly, you should answer honestly. You have some choices about how you do that, however. One is to state your opinion, but make very clear that it’s an opinion, not a fact, and that other people believe differently. Another is to ask to hold your opinion until the end of the discussion, so as not to influence anyone’s thinking while it’s going on. Yet another is to give your opinion after all other members of the group have stated theirs, and then discuss the similarities and differences among all the opinions and people’s reasons for holding them. If you’re asked a direct question, you might want to answer it if it’s a question of fact and you know the answer, and if it’s relevant to the discussion. If the question is less clear-cut, you might want to throw it back to the group, and use it as a spur to discussion.

Group discussions are common in our society, and have a variety of purposes, from planning an intervention or initiative to mutual support to problem-solving to addressing an issue of local concern. An effective discussion group depends on a leader or facilitator who can guide it through an open process – the group chooses what it’s discussing, if not already determined, discusses it with no expectation of particular conclusions, encourages civil disagreement and argument, and makes sure that every member is included and no one dominates. It helps greatly if the leader comes to the task with a democratic or, especially, a collaborative style, and with an understanding of how a group functions.

A good group discussion leader has to pay attention to the process and content of the discussion as well as to the people who make up the group. She has to prepare the space and the setting to the extent possible; help the group establish ground rules that will keep it moving civilly and comfortably; provide whatever materials are necessary; familiarize herself with the topic; and make sure that any pre-discussion readings or assignments get to participants in plenty of time. Then she has to guide the discussion, being careful to promote an open process; involve everyone and let no one dominate; attend to the personal issues and needs of individual group members when they affect the group; summarize or clarify when appropriate; ask questions to keep the discussion moving, and put aside her own agenda, ego, and biases.

It’s not an easy task, but it can be extremely rewarding. An effective group discussion can lay the groundwork for action and real community change.

Online resources

Everyday-Democracy . Study Circles Resource Center. Information and publications related to study circles, participatory discussion groups meant to address community issues.

Facilitating Political Discussions from the Institute for Democracy and Higher Education at Tufts University is designed to assist experienced facilitators in training others to facilitate politically charged conversations. The materials are broken down into "modules" and facilitation trainers can use some or all of them to suit their needs.

Project on Civic Reflection provides information about leading study circles on civic reflection.

“ Suggestions for Leading Small-Group Discussions ,” prepared by Lee Haugen, Center for Teaching Excellence, Iowa State University, 1998. Tips on university teaching, but much of the information is useful in other circumstances as well.

“ Tips for Leading Discussions ,” by Felisa Tibbits, Human Rights Education Associates.

Print resources

Forsyth, D . Group Dynamics . (2006). (4th edition). Belmont, CA: Thomson Wadsworth.

Johnson, D., & Frank P. (2002). Joining Together: Group theory and group skills . (8th edition). Boston: Allyn & Bacon.

This Is What You Need to Know to Pass Your Group Case Interview

Last Updated January, 2024

If you’re on this page, chances are you’ve been told you’re scheduled for a group interview.

After practicing for weeks to get good at cracking a normal case interview, hearing you have a group interview might make you feel like you’ve scaled a huge mountain only to find that there’s an even higher peak beyond it that you need to climb.

Group case interviews present some different challenges than individual cases, but if you know what those challenges are, you can overcome them.

We’ll tell you how.

In this article, we’ll cover what a group case interview is, why consulting firms use them, the key to passing your group interview, and tell you the 6 tips on group interviews you need to know.

If this is your first time to MyConsultingOffer.org, you may want to start with this page on Case Interview Prep . But if you’re ready to learn everything you need to know to pass a group case, you’re in the right place.

Let’s get started!

What is a Group Case Interview?

The group needs to come to a collective point of view on what the client’s problem is, how to structure their analysis, and what the final recommendation should be.

The group should also agree on how the analysis of the case will be conducted at a high level, but the actual number-crunching will need to be divided between group members in order to complete the work in the allotted time.

The group’s analysis and recommendation will be presented to one or more interviewers.

Why Do Consulting Firms Use Group Case Interviews?

It can feel difficult to trust your team members when you know that you’re all competing for the same job, but that’s what the group case is about — it tests teamwork skills in a high-stakes environment.

Management consultants are hired to solve big, thorny business problems, ones that require the work of multiple people to solve.

While there is a hierarchy on consulting teams with a partner leading the work, consulting partners simultaneously manage multiple clients or multiple studies at one large client.

They won’t work with your team every day and in their absence, the team still needs to be able to work together effectively.

Even if a partner is leading a team’s problem-solving discussion, each consultant has a responsibility to make sure the team’s best thinking is being put forward to help the client.

Ideas are both expected from each member of the team and valued.

Even the newest analyst has a contribution to make.

T he analyst may have been the person to analyze the data and therefore be closest to the information that will drive the solution to the problem.

The flat power-structure of the team makes it critical that each consultant works well with others on teams.

In assessing each member of a group case team, interviewers will ask themselves:

Does each of the recruits listen as well as lead?

Are they open to other peoples’ ideas?

Can they perform independent analysis and interpret what impact their work has on the overall problem the team is trying to solve?

Can they persuade team members of their points of view?

The Key to Passing the Group Case: Make Sure Your Group Is Organized

A group case must be solved by going through the same 4 steps as individual cases : the opening, structuring the problem, the analysis, and the recommendation.

Your team should break down the time you have to solve the case into time allotted to each of these steps to ensure you don’t spend too long in one area and not reach a recommendation.

Make sure the team agrees on a single statement of the client’s problem.

Take the time for everyone to read the materials, take notes, and suggest what they think is the key question(s) that need to be solved in this case.

Write it on a whiteboard or somewhere else to ensure there’s agreement. You can’t solve the problem together if you don’t agree on what the problem is.

Usually, someone in the group will take the lead on organizing the group.

If no one does, this is your opportunity to demonstrate your leadership and teamwork skills, but if there are people fighting over the leadership position (unlikely since everyone is on their “best behavior”), then contribute and don’t worry that you aren’t “leading” the discussion just yet.

Create a clear, MECE structure to analyze the problem.

This is even more important to solving a group case than an individual one because you need to make sure that when the group breaks up so each member can perform part of the analysis, all the issues are covered and there’s not duplicated effort between team members.

After your group structures the problem, split up the analysis that needs to be done between members of the group.

If no one suggests breaking up the analysis, then volunteer the idea. Be sure to explain how each person’s piece fits into the team effort.

Each person should do their analysis independently to ensure there is sufficient time to complete all the required tasks, though the team should regroup briefly if someone has a problem they need help with or comes up with an insight that could influence the work other group members are doing.

While you do your own analysis, you’ll need to demonstrate you understand the bigger picture by involving your teammates, sharing how your findings impacts their work, and articulating how all the insights lead to an answer to the client’s problem.

After everyone has completed their analysis, the group should come back together so everyone can report their results and the group can collectively come to a recommendation to present to interviewers.

In addition to the normal 4 parts of the case, group cases usually require you to present your recommendation to the interviewer(s).

Be sure to build time into your schedule for creating slides, deciding who presents what, and practicing your delivery.

Many groups fail because they begin their presentation without deciding who has which role.

In consulting, this is like going into a client meeting without knowing who is presenting which slide to the client and makes your team look unprofessional.

Presentation

Start with your recommendation and then provide the key pieces of analysis and/or reasoning that support it.

Again, the work will need to be divided between team members to ensure you get slides written in the allotted time.

For more information on writing good slide presentations, see Written Case Interview page.

6 Tips to Pass Your Group Case Interview

Tip 1: organize your team.

A disorganized team will not be able to complete their analysis and develop a strong recommendation in the time allotted.

See the previous section for the steps the group needs to complete to solve the case.

If someone else does take charge, don’t fight for control.

Show leadership by making points that help to move the team’s problem solving forward, not fighting so that it goes backwards.

Tip 2: Move the Problem-Solving Forward

With multiple team members trying to contribute and express their point of view, it’s possible to have a lot of discussion without getting closer to a solution to the client’s business problem. You can overcome this by:

Summing up what the team has agreed on so far,
Providing insight into how the team’s discussion impacts the problem you’re tasked with solving, and/or
Steering the team to discuss the next steps.

If it feels like the team is rehashing the same topics, use these options to move the problem solving forward.

Tip 3: Make Fact-Based Decisions

It’s okay to disagree with team members but always disagree like a consultant. Challenge teammates’ ideas with data, not opinions.

If there is analysis that needs to be done to determine which point of view is correct, table the discussion until the analysis has been completed.

Tip 4: Don't Steamroll Teammates

As mentioned earlier, consulting teams value the ideas and input of every team member.

Because of this, cutting off, interrupting or talking over other team members is more likely to get you turned down for a consulting job than hired.

The quality of your contribution to group discussions is more important than the quantity (or air time) you consume.

Demonstrate your collaboration and interpersonal skills.

Tip 5: Remain Confident When the Team Presents

Keep your poker face on even if your teammates don’t make every point the way you would have made it.

Like steamrolling teammates in discussions, frowning or shaking your head as they present will make it look like you’re not a team player.

Tip 6: Remember, Everyone Can Get Offers

In many jobs, there is only one position open.

At consulting firms, a class of new analysts and associates is hired each year.

There aren’t quotas regarding hiring only one person from a group interview team, so working cooperatively to solve the problem is a better strategy than undermining other members of your group to appear smarter than they are.

We’ve seen group interviews where no one gets a job offer and that can be because teammates undermine each other.

Don’t Over-Invest in Prepping for a Group Case Study Interview

Like the written case interview , group cases come up infrequently.

The 2 most common types of case interviews are individual interviews: the candidate-led interview or the interviewer-led interview.

In the candidate-led interview , the recruit is responsible for moving the problem solving forward. After they ensure they understand the problem and structure how they’d approach solving it, they pick one piece of the problem to start drilling down on first. Candidate-led cases are commonly used by Bain and BCG.

In the interviewer-led interview , the interviewer will suggest the first part of the case a recruit should probe after they have presented their opening and structured the problem. Interviewer-led interviews are commonly used by McKinsey .

Because individual cases are much more common than group cases, don’t spend time preparing for a group case unless you’re sure you’ll have one.

If you’re invited to take part in a group case interview, your preparation on individual cases will ensure you have a good approach cracking the case.

At this point, we hope you feel confident you can pass your group case interview.

In this article, we’ve covered what a group case interview is, why consulting firms use them, the key to passing your group interview, and the 6 tips on group interviews you need to know.

Still have questions?

If you have more questions about group interviews, leave them in the comments below. One of My Consulting Offer’s case coaches will answer them.

People prepping for a group case interview have also found the following other pages helpful:

Case Interview Math ,
Written Case Interview , and
Bain One Way Interview .

Help with Case Study Interview Preparation

Thanks for turning to My Consulting Offer for advice on case study interview prep. My Consulting Offer has helped almost 85% of the people we’ve worked with get a job in management consulting. We want you to be successful in your consulting interviews too.

If you want a step-by-step solution to land more offers from consulting firms, then grab the free video training series below. It’s been created by former Bain, BCG, and McKinsey Consultants, Managers and Recruiters.

It contains the EXACT solution used by over 500 of our clients to land offers.

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3 Top Strategies to Master the Case Interview in Under a Week

We are sharing our powerful strategies to pass the case interview even if you have no business background, zero casing experience, or only have a week to prepare.

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All You Wanted to Know About How to Write a Case Study

What do you study in your college? If you are a psychology, sociology, or anthropology student, we bet you might be familiar with what a case study is. This research method is used to study a certain person, group, or situation. In this guide from our dissertation writing service , you will learn how to write a case study professionally, from researching to citing sources properly. Also, we will explore different types of case studies and show you examples — so that you won’t have any other questions left.

What Is a Case Study?

A case study is a subcategory of research design which investigates problems and offers solutions. Case studies can range from academic research studies to corporate promotional tools trying to sell an idea—their scope is quite vast.

What Is the Difference Between a Research Paper and a Case Study?

While research papers turn the reader’s attention to a certain problem, case studies go even further. Case study guidelines require students to pay attention to details, examining issues closely and in-depth using different research methods. For example, case studies may be used to examine court cases if you study Law, or a patient's health history if you study Medicine. Case studies are also used in Marketing, which are thorough, empirically supported analysis of a good or service's performance. Well-designed case studies can be valuable for prospective customers as they can identify and solve the potential customers pain point.

Case studies involve a lot of storytelling – they usually examine particular cases for a person or a group of people. This method of research is very helpful, as it is very practical and can give a lot of hands-on information. Most commonly, the length of the case study is about 500-900 words, which is much less than the length of an average research paper.

The structure of a case study is very similar to storytelling. It has a protagonist or main character, which in your case is actually a problem you are trying to solve. You can use the system of 3 Acts to make it a compelling story. It should have an introduction, rising action, a climax where transformation occurs, falling action, and a solution.

Here is a rough formula for you to use in your case study:

Problem (Act I): > Solution (Act II) > Result (Act III) > Conclusion.

Types of Case Studies

The purpose of a case study is to provide detailed reports on an event, an institution, a place, future customers, or pretty much anything. There are a few common types of case study, but the type depends on the topic. The following are the most common domains where case studies are needed:

Historical case studies are great to learn from. Historical events have a multitude of source info offering different perspectives. There are always modern parallels where these perspectives can be applied, compared, and thoroughly analyzed.
Problem-oriented case studies are usually used for solving problems. These are often assigned as theoretical situations where you need to immerse yourself in the situation to examine it. Imagine you’re working for a startup and you’ve just noticed a significant flaw in your product’s design. Before taking it to the senior manager, you want to do a comprehensive study on the issue and provide solutions. On a greater scale, problem-oriented case studies are a vital part of relevant socio-economic discussions.
Cumulative case studies collect information and offer comparisons. In business, case studies are often used to tell people about the value of a product.
Critical case studies explore the causes and effects of a certain case.
Illustrative case studies describe certain events, investigating outcomes and lessons learned.

Need a compelling case study? EssayPro has got you covered. Our experts are ready to provide you with detailed, insightful case studies that capture the essence of real-world scenarios. Elevate your academic work with our professional assistance.

Case Study Format

The case study format is typically made up of eight parts:

Executive Summary. Explain what you will examine in the case study. Write an overview of the field you’re researching. Make a thesis statement and sum up the results of your observation in a maximum of 2 sentences.
Background. Provide background information and the most relevant facts. Isolate the issues.
Case Evaluation. Isolate the sections of the study you want to focus on. In it, explain why something is working or is not working.
Proposed Solutions. Offer realistic ways to solve what isn’t working or how to improve its current condition. Explain why these solutions work by offering testable evidence.
Conclusion. Summarize the main points from the case evaluations and proposed solutions. 6. Recommendations. Talk about the strategy that you should choose. Explain why this choice is the most appropriate.
Implementation. Explain how to put the specific strategies into action.
References. Provide all the citations.

How to Write a Case Study

Let's discover how to write a case study.

Setting Up the Research

When writing a case study, remember that research should always come first. Reading many different sources and analyzing other points of view will help you come up with more creative solutions. You can also conduct an actual interview to thoroughly investigate the customer story that you'll need for your case study. Including all of the necessary research, writing a case study may take some time. The research process involves doing the following:

Define your objective. Explain the reason why you’re presenting your subject. Figure out where you will feature your case study; whether it is written, on video, shown as an infographic, streamed as a podcast, etc.
Determine who will be the right candidate for your case study. Get permission, quotes, and other features that will make your case study effective. Get in touch with your candidate to see if they approve of being part of your work. Study that candidate’s situation and note down what caused it.
Identify which various consequences could result from the situation. Follow these guidelines on how to start a case study: surf the net to find some general information you might find useful.
Make a list of credible sources and examine them. Seek out important facts and highlight problems. Always write down your ideas and make sure to brainstorm.
Focus on several key issues – why they exist, and how they impact your research subject. Think of several unique solutions. Draw from class discussions, readings, and personal experience. When writing a case study, focus on the best solution and explore it in depth. After having all your research in place, writing a case study will be easy. You may first want to check the rubric and criteria of your assignment for the correct case study structure.

Read Also: ' WHAT IS A CREDIBLE SOURCES ?'

Although your instructor might be looking at slightly different criteria, every case study rubric essentially has the same standards. Your professor will want you to exhibit 8 different outcomes:

Correctly identify the concepts, theories, and practices in the discipline.
Identify the relevant theories and principles associated with the particular study.
Evaluate legal and ethical principles and apply them to your decision-making.
Recognize the global importance and contribution of your case.
Construct a coherent summary and explanation of the study.
Demonstrate analytical and critical-thinking skills.
Explain the interrelationships between the environment and nature.
Integrate theory and practice of the discipline within the analysis.

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Case Study Outline

Let's look at the structure of an outline based on the issue of the alcoholic addiction of 30 people.

Introduction

Statement of the issue: Alcoholism is a disease rather than a weakness of character.
Presentation of the problem: Alcoholism is affecting more than 14 million people in the USA, which makes it the third most common mental illness there.
Explanation of the terms: In the past, alcoholism was commonly referred to as alcohol dependence or alcohol addiction. Alcoholism is now the more severe stage of this addiction in the disorder spectrum.
Hypotheses: Drinking in excess can lead to the use of other drugs.
Importance of your story: How the information you present can help people with their addictions.
Background of the story: Include an explanation of why you chose this topic.
Presentation of analysis and data: Describe the criteria for choosing 30 candidates, the structure of the interview, and the outcomes.
Strong argument 1: ex. X% of candidates dealing with anxiety and depression...
Strong argument 2: ex. X amount of people started drinking by their mid-teens.
Strong argument 3: ex. X% of respondents’ parents had issues with alcohol.
Concluding statement: I have researched if alcoholism is a disease and found out that…
Recommendations: Ways and actions for preventing alcohol use.

Writing a Case Study Draft

After you’ve done your case study research and written the outline, it’s time to focus on the draft. In a draft, you have to develop and write your case study by using: the data which you collected throughout the research, interviews, and the analysis processes that were undertaken. Follow these rules for the draft:

Your draft should contain at least 4 sections: an introduction; a body where you should include background information, an explanation of why you decided to do this case study, and a presentation of your main findings; a conclusion where you present data; and references.
In the introduction, you should set the pace very clearly. You can even raise a question or quote someone you interviewed in the research phase. It must provide adequate background information on the topic. The background may include analyses of previous studies on your topic. Include the aim of your case here as well. Think of it as a thesis statement. The aim must describe the purpose of your work—presenting the issues that you want to tackle. Include background information, such as photos or videos you used when doing the research.
Describe your unique research process, whether it was through interviews, observations, academic journals, etc. The next point includes providing the results of your research. Tell the audience what you found out. Why is this important, and what could be learned from it? Discuss the real implications of the problem and its significance in the world.
Include quotes and data (such as findings, percentages, and awards). This will add a personal touch and better credibility to the case you present. Explain what results you find during your interviews in regards to the problem and how it developed. Also, write about solutions which have already been proposed by other people who have already written about this case.
At the end of your case study, you should offer possible solutions, but don’t worry about solving them yourself.

Use Data to Illustrate Key Points in Your Case Study

Even though your case study is a story, it should be based on evidence. Use as much data as possible to illustrate your point. Without the right data, your case study may appear weak and the readers may not be able to relate to your issue as much as they should. Let's see the examples from essay writing service :

‍ With data: Alcoholism is affecting more than 14 million people in the USA, which makes it the third most common mental illness there. Without data: A lot of people suffer from alcoholism in the United States.

Try to include as many credible sources as possible. You may have terms or sources that could be hard for other cultures to understand. If this is the case, you should include them in the appendix or Notes for the Instructor or Professor.

Finalizing the Draft: Checklist

After you finish drafting your case study, polish it up by answering these ‘ask yourself’ questions and think about how to end your case study:

Check that you follow the correct case study format, also in regards to text formatting.
Check that your work is consistent with its referencing and citation style.
Micro-editing — check for grammar and spelling issues.
Macro-editing — does ‘the big picture’ come across to the reader? Is there enough raw data, such as real-life examples or personal experiences? Have you made your data collection process completely transparent? Does your analysis provide a clear conclusion, allowing for further research and practice?

Problems to avoid:

Overgeneralization – Do not go into further research that deviates from the main problem.
Failure to Document Limitations – Just as you have to clearly state the limitations of a general research study, you must describe the specific limitations inherent in the subject of analysis.
Failure to Extrapolate All Possible Implications – Just as you don't want to over-generalize from your case study findings, you also have to be thorough in the consideration of all possible outcomes or recommendations derived from your findings.

How to Create a Title Page and Cite a Case Study

Let's see how to create an awesome title page.

Your title page depends on the prescribed citation format. The title page should include:

A title that attracts some attention and describes your study
The title should have the words “case study” in it
The title should range between 5-9 words in length
Your name and contact information
Your finished paper should be only 500 to 1,500 words in length.With this type of assignment, write effectively and avoid fluff

Here is a template for the APA and MLA format title page:

There are some cases when you need to cite someone else's study in your own one – therefore, you need to master how to cite a case study. A case study is like a research paper when it comes to citations. You can cite it like you cite a book, depending on what style you need.

Citation Example in MLA ‍ Hill, Linda, Tarun Khanna, and Emily A. Stecker. HCL Technologies. Boston: Harvard Business Publishing, 2008. Print.

Citation Example in APA ‍ Hill, L., Khanna, T., & Stecker, E. A. (2008). HCL Technologies. Boston: Harvard Business Publishing.

Citation Example in Chicago Hill, Linda, Tarun Khanna, and Emily A. Stecker. HCL Technologies.

Case Study Examples

To give you an idea of a professional case study example, we gathered and linked some below.

Eastman Kodak Case Study

Case Study Example: Audi Trains Mexican Autoworkers in Germany

To conclude, a case study is one of the best methods of getting an overview of what happened to a person, a group, or a situation in practice. It allows you to have an in-depth glance at the real-life problems that businesses, healthcare industry, criminal justice, etc. may face. This insight helps us look at such situations in a different light. This is because we see scenarios that we otherwise would not, without necessarily being there. If you need custom essays , try our research paper writing services .

Get Help Form Qualified Writers

Crafting a case study is not easy. You might want to write one of high quality, but you don’t have the time or expertise. If you’re having trouble with your case study, help with essay request - we'll help. EssayPro writers have read and written countless case studies and are experts in endless disciplines. Request essay writing, editing, or proofreading assistance from our custom case study writing service , and all of your worries will be gone.

Don't Know Where to Start?

Crafting a case study is not easy. You might want to write one of high quality, but you don’t have the time or expertise. Request ' write my case study ' assistance from our service.

What Is A Case Study?

How to cite a case study in apa, how to write a case study, related articles.

How to Write a Summary of a Book with an Example

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15+ Professional Case Study Examples [Design Tips + Templates]

By Alice Corner , Jan 12, 2023

Have you ever bought something — within the last 10 years or so — without reading its reviews or without a recommendation or prior experience of using it?

If the answer is no — or at least, rarely — you get my point.

Positive reviews matter for selling to regular customers, and for B2B or SaaS businesses, detailed case studies are important too.

Wondering how to craft a compelling case study ? No worries—I’ve got you covered with 15 marketing case study templates , helpful tips, and examples to ensure your case study converts effectively.

Click to jump ahead:

What is a Case Study?

Business Case Study Examples

Simple case study examples.

Marketing Case Study Examples

Sales Case Study Examples

Case Study FAQs

What is a case study?

A case study is an in-depth, detailed analysis of a specific real-world situation. For example, a case study can be about an individual, group, event, organization, or phenomenon. The purpose of a case study is to understand its complexities and gain insights into a particular instance or situation.

In the context of a business, however, case studies take customer success stories and explore how they use your product to help them achieve their business goals.

As well as being valuable marketing tools , case studies are a good way to evaluate your product as it allows you to objectively examine how others are using it.

It’s also a good way to interview your customers about why they work with you.

Related: What is a Case Study? [+6 Types of Case Studies]

Marketing Case Study Template

A marketing case study showcases how your product or services helped potential clients achieve their business goals. You can also create case studies of internal, successful marketing projects. A marketing case study typically includes:

Company background and history
The challenge
How you helped
Specific actions taken
Visuals or Data
Client testimonials

Here’s an example of a marketing case study template:

Whether you’re a B2B or B2C company, business case studies can be a powerful resource to help with your sales, marketing, and even internal departmental awareness.

Business and business management case studies should encompass strategic insights alongside anecdotal and qualitative findings, like in the business case study examples below.

Conduct a B2B case study by researching the company holistically

When it comes to writing a case study, make sure you approach the company holistically and analyze everything from their social media to their sales.

Think about every avenue your product or service has been of use to your case study company, and ask them about the impact this has had on their wider company goals.

Venngage orange marketing case study example

In business case study examples like the one above, we can see that the company has been thought about holistically simply by the use of icons.

By combining social media icons with icons that show in-person communication we know that this is a well-researched and thorough case study.

This case study report example could also be used within an annual or end-of-year report.

Highlight the key takeaway from your marketing case study

To create a compelling case study, identify the key takeaways from your research. Use catchy language to sum up this information in a sentence, and present this sentence at the top of your page.

This is “at a glance” information and it allows people to gain a top-level understanding of the content immediately.

Purple SAAS Business Case Study Template

You can use a large, bold, contrasting font to help this information stand out from the page and provide interest.

Learn how to choose fonts effectively with our Venngage guide and once you’ve done that.

Upload your fonts and brand colors to Venngage using the My Brand Kit tool and see them automatically applied to your designs.

The heading is the ideal place to put the most impactful information, as this is the first thing that people will read.

In this example, the stat of “Increase[d] lead quality by 90%” is used as the header. It makes customers want to read more to find out how exactly lead quality was increased by such a massive amount.

Purple SAAS Business Case Study Template Header

If you’re conducting an in-person interview, you could highlight a direct quote or insight provided by your interview subject.

Pick out a catchy sentence or phrase, or the key piece of information your interview subject provided and use that as a way to draw a potential customer in.

Use charts to visualize data in your business case studies

Charts are an excellent way to visualize data and to bring statistics and information to life. Charts make information easier to understand and to illustrate trends or patterns.

Making charts is even easier with Venngage.

In this consulting case study example, we can see that a chart has been used to demonstrate the difference in lead value within the Lead Elves case study.

Adding a chart here helps break up the information and add visual value to the case study.

Using charts in your case study can also be useful if you’re creating a project management case study.

You could use a Gantt chart or a project timeline to show how you have managed the project successfully.

event marketing project management gantt chart example

Use direct quotes to build trust in your marketing case study

To add an extra layer of authenticity you can include a direct quote from your customer within your case study.

According to research from Nielsen , 92% of people will trust a recommendation from a peer and 70% trust recommendations even if they’re from somebody they don’t know.

So if you have a customer or client who can’t stop singing your praises, make sure you get a direct quote from them and include it in your case study.

You can either lift part of the conversation or interview, or you can specifically request a quote. Make sure to ask for permission before using the quote.

Contrast Lead Generation Business Case Study Template

This design uses a bright contrasting speech bubble to show that it includes a direct quote, and helps the quote stand out from the rest of the text.

This will help draw the customer’s attention directly to the quote, in turn influencing them to use your product or service.

Less is often more, and this is especially true when it comes to creating designs. Whilst you want to create a professional-looking, well-written and design case study – there’s no need to overcomplicate things.

These simple case study examples show that smart clean designs and informative content can be an effective way to showcase your successes.

Use colors and fonts to create a professional-looking case study

Business case studies shouldn’t be boring. In fact, they should be beautifully and professionally designed.

This means the normal rules of design apply. Use fonts, colors, and icons to create an interesting and visually appealing case study.

In this case study example, we can see how multiple fonts have been used to help differentiate between the headers and content, as well as complementary colors and eye-catching icons.

Blue Simple Business Case Study Template

Marketing case study examples

Marketing case studies are incredibly useful for showing your marketing successes. Every successful marketing campaign relies on influencing a consumer’s behavior, and a great case study can be a great way to spotlight your biggest wins.

In the marketing case study examples below, a variety of designs and techniques to create impactful and effective case studies.

Show off impressive results with a bold marketing case study

Case studies are meant to show off your successes, so make sure you feature your positive results prominently. Using bold and bright colors as well as contrasting shapes, large bold fonts, and simple icons is a great way to highlight your wins.

In well-written case study examples like the one below, the big wins are highlighted on the second page with a bright orange color and are highlighted in circles.

Making the important data stand out is especially important when attracting a prospective customer with marketing case studies.

Light simplebusiness case study template

Use a simple but clear layout in your case study

Using a simple layout in your case study can be incredibly effective, like in the example of a case study below.

Keeping a clean white background, and using slim lines to help separate the sections is an easy way to format your case study.

Making the information clear helps draw attention to the important results, and it helps improve the accessibility of the design .

Business case study examples like this would sit nicely within a larger report, with a consistent layout throughout.

Modern lead Generaton Business Case Study Template

Use visuals and icons to create an engaging and branded business case study

Nobody wants to read pages and pages of text — and that’s why Venngage wants to help you communicate your ideas visually.

Using icons, graphics, photos, or patterns helps create a much more engaging design.

With this Blue Cap case study icons, colors, and impactful pattern designs have been used to create an engaging design that catches your eye.

Social Media Business Case Study template

Use a monochromatic color palette to create a professional and clean case study

Let your research shine by using a monochromatic and minimalistic color palette.

By sticking to one color, and leaving lots of blank space you can ensure your design doesn’t distract a potential customer from your case study content.

In this case study on Polygon Media, the design is simple and professional, and the layout allows the prospective customer to follow the flow of information.

The gradient effect on the left-hand column helps break up the white background and adds an interesting visual effect.

Gray Lead Generation Business Case Study Template

Did you know you can generate an accessible color palette with Venngage? Try our free accessible color palette generator today and create a case study that delivers and looks pleasant to the eye:

Venngage's accessible color palette generator

Add long term goals in your case study

When creating a case study it’s a great idea to look at both the short term and the long term goals of the company to gain the best understanding possible of the insights they provide.

Short-term goals will be what the company or person hopes to achieve in the next few months, and long-term goals are what the company hopes to achieve in the next few years.

Check out this modern pattern design example of a case study below:

Lead generation business case study template

In this case study example, the short and long-term goals are clearly distinguished by light blue boxes and placed side by side so that they are easy to compare.

Lead generation case study example short term goals

Use a strong introductory paragraph to outline the overall strategy and goals before outlining the specific short-term and long-term goals to help with clarity.

This strategy can also be handy when creating a consulting case study.

Use data to make concrete points about your sales and successes

When conducting any sort of research stats, facts, and figures are like gold dust (aka, really valuable).

Being able to quantify your findings is important to help understand the information fully. Saying sales increased 10% is much more effective than saying sales increased.

While sales dashboards generally tend it make it all about the numbers and charts, in sales case study examples, like this one, the key data and findings can be presented with icons. This contributes to the potential customer’s better understanding of the report.

They can clearly comprehend the information and it shows that the case study has been well researched.

Vibrant Content Marketing Case Study Template

Use emotive, persuasive, or action based language in your marketing case study

Create a compelling case study by using emotive, persuasive and action-based language when customizing your case study template.

In this well-written case study example, we can see that phrases such as “Results that Speak Volumes” and “Drive Sales” have been used.

Using persuasive language like you would in a blog post. It helps inspire potential customers to take action now.

Bold Content Marketing Case Study Template

Keep your potential customers in mind when creating a customer case study for marketing

82% of marketers use case studies in their marketing because it’s such an effective tool to help quickly gain customers’ trust and to showcase the potential of your product.

Why are case studies such an important tool in content marketing?

By writing a case study you’re telling potential customers that they can trust you because you’re showing them that other people do.

Not only that, but if you have a SaaS product, business case studies are a great way to show how other people are effectively using your product in their company.

In this case study, Network is demonstrating how their product has been used by Vortex Co. with great success; instantly showing other potential customers that their tool works and is worth using.

Teal Social Media Business Case Study Template

Related: 10+ Case Study Infographic Templates That Convert

Case studies are particularly effective as a sales technique.

A sales case study is like an extended customer testimonial, not only sharing opinions of your product – but showcasing the results you helped your customer achieve.

Make impactful statistics pop in your sales case study

Writing a case study doesn’t mean using text as the only medium for sharing results.

You should use icons to highlight areas of your research that are particularly interesting or relevant, like in this example of a case study:

Coral content marketing case study template.jpg

Icons are a great way to help summarize information quickly and can act as visual cues to help draw the customer’s attention to certain areas of the page.

In some of the business case study examples above, icons are used to represent the impressive areas of growth and are presented in a way that grabs your attention.

Use high contrast shapes and colors to draw attention to key information in your sales case study

Help the key information stand out within your case study by using high contrast shapes and colors.

Use a complementary or contrasting color, or use a shape such as a rectangle or a circle for maximum impact.

This design has used dark blue rectangles to help separate the information and make it easier to read.

Coupled with icons and strong statistics, this information stands out on the page and is easily digestible and retainable for a potential customer.

Blue Content Marketing Case Study Tempalte

Case Study Examples Summary

Once you have created your case study, it’s best practice to update your examples on a regular basis to include up-to-date statistics, data, and information.

You should update your business case study examples often if you are sharing them on your website .

It’s also important that your case study sits within your brand guidelines – find out how Venngage’s My Brand Kit tool can help you create consistently branded case study templates.

Case studies are important marketing tools – but they shouldn’t be the only tool in your toolbox. Content marketing is also a valuable way to earn consumer trust.

Case Study FAQ

Why should you write a case study.

Case studies are an effective marketing technique to engage potential customers and help build trust.

By producing case studies featuring your current clients or customers, you are showcasing how your tool or product can be used. You’re also showing that other people endorse your product.

In addition to being a good way to gather positive testimonials from existing customers , business case studies are good educational resources and can be shared amongst your company or team, and used as a reference for future projects.

How should you write a case study?

To create a great case study, you should think strategically. The first step, before starting your case study research, is to think about what you aim to learn or what you aim to prove.

You might be aiming to learn how a company makes sales or develops a new product. If this is the case, base your questions around this.

You can learn more about writing a case study from our extensive guide.

Related: How to Present a Case Study like a Pro (With Examples)

Some good questions you could ask would be:

Why do you use our tool or service?
How often do you use our tool or service?
What does the process of using our product look like to you?
If our product didn’t exist, what would you be doing instead?
What is the number one benefit you’ve found from using our tool?

Learning Home

Not Now! Will rate later

Practice Case Studies: Long

The Exotic Melons: You are the manager (Worldwide Sales Cock and Bull Melons) in a Dubai-based company that deals in selling exotic fruits. Cock and Bull Melons are a special variety of melons that can be cultivated only on the sandy dunes surrounding the Cock and Bull oasis in the Sahara desert. Worldwide demand and supply have been quite stable so far at 100 melons a year, with the supply being just sufficient to cover the demand. Cock and Bull Melons have traditionally been sold to the sheikhs in the Middle East, and Hollywood and Bollywood actors and actresses. Their exorbitant prices take them out of reach of common people. In January 2002, the research centre at Punjab Agricultural University (PAU), India discovers that Cock and Bull melons can cure the fatal MarGaya syndrome in pregnant women, which kills both he mother and the child. Also, it can cure the fatal MaraGaya syndrome in diabetic patients. Both these symptoms are very rare. Unfortunately for you, in May 2002, the MaraGaya syndrome strikes 2000 people in America and the MarGaya syndrome strikes 1000 pregnant women in Sweden. 100 Cock and Bull melons are required to cure the 1000 cases in America while 100 are required to cure the Swedish problem. You know that the patients in both the countries cannot afford the high cost of Cock and Bull melon treatment. You also know that the revenues from treating patients would be much lower than selling them to sheikhs and film stars. You are in a real dilemma. What would you do?
Confidential Information? Mr. SecretKeeper is a Corporate Head (HR) in a company. He is very nice and gets along well with all people. People often consult him for help and advice. One person (named “Mr. A”) approaches him for a job because he is right now jobless. Mr. SecretKeeper takes the guy's qualifications and asks him to come after a week however, since no job available. He keeps frequently postponing the job offer. Mr. A keeps visiting the HR head, Mr. Secret Keeper, often and becomes his close friend. Then, one day, Mr. A confides with the HR Head “I was in prison for 18 years for a crime that I had not committed. With two years remaining of the sentence, I ran away from jail. Even now, police is in look out for me.” Mr. SecretKeeper tells the person to go home and that he would give him a job. However as soon as he leaves, Mr. SecretKeeper calls up the police and gives the details of Mr. A and asks them to arrest Mr. A. Because of this betrayal of trust by the HR head, people in the organisation have started losing faith in him. A senior person in the office complains to the VP that the Mr. Secret Keeper has “broken faith”, so others could not come to him. Assume that you are the VP of the company. What would you do about the situation?
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In a fix! You are the young dynamic, blue-eyed boy (girl) in a firm, which is a known leader in the industrial oils business. Under your leadership, the company has done extremely well in a slow, sluggish, mature market and has also effectively warded off competition from the superior industrial oil segment. However, as a young blooded individual, you decide that the company should branch into something more glamorous and contemporary. You manage to convince the top management to get into the film-making business. The film-making business is started as another division, where the systems and processes are kept the same to have uniformity across businesses. You manage to hire top talent in this field Mr. A, Mr. B and Mr. C from different competitors. You have big hopes from the trio as these people have come together as a team for the first time. You grant every freedom to these people to recruit their own subordinates. Barely a month after the film-making business has started, you are in a fix! Mr. B throws his cap, sheds a zillion tears and tells you in a choked voice that he would rather die than continue with your business. A couple of months later Mr. C blames your policies and quits. Your six monthly profit and loss statement shows that film-making business had been a horrific disaster. The only remaining member of the star trio, Mr. A says that the business is slightly out of form and that he might deliver if you grant him complete freedom. You can now see your own future as dark as the industrial oils your company specializes in. You are wondering what went wrong and what should you do now?

Tension on the job: Sujit Bhattacharyya (Bhola) had been an exceptionally bright student throughout his studies at IIT-Kharagpur. He devoted four years in pursuit of academic excellence. He had very few friends. Few peers liked him, but he was the darling of all his professors. Bhola joined TELCO from the campus as production supervisor in charge of vehicle assembly. Bhola used to manage shop floor operations consisting of truck assembly and in a shift 30-33 operator used to report to him. The IQ level of a typical operator could be compared to that of a class VIII student, but years of experience had made them confident about their job. GRAB THE OFFER: Kick start Your Preparations with FREE access to 25+ Mocks, 75+ Videos & 100+ Chapterwise Tests. Sign Up Now The operators, by virtue of doing the same job for so many years, had developed a highly robotic style of functioning and were highly resistant to change. The trade union was powerful and exercised a lot of leverage with the management, to secure incentives and overtime payment, which were fixed at a uniform rate across the departments. Nilesh was an operator in charge of front axle assembly. The number of trucks that rolled out of the factory was equal to the number of axles assembled. Thus, Nilesh was looking after a highly sensitive assembly operation. Nilesh, lately, had lost a lot of money in the stock market, had frequent quarrels with his wife and many times used to come drunk to the shop floor. His abrasive behavior had caused a lot of worry to Bhola. Nilesh also started absenting himself from duty and became casual in his approach. Subsequently, Nilesh was transferred to the quality control department to reduce his physical workload. Bhola found it very difficult to find a suitable replacement for Nilesh in the assembly area. He had to frequently interchange workers who were unable to cope with the high pressure work at the axle assembly. They deliberately started going slow, and thereby, affected productivity. Bhola did his best to pinpoint the problem. He was under tremendous pressure from the top to increase productivity to previous levels. The workers started demanding additional incentives and overtime payments. The management, on the other hand, was opposed to any change in the incentive structure. Bhola was helpless. He tried his best and at times did the work himself. The workers, sensing that Bhola had little control over them, became more aggressive and further slowed their work. Bhola suffered an emotional breakdown and had to stay away from work for two months. Discuss what the main issues in the case are and what would be your approach in this situation.
Tuna-Tuna Lactuna!: The Minicoy Canning Factory (henceforth MCF) was set up by the Lakshadweep administration in 1969 with an aim to step up fishery production, provide employment and enable fishermen to sell their excess fish for better returns. MCF could produce only up to 150,000 cans per year because of labour constraint. However, due to excess production, by September 2001, MCF had accumulated an unsold inventory of 150,000 cans amounting to Rs. 12,807,700. In 2001, 64,322 cans were sold resulting in a turnover of Rs. 6,302,500 and a profit of Rs. 810,380. Competition for MCF came from Integrated Fisheries Project (henceforth IFP), a government undertaking set up with an aim to introduce and popularize diversified fishery products in rural and urban markets. MCF canned a type of tuna called Skipjack tuna, whose meat was harder and different in taste as compared to Yellow fin tuna canned by IFP. The distributors felt that higher price of Skipjack tuna was the culprit for lower sales vis-à-vis IFP. The higher price was on account of higher overheads for MCF attributed to lower volumes. IFP also had a stronger dealer network and a much larger promotion budget. The demand for canned tuna is concentrated in upcountry areas. However, the sale of MCF's tuna to these regions has been low. Sales enquiries had also been received from the Middle East, but no action had been taken on them. Markets other than the retail market were also being explored. The management of MCF was pondering over what the problem was and what could be done to resolve it amicably, both in the short term as well as in the longer term.
Et tu Brutus!: Yahan Gadbad Inc. is a reputed multinational that specialized in organizing beauty pageants. The protagonists of this piece, besides you (of course), are Mr. Bhartus, the HR Manager and Mr. BigMouth, the flamboyant hospitality manager. Mr. BigMouth has been in Yahan Gadbad Inc. for over a decade now, during which he has successfully organized half a dozen pageants at exotic locales around the world. People in Yahan Gadbad swear by his integrity and professionalism and he has been the role model in the company for the last decade. Mr. Bhartus and Mr. BigMouth were good friends. One day after they had had a drink too many, Mr. BigMouth said to Mr. Bhartus, “Bhartu, I have something to confess to you. Bhartu dear, please listen to me as a friend and not as an HR manager”. “Of course Biggie!” said Mr. Bhartus, “I have big stomach. I can digest any secret”. Mr. BigMouth then said, “Do you remember the pageant we had in Polynesian Islands? You know, Bhartu the human heart is frail. I kind of got bowled over by a contestant. We had a week of debauchery. I rigged the contest to help her get the second runners up title”. In spite of the promise made to Mr. BigMouth, Mr. Bhartus comes to you (President, Yahan Gadbad Inc.) with the information. You think aloud, “Damn! What do I do now? The HR department handles confidential information and this fool could not keep a secret. On the other hand… God! Please guide me!”
Student's BIG problem: In an institute AIM, the students' council is selected by a voting wherein each student is allocated a vote for each position in the council. The council is supposed to undertake activities of students' interests. Each student pays Rs. 50 per year towards council dues. Extending the brief of the council, it decides to add responsibilities and projects. As a first, it introduces a scheme for students wherein it provides them stationary and hosiery at a subsidized price. This is to be done on a no-profit no-loss basis. Initially, it is done only for a select group of students as a pilot exercise. Extending in the first month, the council has a sale of Rs.3500. They make a profit of Rs. 300. Seeing this, the council decides to expand its store for the complete instituted. They buy goods worth Rs.15000 for the first time and Rs 10000 the second time. In order to buy these goods, it takes loan of Rs.8000 at an interest of 18% per annum. Rumors of bungling of money start floating around the campus. Some council members are alleged to have taken money from the store and the council funds. As a result of these rumors, some students begin to boycott the council and start to doubts its intentions. In addition, they allege that the store was supposed to be on a no profit no-loss basis, but still it aimed at earning profits. On complaints to the institute authorities, the store is closed for business till further notice, pending an internal investigation into the matter. As a result of the store closure, the council is left with stocks of Rs.13500. In addition, the council also has to repay Rs. 8000 plus interest to the financial institution. In the present scenario, what could be the possible solutions?

The Video Games Case You are the CEO of a large, diversified entertainment company. A division of your firm manufactures video games. The division is the third largest manufacturer of hardware in the industry and has a 10% market share, with the top two having 40% and 35% respectively. The industry growth has been strong, though over the last few months, the overall industry sales growth has slowed a bit. The division's sales have increased rapidly over the last year from a relatively small base. Current estimate is annual sales of 500,000 units for your division. The selling price of the basic Video Game unit (hardware) is Rs. 1000. The current cost of manufacturing a unit is Rs. 700, excluding the marketing costs. The top two competitors are estimated to have a 10 to 15% cost advantage currently. The division currently exceeds corporate return requirements; however, margins have recently been falling. The product features are constantly developed (e.g., new type of remote joy stick), to appeal to the segments of the market. However, the division estimates much of the initial target market (young families) has now purchased the video game hardware. No large new user segments have been identified . Recently, a request has come to you, the CEO, for approval of Rs. 20 Cr. for tripling the division's capacity. The requested expansion will also reduce the cost of manufacture by 5 to 7 % from the present value. Should you approve the expansion?
Bow Bow! You are the General Manager (Procurement) in a large, international trading firm, Idhar Udhar Inc. Your current responsibilities involve procurement of rats, dogs and cats from the dark interiors of Africa and selling them at a profit in developed countries as pets. Of these products, dogs are extremely seasonal, being available only from the middle of May to the end of August. You are expecting a bumper season this time around. Also, the price of dogs in the developed countries being at an all time high, you are expecting record profits which would, in a swift move, also put your career on the fast track. Bang in the middle of the procurement season, an internal audit reveals that Mr. Ghotala Doggy, your star manager (Procurement Dogs) has siphoned off Rs. 20,000 from company funds. Mr. Doggy has excellent relations with the suppliers and you know that it would be impossible to meet targets without him. On your questioning, Mr. Doggy reveals that he had taken the money for paying the medical bills of his daughter, Ms. Bitchy Doggy, who was seriously ill. Following this incident, audits were conducted in other divisions and irregularities were found there also. However, since your division was the first where such an incident took place, people are looking at you to set a precedent. Your company lays extreme emphasis on personal integrity and this is the first time in the company's century old history that such an incident has occurred. What would you do?
The Dilemma! You are the GM (HR) of a small firm involved in manufacturing and selling AM/FM radios. Of late, sales of radios have declined due to emergence of TV, Cable etc. The main departments are the production, marketing and accounting. Bharat is a clerk in the accounting department. He has been with the company for 15 years now. He knows the job well, but of late, is increasingly coming late for work. He is married with two children and he cites family problems as the cause of late arrival on job. Every time he promises to mend his ways, but has not done so till date. Om is the production supervisor. He has been with the company since its inception 30 years ago and commands a lot of respect from his workers. But, age is catching up on him fast. Also, the much younger workers are increasingly questioning and resisting his authority. If chucked out of the job, it might be difficult for him to find another job at his age. He is due to retire in another two years. Jai is a young MBA in marketing from a major B-School. He joined the company a year ago and started new advertising and marketing campaigns, at a tremendous cost to the company. His plans met with initial success, but then the sales were back to its initial levels. He handles the company's dealers in the northern region. But, his initial success seems to have gone to his head. He increasingly feels discontented when some of his new ideas are turned down by the higher management. Jagdish is a marketing executive with the company for the last 6 years. Though not an MBA, he was still hired for the job due to his sharp acumen. In the years to follow, with an increasing mumber of MBA's joining the company, he was denied promotion last year. This caused bouts of deep depression, from which he recovered after two months. After that, he has been complacent in his work and sometimes even rude to the customers. In a desperate cost-cutting measure, your company decides that it must reduce the workforce as a first measure. These four are the possible candidates for job termination. You, as a group, have to decide how many you will sack, which ones, and why?

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Case Study - Example

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Case study — example

An International Business professor prepared a case study in which conflict between two countries escalated to the point that war was imminent. The pressure to find a diplomatic resolution was strong during a period of heightened world tensions. Students broke into groups to support an ambassador charged with resolving the conflict. Students had three class sessions to analyze the conflict's historical, political, and economic roots and propose a solution. The professor informed the groups that they needed to develop a learning plan (identifying knowledge gaps and determining how to fill them) and a work plan (identifying how they would formulate their diplomatic resolutions). To facilitate the process, he distributed a template of both plans that groups cause or modify to suit their needs. After all the teams had met and completed this proposal, he asked them to evaluate the proposals of two other groups and select the most appealing one. An ambassador from each team that had created the top three proposals presented their group’s proposal to the class, and the whole class voted on the most persuasive one. Upon completing the activity, the professor found that it enhanced students’ understanding of the complexity of factors underlying international relations (Barkley 241-242).

Discussion prompt : Post your group's learning plan and work plan in the Case Study forum in the Canvas Discussions tool.
Response prompt : Respond to two other groups' learning and work plans.
Followup activity : Post your group's selection for the most persuasive proposal.
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Group case interviews: what to expect and how to prepare

It's no secret that leading consulting firms use case interviews to evaluate candidates before extending offers. But over the last several years, group case interviews have become more common at top firms like McKinsey, Deloitte, and EY.

Group case interviews demand the same analytical and communication skills as normal case interviews , but they take things a step further. They also evaluate a candidate's ability to work well with others in a high-pressure team environment.

In this guide, we'll examine group case interviews, their different formats, and key tips you can use to maximise your chances of getting a job offer. Here's an overview:

What is a group case interview?
Group case interview process
Group case interview preparation
Group case interview tips
Group case interview examples

Click here to practise 1-on-1 with MBB ex-interviewers

1. what is a group case interview ↑.

A group case interview is a case interview performed by a team of 3-6 candidates. The cases themselves are similar to what you'd find in a normal case interview, but the added challenge is solving it collaboratively as a team.

Group case interviews are usually not used in the first round and typically come up in the second or final round of interviews. For example, PWC uses group case interviews for their Super Day (e.g. Assessment Centre), which is usually held during the second round of interviews.

To fully understand group case interviews, it's critical to first understand normal case interviews. If you'd like to learn more about the fundamentals of case interviews, check out our ultimate guide to case interviews .

Like in normal case interviews, the quality of your analysis and communication will be important in group case interviews. But, you will also be evaluated on additional collaboration and interpersonal skills.

You should approach a group case interview like you're solving a real business problem with your team. Don't focus on the fact that you are competing with the other candidates. Instead, concentrate on working together to come up with the best solution possible.

The consulting firm may actually award multiple offers to members of your group, so your first priority should be developing a great solution.

As a general rule, if something would be helpful and positive in a real work environment, it will probably reflect well on you during a group case interview. Similarly, if something would be rude or unhelpful in the real world, don't do it during your interview.

Let's now look at the process you can expect when facing a group case interview.

2. Group case interview process ↑

A. types of group case interviews.

First, it's important to know that there are different types of group case interviews. Each firm, and even different internal groups or geographies, may approach group interviews differently. But in our experience, there are two primary formats:

Interview format
Presentation format

The interview format uses a similar style of questions as normal case interviews. But with these, you would be working through the process with a group of 2-5 other candidates.

Presentation format requires you to analyse provided materials, in order to prepare a presentation with your group. After preparing, your team will present to a panel of interviewers, who will typically ask follow-up questions for a few minutes.

To further clarify the process, let's look at each of these two formats in more detail. Before you read the snapshot of each format below, it's worth noting that the details can vary, so check with your recruiter ahead of time if you're already in the application process.

B. Interview format

Here's a snapshot of what you can typically expect with the interview-format, group case interview:

Candidates get divided into groups of 3 to 6
Each group is given information about a case (i.e. a client facing a problem)
You are given 10 minutes to review the materials by yourself or with another person in your group
You are then asked to discuss a few questions with your group, for about 20 minutes in front of your interviewers
Finally, the interviewers will ask a few questions to the group for 15 to 20 minutes

Okay, now let's take a look at the presentation format, which has some similarities and also important differences.

C. Presentation format

Here's what you can typically expect with a presentation-format, group case interview:

You are given 1 hour to review, and prepare a group presentation
An interviewer will watch during your prep time, but they won't intervene
Your group delivers a 15-minute presentation to a panel of interviewers
After you present, the interviewers will ask questions for 15-20 minutes

After reviewing the details on each format above, you should have a pretty good idea of what to expect in your upcoming group case interview. As an additional note, for any type of case interview where you need to analyse written case materials, you may benefit from the tips outlined in our written case interview guide . Now let's turn our attention to preparation.

3. Group case interview preparation ↑

There are a few things you should do to prepare for your group case interview, that can make a huge difference in your performance.

Some of these steps apply to both group case interviews and normal case interviews , while others are specific to group case interviews.

Use the steps below, to help you maximise your chances of success:

A. Become really confident at maths.

Similar to normal case interviews, being able to perform maths calculations quickly and accurately, can mean the difference between an offer and no offer.

Check out our free guide for case interview maths if you'd like to learn more.

B. Develop a consistent method for cracking cases.

If you can't solve a case on your own, you probably won't know where to start in a group case interview. So it's important that you have this foundation.

C. Practice cases out loud.

For a group case interview, the ideal preparation would be to do mock interviews with a group of 3-5 other people. This might be possible if you are in a consulting club, professional organisation, or if you have a great network.

However, if this isn't realistic for you, you can still practice by yourself. Just ask and answer case questions out loud. This may feel odd at first, but it will help you hone your thinking and communication.

D. Learn from every mistake you make

During practice for both group case interviews and normal case interviews, you'll want to go for quality over quantity.

For example, successful candidates find it more valuable to do 20 cases thoughtfully than to rush through 40 cases. A great way to do this is by keeping a notebook, where you write down mistakes and improvement opportunities after each case. Then you can check your progress by re-doing old cases later. This will help you make sure you’re headed in the right direction.

E. Learn how you come across to others

A central focus of group case interviews is to evaluate interpersonal skills. You'll want to put your best foot forward and come across as someone the interviewers would like to work with.

It's very difficult to objectively evaluate your own tone and communication style. As a result, it can be really helpful to ask friends and colleagues for feedback.

Ask them to be honest, and you may be surprised what you learn. Now is the time to identify if you have any tendencies that sound abrasive, dismissive, etc. You'll want to be aware of these, so you can work on them before your interview.

F. Practice the art of debate

I would consider this an optional preparation step, but it could give you a leg-up on your competition.

An important skill for a group case interview is the ability to persuade others with grace and supporting evidence. Great consultants are skilled at communicating with tact and can disagree with a client in a way that creates a positive impression.

A good way to practice this type of communication is through academic style debate. Perhaps you can get involved with a local debate club, or participate in a Toastmasters event. Or, simply initiate a discussion with a friend.

4. Group case interview tips ↑

Now that we've reviewed preparation steps, let's turn our focus to the day of the interview. Here are 8 tips to follow during your group case interview, that can really set you apart from other candidates.

Tip #1: Speak with a purpose

A lot of candidates will want to speak their mind as they know participating is important. But, participation alone is not enough.

The QUALITY of your input is crucial. Sometimes, it's better to let two or three people speak first, and then make a very thoughtful point based on how they started the discussion.

Focus more on the quality of your input, and less on the quantity.

Tip #2: Involve everyone

Keep an eye on who's participating in the conversation and who's not.

If you identify a member of the group who's struggling to make themselves heard, you should not hesitate to help them by saying something like: "We haven't heard everyone's opinion on this yet. John, Rebecca what do you think?".

This is a sign of leadership, and will also help you develop a more thoughtful and balanced solution.

Tip #3: Summarise

Plan to summarise key points. This can be done during team discussion, when answering case questions, or when delivering a presentation.

Summarising will position you as the person bringing everyone together. It will also contribute to better alignment within the group and clearer communication with interviewers.

This is a skill used by partners in real-world conversations with clients. You should aim to do this at least once or twice during your interview.

Tip #4: Anticipate questions

This is most helpful for interviews that include a group presentation. However, it could also help you prepare for follow-ups to a normal case question.

While preparing your analysis, you may notice some weaknesses. It's good to carve out a couple of minutes, to think through potential challenges from the interviewers.

It can also be helpful to ask yourself questions, like "if I was hearing this for the first time, what would I ask about?". The interviewers won't always ask the questions you most expect, but if they do, you'll be prepared with a thoughtful response.

Tip #5: Don't be easy to read

A group interview is a good time to use your poker face.

Everyone is stressed, but you need to come across as confident. A good way to do this is to focus on basic body language: look at people in the eye, sit confidently, don't cross your arms, etc.

Tip #6: Don't Interrupt others

Consultants need to be client-friendly, and interrupting someone in a discussion is not client-friendly at all.

You should listen carefully to what others are saying. Try to have a genuine interest in what they think. Before making your point, summarise their point to show that you understand what they mean.

Tip #7: Don't spend too much time reading

It's important to understand the case materials, but if you're not careful it could consume your full preparation time.

A great way to prepare efficiently is to first scan through the provided materials and form one or two initial hypotheses. Then you can search for specific data points that confirm or disprove it before you finalise your approach.

Tip #8: Don't dominate speaking time

Some candidates are so eager to participate that they end up completely dominating the rest of the group without realising it. Don't be that person!

A practical way of avoiding this is to keep an eye on how much time you talk. If you are in a 5-person group you should aim to speak 20% (1/5th) of the time and really no more than 25%.

Interviewers pay close attention to this, so be intentional about balancing your speaking time. Not too much, not too little.

5. Group case interview examples ↑

At the end of the day, a business case is a business case.

You may solve the case independently or with a team. The content will vary, and the amount of data provided can differ, but the basic premise remains the same.

As a result, you can prepare for a group case interview, by practicing with cases from normal case interviews.

When searching for sample cases, it can be really difficult to know where to start. Especially when the quality of cases is unclear. That's why we put together this list of the best free practice cases available .

It contains links to cases provided directly by leading consulting firms like McKinsey, BCG, Bain, and more. It also contains case books from consulting clubs at leading target schools, like Harvard, London Business School, and MIT. This list is a great place to go for example cases.

6. Mock interviews

The best way to improve at case interviews is to practise interviewing out loud, and you can do that in three main ways:

Interview yourself (out loud)
Practise interviewing with friends or family
Practise interviewing with ex-interviewers

Practising by yourself is a great way to get started, and can help you get more comfortable with the flow of a case interview. However, this type of practice won’t prepare you for realistic interview conditions.

After getting some practice on your own, you should find someone who can do a mock interview with you, like a friend or family member.

We’d also recommend that you practise 1-1 with ex-interviewers from top consulting firms . This is the best way to replicate the conditions of a real case interview, and to get feedback from someone who understands the process extremely well.

Click here to book your mock case interview.

Interview coach and candidate conduct a video call

Group exercises: what to expect

Abigail Lewis

Last updated: 21 Jun 2023, 15:38

The group exercise is a key part of an assessment centre day and helps graduate recruiters assess how you'd perform in the job. Find out how to impress them.

Supported by:

The assessment centre group exercise is used to see your communication and problem-solving skills in action, and to ensure that you can work effectively in a team. You need to support the group in completing the task that has been set, whether that involves discussing a particular issue, constructing something from bits of stationery, or analysing a complex business case study and presenting your findings. The best way to impress the assessors is to show yourself as a good team player – flexible, full of ideas but willing to listen to and help expand the ideas of others.

In recent years, some recruiters have switched to running virtual or digital assessment centres and, by and large, have continued with group exercises. However, a few have chosen not to. Instead, they have found other ways to assess the skills they would have through group exercises that better suit the platform they use – for instance, by adding questions to interviews. It's a good idea to be prepared to carry out a group exercise either way, whether as preparation to undertake one or so you know the kinds of skills the recruiter might assess elsewhere.

Find out more about what to expect during virtual assessment centres, along with tips for how best to approach them

How to impress recruiters during a group exercise

You need to contribute, but not to dominate. Be assertive, but not aggressive. If you are aware that you are usually a shy person who does not speak up, do your best to participate. If you know that you can sometimes be overbearing in groups, hold that tendency in check.
Speak clearly and confidently. Listen and don't interrupt. If undertaking a virtual group exercise, you could suggest using the 'raise a hand' function or similar so you can all take it in turn to speak. Be aware of what others in the group are contributing. Try to draw out quieter members and seek their views.
Be diplomatic. If one person is behaving in a dominant way, don't shout them down, but try to make sure that everybody gets a chance to share their thoughts. You can say things such as: 'That's a really good point [name], but [name] hasn't had a chance to contribute yet' or 'You've made some good points, but we haven't yet considered X, Y and Z and I think we should before coming to a decision'. Be prepared to compromise.
Make use of the resources available to you. If you are in the room together, use the flipchart and pens provided; if you are communicating digitally, use the virtual whiteboard if there is one.
Volunteering to be notetaker or timekeeper can be a good way to impress, as it shows that you are a considerate team player who takes responsibility. The flip side of this, however, is that you need to perform those functions well and make sure that you also contribute to the overarching discussions.
Keep an eye on the time and stay focused on the overall objective. From time to time, summarise the group's progress, even if you aren't notetaker or timekeeper.
Remember that you are not being primarily assessed on whether you reach the 'right' answer (often there isn't one), but on how you work with others. Take a look at our in-depth features on demonstrating communication and teamworking skills for more insights.

Example group exercise 1: the case study

This is probably the most common group exercise you will face at an assessment centre. In this type of exercise the group is given a set period of time to work together to respond to a case study brief, often a set of documents based on a real-life business situation. At some assessment centres the candidates may have already been interviewed about the case study brief on an individual basis. The group may be invited to present its findings as part of the exercise.

The case study scenario is likely to present the sort of challenges that you would encounter on the job and gives the assessors a chance to see how you would perform. Sometimes each candidate is given a different briefing document or role to play, and the group has to reach a conclusion despite the conflicting views of its members.

Example case studies and how to approach them

Example group exercise 2: the discussion group

A discussion group involves group members being given a topic or topics to discuss. The nature of the topics can vary but usually they involve an issue of current importance to students or something that's been in the news recently. Sometimes they are related to the industry that the employer works in: candidates applying for construction graduate programmes may be asked how the industry could address skills shortages, for example.

You are not usually given time to prepare so it's a good idea to read a quality newspaper or current affairs magazines/websites (such as The Economist ) in the weeks before the assessment centre.

At the end of the discussion each candidate may be invited to comment briefly in turn on one of the group's conclusions, so it's vital to listen as well as to speak up.

Get the insights and skills you need to shape your career journey with Pathways. Gain a strong grounding in the various ways you can prepare for an assessment centre, so you can give yourself the best chance of success.

Example group exercise 3: the leaderless task

This group exercise is similar to a case study exercise in that each group member will be given an individual briefing document. However, it is often different from other people’s in the group. Typically, the task will involve making a business decision and each member of the group will represent different business functions, such as marketing, sales or operations. As a group you must come up with a decision acceptable to all within the time limit. No one in the group is designated leader and so the group has to find a compromise solution.

Example group exercise 4: the leadership task

Occasionally, when the organisation is particularly interested in testing your leadership skills, you will be asked to chair a meeting or act as leader of your group. Once again there will be a set task but this time you will be expected to be in charge and to lead the others to success. This is what the assessors will be looking for:

A good leader delegates. The task cannot be done by you alone. You must divide up the work between the others.
A good leader uses the strengths of others. You must identify the strengths of the individuals in your group and use them in appropriate ways.
A good leader knows what's going on. Don’t get too involved in doing things. It's better to monitor what's going on and make changes if things don't work out

Example group exercise 5: the ‘build a…’ challenge

This is a classic way of seeing your teamworking skills in action, but for obvious reasons will only be undertaken at an in-person assessment centre. You might be asked to build a bridge or a tower from straw, paper and pins; you might be asked to put up a tent (tent poles and all); or you might be given another building task. Make sure the group doesn’t spend too much time discussing and designing and too little time building.

Example group exercise 6: the ice-breaker

Organisations use ice-breakers to help you relax and to help the group to gel. Sometimes ice-breakers can be a ‘build a…’ challenge, but sometimes they can be more discussion-led. You could be asked to introduce yourself to the group and share an interesting fact about yourself. Alternatively, you could be asked to introduce yourself to your neighbour and ask them questions, before summarising what you’ve heard to the rest of the group, for example: ‘This is James. He once ran a marathon for charity dressed as a Minion from the Despicable Me films’.

Another typical ice-breaker is to decide as a group what you’d save from a shipwreck to help you survive on a desert island.

Make sure that you throw yourself into the task, that you actively contribute, share information and listen to others. Although the ice-breaker’s primary purpose is to make you feel at ease, assessors will still be interested in how you express yourself and interact with others.

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Currently reading: Business school teaching case study: can green hydrogen’s potential be realised?
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Business school teaching case study: can green hydrogen’s potential be realised?

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Jennifer Howard-Grenville and Ujjwal Pandey

Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.

Hydrogen is often hyped as the “Swiss army knife” of the energy transition because of its potential versatility in decarbonising fossil fuel-intensive energy production and industries. Making use of that versatility, however, will require hydrogen producers and distributors to cut costs, manage technology risks, and obtain support from policymakers.

To cut carbon dioxide emissions, hydrogen production must shift from its current reliance on fossil fuels. The most common method yields “grey hydrogen”, made from natural gas but without emissions capture. “Blue hydrogen,” which is also made from natural gas but with the associated carbon emissions captured and stored, is favourable.

But “green hydrogen” uses renewable energy sources, including wind and solar, to split water into hydrogen and oxygen via electrolysis. And, because there are no carbon emissions during production or combustion, green hydrogen can help to decarbonise energy generation as well as industry sectors — such as steel, chemicals and transport — that rely heavily on fossil fuels.

Ultimately, though, the promise of green hydrogen will hinge on how businesses and policymakers weigh several questions, trade-offs, and potential long-term consequences. We know from previous innovations that progress can be far from straightforward.

Wind power, for example, is a mature renewable energy technology and a key enabler in green hydrogen production, but it suffers vulnerabilities on several fronts. Even Denmark’s Ørsted — the world’s largest developer of offshore wind power and a beacon for renewable energy — recently said it was struggling to deliver new offshore wind projects profitably in the UK.

Generally, the challenge arises from interdependencies between macroeconomic conditions — such as energy costs and interest rates — and business decision-making around investments. In the case of Ørsted, it said the escalating costs of turbines, labour, and financing have exceeded the inflation-linked fixed price for electricity set by regulators.

Business leaders will also need to steer through uncertainties — such as market demand, technological risks, regulatory ambiguity, and investment risks — as they seek to incorporate green hydrogen.

Test yourself

This is the third in a series of monthly business school-style teaching case studies devoted to responsible-business dilemmas faced by organisations. Read the piece and FT articles suggested at the end before considering the questions raised.

About the authors: Jennifer Howard-Grenville is Diageo professor of organisation studies at Cambridge Judge Business School; Ujjwal Pandey is an MBA candidate at Cambridge Judge and a former consultant at McKinsey.

The series forms part of a wide-ranging collection of FT ‘instant teaching case studies ’ that explore business challenges.

Two factors could help business leaders gain more clarity.

The first factor will be where, and how quickly, costs fall and enable the necessary increase to large-scale production. For instance, the cost of the electrolysers needed to split water into hydrogen and oxygen remains high because levels of production are too low. These costs and slow progress in expanding the availability and affordability of renewable energy sources have made green hydrogen much more expensive than grey hydrogen, so far — currently, two to three times the cost.

The FT’s Lex column calculated last year that a net zero energy system would create global demand for hydrogen of 500mn tonnes, annually, by 2050 — which would require an investment of $20tn. However, only $29bn had been committed by potential investors, Lex noted, despite some 1,000 new projects being announced globally and estimated to require total investment of $320bn.

A worker in a cleanroom suit inspects a large flexible solar panel in a high-tech manufacturing setting, with the panel’s reflection visible on a shiny surface below

Solar power faced similar challenges a decade ago. Thanks to low-cost manufacturing in China and supportive government policies, the sector has grown and is, within a very few years , expected to surpass gas-fired power plant installed capacity, globally. Green hydrogen requires a similar concerted effort. With the right policies and technological improvements, the cost of green hydrogen could fall below the cost of grey hydrogen in the next decade, enabling widespread adoption of the former.

Countries around the world are introducing new and varied incentives to address this gap between the expected demand and supply of green hydrogen. In Canada, for instance, Belgium’s Tree Energy Solutions plans to build a $4bn plant in Quebec, to produce synthetic natural gas from green hydrogen and captured carbon, attracted partly by a C$17.7bn ($12.8bn) tax credit and the availability of hydropower.

Such moves sound like good news for champions of green hydrogen, but companies still need to manage the short-term risks from potential policy and energy price swings. The US Inflation Reduction Act, which offers tax credits of up to $3 per kilogramme for producing low-carbon hydrogen, has already brought in limits , and may not survive a change of government.

Against such a backdrop, how should companies such as Hystar — a Norwegian maker of electrolysers already looking to expand capacity from 50 megawatts to 4 gigawatts a year in Europe — decide where and when to open a North American production facility?

The second factor that will shape hydrogen’s future is how and where it is adopted across different industries. Will it be central to the energy sector, where it can be used to produce synthetic fuels, or to help store the energy generated by intermittent renewables, such as wind and solar? Or will it find its best use in hard-to-abate sectors — so-called because cutting their fossil fuel use, and their CO₂ emissions, is difficult — such as aviation and steelmaking?

Steel producers are already seeking to pivot to hydrogen, both as an energy source and to replace the use of coal in reducing iron ore. In a bold development in Sweden, H2 Green Steel says it plans to decarbonise by incorporating hydrogen in both these ways, targeting 2.5mn tonnes of green steel production annually .

Meanwhile, the global aviation industry is exploring the use of hydrogen to replace petroleum-based aviation fuels and in fuel cell technologies that transform hydrogen into electricity. In January 2023, for instance, Anglo-US start-up ZeroAvia conducted a successful test flight of a hydrogen fuel cell-powered aircraft.

A propeller-driven aircraft with the inscription ‘ZEROAVIA’ is seen ascending above a grassy airfield with buildings and trees in the background

The path to widespread adoption, and the transformation required for hydrogen’s range of potential applications, will rely heavily on who invests, where and how. Backers have to be willing to pay a higher initial price to secure and build a green hydrogen supply in the early phases of their investment.

It will also depend on how other technologies evolve. No industry is looking only to green hydrogen to achieve their decarbonisation aims. Other, more mature technologies — such as battery storage for renewable energy — may instead dominate, leaving green hydrogen to fulfil niche applications that can bear high costs.

As with any transition, there will be unintended consequences. Natural resources (sun, wind, hydropower) and other assets (storage, distribution, shipping) that support the green hydrogen economy are unevenly distributed around the globe. There will be new exporters — countries with abundant renewables in the form of sun, wind or hydropower, such as Australia or some African countries — and new importers, such as Germany, with existing industry that relies on hydrogen but has relatively low levels of renewable energy sourced domestically.

How will the associated social and environmental costs be borne, and how will the economic and development benefits be shared? Tackling climate change through decarbonisation is urgent and essential, but there are also trade-offs and long-term consequences to the choices made today.

Questions for discussion

Lex in depth: the staggering cost of a green hydrogen economy

How Germany’s steelmakers plan to go green

Hydrogen-electric aircraft start-up secures UK Infrastructure Bank backing

Aviation start-ups test potential of green hydrogen

Consider these questions:

Are the trajectories for cost/scale-up of other renewable energy technologies (eg solar, wind) applicable to green hydrogen? Are there features of the current economic, policy, and business landscape that point to certain directions for green hydrogen’s development and application?

Take the perspective of someone from a key industry that is part of, or will be affected by, the development of green hydrogen. How should you think about the technology and business opportunities and risks in the near term, and longer term? How might you retain flexibility while still participating in these key shifts?

Solving one problem often creates or obscures new ones. For example, many technologies that decarbonise (such as electric vehicles) have other impacts (such as heavy reliance on certain minerals and materials). How should those participating in the emerging green hydrogen economy anticipate, and address, potential environmental and social impacts? Can we learn from energy transitions of the past?

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Where climate change meets business, markets and politics. Explore the FT’s coverage here .

Are you curious about the FT’s environmental sustainability commitments? Find out more about our science-based targets here

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International Edition

Research article
Open access
Published: 15 April 2024

What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography

Trisha Greenhalgh ORCID: orcid.org/0000-0003-2369-8088 1 ,
Julie L. Darbyshire 1 ,
Cassie Lee 2 ,
Emma Ladds 1 &
Jenny Ceolta-Smith 3

BMC Medicine volume 22 , Article number: 159 ( 2024 ) Cite this article

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Metrics details

Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards to reduce a so-called “postcode lottery” of care. The original aim of this study—to examine the nature of quality in long covid care and reduce unwarranted variation in services—evolved to focus on examining the reasons why standardizing care was so challenging in this condition.

In 2021–2023, we ran a quality improvement collaborative across 10 UK sites. The dataset reported here was mostly but not entirely qualitative. It included data on the origins and current context of each clinic, interviews with staff and patients, and ethnographic observations at 13 clinics (50 consultations) and 45 multidisciplinary team (MDT) meetings (244 patient cases). Data collection and analysis were informed by relevant lenses from clinical care (e.g. evidence-based guidelines), improvement science (e.g. quality improvement cycles) and philosophy of knowledge.

Participating clinics made progress towards standardizing assessment and management in some topics; some variation remained but this could usually be explained. Clinics had different histories and path dependencies, occupied a different place in their healthcare ecosystem and served a varied caseload including a high proportion of patients with comorbidities. A key mechanism for achieving high-quality long covid care was when local MDTs deliberated on unusual, complex or challenging cases for which evidence-based guidelines provided no easy answers. In such cases, collective learning occurred through idiographic (case-based) reasoning , in which practitioners build lessons from the particular to the general. This contrasts with the nomothetic reasoning implicit in evidence-based guidelines, in which reasoning is assumed to go from the general (e.g. findings of clinical trials) to the particular (management of individual patients).

Not all variation in long covid services is unwarranted. Largely because long covid’s manifestations are so varied and comorbidities common, generic “evidence-based” standards require much individual adaptation. In this complex condition, quality improvement resources may be productively spent supporting MDTs to optimise their case-based learning through interdisciplinary discussion. Quality assessment of a long covid service should include review of a sample of individual cases to assess how guidelines have been interpreted and personalized to meet patients’ unique needs.

Study registration

NCT05057260, ISRCTN15022307.

Peer Review reports

The term “long covid” [ 1 ] means prolonged symptoms following SARS-CoV-2 infection not explained by an alternative diagnosis [ 2 ]. It embraces the US term “post-covid conditions” (symptoms beyond 4 weeks) [ 3 ], the UK terms “ongoing symptomatic covid-19” (symptoms lasting 4–12 weeks) and “post covid-19 syndrome” (symptoms beyond 12 weeks) [ 4 ] and the World Health Organization’s “post covid-19 condition” (symptoms occurring beyond 3 months and persisting for at least 2 months) [ 5 ]. Long covid thus defined is extremely common. In UK, for example, 1.8 million of a population of 67 million met the criteria for long covid in early 2023 and 41% of these had been unwell for more than 2 years [ 6 ].

Long covid is characterized by a constellation of symptoms which may include breathlessness, fatigue, muscle and joint pain, chest pain, memory loss and impaired concentration (“brain fog”), sleep disturbance, depression, anxiety, palpitations, dizziness, gastrointestinal problems such as diarrhea, skin rashes and allergy to food or drugs [ 2 ]. These lead to difficulties with essential daily activities such as washing and dressing, impaired exercise tolerance and ability to work, and reduced quality of life [ 2 , 7 , 8 ]. Symptoms typically cluster (e.g. in different patients, long covid may be dominated by fatigue, by breathlessness or by palpitations and dizziness) [ 9 , 10 ]. Long covid may follow a fairly constant course or a relapsing and remitting one, perhaps with specific triggers [ 11 ]. Overlaps between fatigue-dominant subtypes of long covid, myalgic encephalomyelitis and chronic fatigue syndrome have been hypothesized [ 12 ] but at the time of writing remain unproven.

Long covid has been a contested condition from the outset. Whilst long-term sequelae following other coronavirus (SARS and MERS) infections were already well-documented [ 13 ], SARS-CoV-2 was originally thought to cause a short-lived respiratory illness from which the patient either died or recovered [ 14 ]. Some clinicians dismissed protracted or relapsing symptoms as due to anxiety or deconditioning, especially if the patient had not had laboratory-confirmed covid-19. People with long covid got together in online groups and shared accounts of their symptoms and experiences of such “gaslighting” in their healthcare encounters [ 15 , 16 ]. Some groups conducted surveys on their members, documenting the wide range of symptoms listed in the previous paragraph and showing that whilst long covid is more commonly a sequel to severe acute covid-19, it can (rarely) follow a mild or even asymptomatic acute infection [ 17 ].

Early publications on long covid depicted a post-pneumonia syndrome which primarily affected patients who had been hospitalized (and sometimes ventilated) [ 18 , 19 ]. Later, covid-19 was recognized to be a multi-organ inflammatory condition (the pneumonia, for example, was reclassified as pneumonitis ) and its long-term sequelae attributed to a combination of viral persistence, dysregulated immune response (including auto-immunity), endothelial dysfunction and immuno-thrombosis, leading to damage to the lining of small blood vessels and (thence) interference with transfer of oxygen and nutrients to vital organs [ 20 , 21 , 22 , 23 , 24 ]. But most such studies were highly specialized, laboratory-based and written primarily for an audience of fellow laboratory researchers. Despite demonstrating mean differences in a number of metabolic variables, they failed to identify a reliable biomarker that could be used routinely in the clinic to rule a diagnosis of long covid in or out. Whilst the evidence base from laboratory studies grew rapidly, it had little influence on clinical management—partly because most long covid clinics had been set up with impressive speed by front-line clinical teams to address an immediate crisis, with little or no input from immunologists, virologists or metabolic specialists [ 25 ].

Studies of the patient experience revealed wide geographical variation in whether any long covid services were provided and (if they were) which patients were eligible for these and what tests and treatments were available [ 26 ]. An interim UK clinical guideline for long covid had been produced at speed and published in December 2020 [ 27 ], but it was uncertain about diagnostic criteria, investigations, treatments and prognosis. Early policy recommendations for long covid services in England, based on wide consultation across UK, had proposed a tiered service with “tier 1” being supported self-management, “tier 2” generalist assessment and management in primary care, “tier 3” specialist rehabilitation or respiratory follow-up with oversight from a consultant physician and “tier 4” tertiary care for patients with complications or complex needs [ 28 ]. In 2021, ring-fenced funding was allocated to establish 90 multidisciplinary long covid clinics in England [ 29 ]; some clinics were also set up with local funding in Scotland and Wales. These clinics varied widely in eligibility criteria, referral pathways, staffing mix (some had no doctors at all) and investigations and treatments offered. A further policy document on improving long covid services was published in 2022 [ 30 ]; it recommended that specialist long covid clinics should continue, though the long-term funding of these services remains uncertain [ 31 ]. To build the evidence base for delivering long covid services, major programs of publicly funded research were commenced in both UK [ 32 ] and USA [ 33 ].

In short, at the time this study began (late 2021), there appeared to be much scope for a program of quality improvement which would capture fast-emerging research findings, establish evidence-based standards and ensure these were rapidly disseminated and consistently adopted across both specialist long covid services and in primary care.

Quality improvement collaboratives

The quality improvement movement in healthcare was born in the early 1980s when clinicians and policymakers US and UK [ 34 , 35 , 36 , 37 ] began to draw on insights from outside the sector [ 38 , 39 , 40 ]. Adapting a total quality management approach that had previously transformed the Japanese car industry, they sought to improve efficiency, reduce waste, shift to treating the upstream causes of problems (hence preventing disease) and help all services approach the standards of excellence achieved by the best. They developed an approach based on (a) understanding healthcare as a complex system (especially its key interdependencies and workflows), (b) analysing and addressing variation within the system, (c) learning continuously from real-world data and (d) developing leaders who could motivate people and help them change structures and processes [ 41 , 42 , 43 , 44 ].

Quality improvement collaboratives (originally termed “breakthrough collaboratives” [ 45 ]), in which representatives from different healthcare organizations come together to address a common problem, identify best practice, set goals, share data and initiate and evaluate improvement efforts [ 46 ], are one model used to deliver system-wide quality improvement. It is widely assumed that these collaboratives work because—and to the extent that—they identify, interpret and implement high-quality evidence (e.g. from randomized controlled trials).

Research on why quality improvement collaboratives succeed or fail has produced the following list of critical success factors: taking a whole-system approach, selecting a topic and goal that fits with organizations’ priorities, fostering a culture of quality improvement (e.g. that quality is everyone’s job), engagement of everyone (including the multidisciplinary clinical team, managers, patients and families) in the improvement effort, clearly defining people’s roles and contribution, engaging people in preliminary groundwork, providing organizational-level support (e.g. chief executive endorsement, protected staff time, training and support for teams, resources, quality-focused human resource practices, external facilitation if needed), training in specific quality improvement techniques (e.g. plan-do-study-act cycle), attending to the human dimension (including cultivating trust and working to ensure shared vision and buy-in), continuously generating reliable data on both processes (e.g. current practice) and outcomes (clinical, satisfaction) and a “learning system” infrastructure in which knowledge that is generated feeds into individual, team and organizational learning [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ].

The quality improvement collaborative approach has delivered many successes but it has been criticized at a theoretical level for over-simplifying the social science of human motivation and behaviour and for adopting a somewhat mechanical approach to the study of complex systems [ 55 , 56 ]. Adaptations of the original quality improvement methodology (e.g. from Sweden [ 57 , 58 ]) have placed greater emphasis on human values and meaning-making, on the grounds that reducing the complexities of a system-wide quality improvement effort to a set of abstract and generic “success factors” will miss unique aspects of the case such as historical path dependencies, personalities, framing and meaning-making and micropolitics [ 59 ].

Perhaps this explains why, when the abovementioned factors are met, a quality improvement collaborative’s success is more likely but is not guaranteed, as a systematic review demonstrated [ 60 ]. Some well-designed and well-resourced collaboratives addressing clear knowledge gaps produced few or no sustained changes in key outcome measures [ 49 , 53 , 60 , 61 , 62 ]. To identify why this might be, a detailed understanding of a service’s history, current challenges and contextual constraints is needed. This explains our decision, part-way through the study reported here, to collect rich contextual data on participating sites so as to better explain success or failure of our own collaborative.

Warranted and unwarranted variation in clinical practice

A generation ago, Wennberg described most variation in clinical practice as “unwarranted” (which he defined as variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences) [ 63 ]. Others coined the term “postcode lottery” to depict how such variation allegedly impacted on health outcomes [ 64 ]. Wennberg and colleagues’ Atlas of Variation , introduced in 1999 [ 65 ], and its UK equivalent, introduced in 2010 [ 66 ], described wide regional differences in the rates of procedures from arthroscopy to hysterectomy, and were used to prompt services to identify and address examples of under-treatment, mis-treatment and over-treatment. Numerous similar initiatives, mostly based on hospital activity statistics, have been introduced around the world [ 66 , 67 , 68 , 69 ]. Sutherland and Levesque’s proposed framework for analysing variation, for example, has three domains: capacity (broadly, whether sufficient resources are allocated at organizational level and whether individuals have the time and headspace to get involved), evidence (the extent to which evidence-based guidelines exist and are followed), and agency (e.g. whether clinicians are engaged with the issue and the effect of patient choice) [ 70 ].

Whilst it is clearly a good idea to identify unwarranted variation in practice, it is also important to acknowledge that variation can be warranted . The very act of measuring and describing variation carries great rhetorical power, since revealing geographical variation in any chosen metric effectively frames this as a problem with a conceptually simple solution (reducing variation) that will appeal to both politicians and the public [ 71 ]. The temptation to expose variation (e.g. via visualizations such as maps) and address it in mechanistic ways should be resisted until we have fully understood the reasons why it exists, which may include perverse incentives, insufficient opportunities to discuss cases with colleagues, weak or absent feedback on practice, unclear decision processes, contested definitions of appropriate care and professional challenges to guidelines [ 72 ].

Research question, aims and objectives

Research question.

What is quality in long covid care and how can it best be achieved?

To identify best practice and reduce unwarranted variation in UK long covid services.

To explain aspects of variation in long covid services that are or may be warranted.

Our original objectives were to:

Establish a quality improvement collaborative for 10 long covid clinics across UK.

Use quality improvement methods in collaboration with patients and clinic staff to prioritize aspects of care to improve. For each priority topic, identify best (evidence-informed) clinical practice, measure performance in each clinic, compare performance with a best practice benchmark and improve performance.

Produce organizational case studies of participating long covid clinics to explain their origins, evolution, leadership, ethos, population served, patient pathways and place in the wider healthcare ecosystem.

Examine these case studies to explain variation in practice, especially in topics where the quality improvement cycle proves difficult to follow or has limited impact.

The LOCOMOTION study

LOCOMOTION (LOng COvid Multidisciplinary consortium Optimising Treatments and services across the NHS) was a 30-month multi-site case study of 10 long covid clinics (8 in England, 1 in Wales and 1 in Scotland), beginning in 2021, which sought to optimise long covid care. Each clinic offered multidisciplinary care to patients referred from primary or secondary care (and, in some cases, self-referred), and held regular multidisciplinary team (MDT) meetings, mostly online via Microsoft Teams, to discuss cases. A study protocol for LOCOMOTION, with details of ethical approvals, management, governance and patient involvement has been published [ 25 ]. The three main work packages addressed quality improvement, technology-supported patient self-management and phenotyping and symptom clustering. This paper reports on the first work package, focusing mainly on qualitative findings.

Setting up the quality improvement collaborative

We broadly followed standard methodology for “breakthrough” quality improvement collaboratives [ 44 , 45 ], with two exceptions. First, because of geographical distance, continuing pandemic precautions and developments in videoconferencing technology, meetings were held online. Second, unlike in the original breakthrough model, patients were included in the collaborative, reflecting the cultural change towards patient partnerships since the model was originally proposed 40 years ago.

Each site appointed a clinical research fellow (doctor, nurse or allied health professional) funded partly by the LOCOMOTION study and partly with clinical sessions; some were existing staff who were backfilled to take on a research role whilst others were new appointments. The quality improvement meetings were held approximately every 8 weeks on Microsoft Teams and lasted about 2 h; there was an agenda and a chair, and meetings were recorded with consent. The clinical research fellow from each clinic attended, sometimes joined by the clinical lead for that site. In the initial meeting, the group proposed and prioritized topics before merging their consensus with the list of priority topics generated separately by patients (there was much overlap but also some differences).

In subsequent meetings, participants attempted to reach consensus on how to define, measure and achieve quality for each priority topic in turn, implement this approach in their own clinic and monitor its impact. Clinical leads prepared illustrative clinical cases and summaries of the research evidence, which they presented using Microsoft Powerpoint; the group then worked towards consensus on the implications for practice through general discussion. Clinical research fellows assisted with literature searches, collected baseline data from their own clinic, prepared and presented anonymized case examples, and contributed to collaborative goal-setting for improvement. Progress on each topic was reviewed at a later meeting after an agreed interval.

An additional element of this work package was semi-structured interviews with 29 patients, recruited from 9 of the 10 participating sites, about their clinic experiences with a view to feeding into service improvement (in the other site, no patient volunteered).

Our patient advisory group initially met separately from the quality improvement collaborative. They designed a short survey of current practice and sent it to each clinic; the results of this informed a prioritization exercise for topics where they considered change was needed. The patient-generated list was tabled at the quality improvement collaborative discussions, but patients were understandably keen to join these discussions directly. After about 9 months, some patient advisory group members joined the regular collaborative meetings. This dynamic was not without its tensions, since sharing performance data requires trust and there were some concerns about confidentiality when real patient cases were discussed with other patients present.

How evidence-informed quality targets were set

At the time the study began, there were no published large-scale randomized controlled trials of any interventions for long covid. We therefore followed a model used successfully in other quality improvement efforts where research evidence was limited or absent or it did not translate unambiguously into models for current services. In such circumstances, the best evidence may be custom and practice in the best-performing units. The quality improvement effort becomes oriented to what one group of researchers called “potentially better practices”—that is, practices that are “developed through analysis of the processes of care, literature review, and site visits” (page 14) [ 73 ]. The idea was that facilitated discussion among clinical teams, drawing on published research where available but also incorporating clinical experience, established practice and systematic analysis of performance data across participating clinics would surface these “potentially better practices”—an approach which, though not formally tested in controlled trials, appears to be associated with improved outcomes [ 46 , 73 ].

Adding an ethnographic component

Following limited progress made on some topics that had been designated high priority, we interviewed all 10 clinical research fellows (either individually or, in two cases, with a senior clinician present) and 18 other clinic staff (five individually plus two groups of 5 and 8), along with additional informal discussions, to explore the challenges of implementing the changes that had been agreed. These interviews were not audiotaped but detailed notes were made and typed up immediately afterwards. It became evident that some aspects of what the collaborative had deemed “evidence-informed” care were contested by front-line clinic staff, perceived as irrelevant to the service they were delivering, or considered impossible to implement. To unpack these issues further, the research protocol was amended to include an ethnographic component.

TG and EL (academic general practitioners) and JLD (a qualitative researcher with a PhD in the patient experience) attended a total of 45 MDT meetings in participating clinics (mostly online or hybrid). Staff were informed in advance that there would be an observer present; nobody objected. We noted brief demographic and clinical details of cases discussed (but no identifying data), dilemmas and uncertainties on which discussions focused, and how different staff members contributed.

TG made 13 in-person visits to participating long covid clinics. Staff were notified in advance; all were happy to be observed. Visits lasted between 5 and 8 h (54 h in total). We observed support staff booking patients in and processing requests and referrals, and shadowed different clinical staff in turn as they saw patients. Patients were informed of our presence and its purpose beforehand and given the opportunity to decline (three of 53 patients approached did). We discussed aspects of each case with the clinician after the patient left. When invited, we took breaks with staff and used these as an opportunity to ask them informally what it was like working in the clinic.

Ethnographic observation, analysis and reporting was geared to generating a rich interpretive account of the clinical, operational and interpersonal features of each clinic—what Van Maanen calls an “impressionist tales” [ 74 ]. Our work was also guided by the principles set out by Golden-Biddle and Locke, namely authenticity (spending time in the field and basing interpretations on these direct observations), plausibility (creating a plausible account through rich persuasive description) and criticality (e.g. reflexively examining our own assumptions) [ 75 ]. Our collection and analysis of qualitative data was informed by our own professional backgrounds (two general practitioners, one physical therapist, two non-clinicians).

In both MDTs and clinics, we took contemporaneous notes by hand and typed these up immediately afterwards.

Data management and analysis

Typed interview notes and field notes from clinics were collated in a set of Word documents, one for each clinic attended. They were analysed thematically [ 76 ] with attention to the literature on quality improvement and variation (see “ Background ”). Interim summaries were prepared on each clinic, setting out the narrative of how it had been established, its ethos and leadership, setting and staffing, population served and key links with other parts of the local healthcare ecosystem.

Minutes and field notes from the quality improvement collaborative meetings were summarized topic by topic, including initial data collected by the researchers-in-residence, improvement actions taken (or attempted) in that clinic, and any follow-up data shared. Progress or lack of it was interpreted in relation to the contextual case summary for that clinic.

Patient cases seen in clinic, and those discussed by MDTs, were summarized as brief case narratives in Word documents. Using the constant comparative method [ 77 ], we produced an initial synthesis of the clinical picture and principles of management based on the first 10 patient cases seen, and refined this as each additional case was added. Demographic and brief clinical and social details were also logged on Excel spreadsheets. When writing up clinical cases, we used the technique of composite case construction (in which we drew on several actual cases to generate a fictitious one, thereby protecting anonymity whilst preserving key empirical findings [ 78 ]); any names reported in this paper are pseudonyms.

Member checking

A summary was prepared for each clinic, including a narrative of the clinic’s own history and a summary of key quality issues raised across the ten clinics. These summaries included examples from real cases in our dataset. These were shared with the clinical research fellow and a senior clinician from the clinic, and amended in response to feedback. We also shared these summaries with representatives from the patient advisory group.

Overview of dataset

This study generated three complementary datasets. First, the video recordings, minutes, and field notes of 12 quality improvement collaborative meetings, along with the evidence summaries prepared for these meetings and clinic summaries (e.g. descriptions of current practice, audits) submitted by the clinical research fellows. This dataset illustrated wide variation in practice, and (in many topics) gaps or ambiguities in the evidence base.

Second, interviews with staff ( n = 30) and patients ( n = 29) from the clinics, along with ethnographic field notes (approximately 100 pages) from 13 in-person clinic visits (54 h), including notes on 50 patient consultations (40 face-to-face, 6 telephone, 4 video). This dataset illustrated the heterogeneity among the ten participating clinics.

Third, field notes (approximately 100 pages), including discussions on 244 clinical cases from the 45 MDT meetings (49 h) that we observed. This dataset revealed further similarities and contrasts among clinics in how patients were managed. In particular, it illustrated how, for the complex patients whose cases were presented at these meetings, teams made sense of, and planned for, each case through multidisciplinary dialogue. This dialogue typically began with one staff member presenting a detailed clinical history along with a narrative of how it had affected the patient’s life and what was at stake for them (e.g. job loss), after which professionals from various backgrounds (nursing, physical therapy, occupational therapy, psychology, dietetics, and different medical specialties) joined in a discussion about what to do.

The ten participating sites are summarized in Table 1 .

In the next two sections, we explore two issues—difficulty defining best practice and the heterogeneous nature of the clinics—that were key to explaining why quality, when pursued in a 10-site collaborative, proved elusive. We then briefly summarize patients’ accounts of their experience in the clinics and give three illustrative examples of the elusiveness of quality improvement using selected topics that were prioritized in our collaborative: outcome measures, investigation of palpitations and management of fatigue. In the final section of the results, we describe how MDT deliberations proved crucial for local quality improvement. Further detail on clinical priority topics will be presented in a separate paper.

“Best practice” in long covid: uncertainty and conflict

The study period (September 2021 to December 2023) corresponded with an exponential increase in published research on long covid. Despite this, the quality improvement collaborative found few unambiguous recommendations for practice. This gap between what the research literature offered and what clinical practice needed was partly ontological (relating what long covid is ). One major bone of contention between patients and clinicians (also evident in discussions with our patient advisory group), for example, was how far (and in whom) clinicians should look for and attempt to treat the various metabolic abnormalities that had been documented in laboratory research studies. The literature on this topic was extensive but conflicting [ 20 , 21 , 22 , 23 , 24 , 79 , 80 , 81 , 82 ]; it was heavy on biological detail but light on clinical application.

Patients were often aware of particular studies that appeared to offer plausible molecular or cellular explanations for symptom clusters along with a drug (often repurposed and off-label) whose mechanism of action appeared to be a good fit with the metabolic chain of causation. In one clinic, for example, we were shown an email exchange between a patient (not medically qualified) and a consultant, in which the patient asked them to reconsider their decision not to prescribe low-dose naltrexone, an opioid receptor antagonist with anti-inflammatory properties. The request included a copy of a peer-reviewed academic paper describing a small, uncontrolled pre-post study (i.e. a weak study design) in which this drug appeared to improve symptoms and functional performance in patients with long covid, as well as a mechanistic argument explaining why the patient felt this drug was a plausible choice in their own case.

This patient’s clinician, in common with most clinicians delivering front-line long covid services, considered that the evidence for such mechanism-based therapies was weak. Clinicians generally felt that this evidence, whilst promising, did not yet support routine measurement of clotting factors, antibodies, immune cells or other biomarkers or the prescription of mechanism-based therapies such as antivirals, anti-inflammatories or anticoagulants. Low-dose naltroxone, for example, is currently being tested in at least one randomized controlled trial (see National Clinical Trials Registry NCT05430152), which had not reported at the time of our observations.

Another challenge to defining best practice was the oft-repeated phrase that long covid is a “diagnosis by exclusion”, but the high prevalence of comorbidities meant that the “pure” long covid patient untainted by other potential explanations for their symptoms was a textbook ideal. In one MDT, for example, we observed a discussion about a patient who had had both swab-positive covid-19 and erythema migrans (a sign of Lyme disease) in the weeks before developing fatigue, yet local diagnostic criteria for each condition required the other to be excluded.

The logic of management in most participating clinics was pragmatic: prompt multidisciplinary assessment and treatment with an emphasis on obtaining a detailed clinical history (including premorbid health status), excluding serious complications (“red flags”), managing specific symptom clusters (for example, physical therapy for breathing pattern disorder), treating comorbidities (for example, anaemia, diabetes or menopause) and supporting whole-person rehabilitation [ 7 , 83 ]. The evidentiary questions raised in MDT discussions (which did not include patients) addressed the practicalities of the rehabilitation model (for example, whether cognitive therapy for neurocognitive complications is as effective when delivered online as it is when delivered in-person) rather than the molecular or cellular mechanisms of disease. For example, the question of whether patients with neurocognitive impairment should be tested for micro-clots or treated with anticoagulants never came up in the MDTs we observed, though we did visit a tertiary referral clinic (the tier 4 clinic in site H), whose lead clinician had a research interest in inflammatory coagulopathies and offered such tests to selected patients.

Because long covid typically produces dozens of symptoms that tend to be uniquely patterned in each patient, the uncertainties on which MDT discussions turned were rarely about general evidence of the kind that might be found in a guideline (e.g. how should fatigue be managed?). Rather they concerned particular case-based clinical decisions (e.g. how should this patient’s fatigue be managed, given the specifics of this case?). An example from our field notes illustrates this:

Physical therapist presents the case of a 39-year-old woman who works as a cleaner on an overnight ferry. Has had long covid for 2 years. Main symptoms are shortness of breath and possible anxiety attacks, especially when at work. She has had a course of physical therapy to teach diaphragmatic breathing but has found that focusing on her breathing makes her more anxious. Patient has to do a lot of bending in her job (e.g. cleaning toilets and under seats), which makes her dizzy, but Active Stand Test was normal. She also has very mild tricuspid incompetence [someone reads out a cardiology report—not hemodynamically significant].

Rehabilitation guidelines (e.g. WHO) recommend phased return to work (e.g. with reduced hours) and frequent breaks. “Tricky!” says someone. The job is intense and busy, and the patient can’t afford not to work. Discussion on whether all her symptoms can be attributed to tension and anxiety. Physical therapist who runs the breathing group says, “No, it’s long covid”, and describes severe initial covid-19 episode and results of serial chest X-rays which showed gradual clearing of ground glass shadows. Team discussion centers on how to negotiate reduced working hours in this particular job, given the overnight ferry shifts. --MDT discussion, Site D

This example raises important considerations about the nature of clinical knowledge in long covid. We return to it in the final section of the “ Results ” and in the “ Discussion ”.

Long covid clinics: a heterogeneous context for quality improvement

Most participating clinics had been established in mid-2020 to follow up patients who had been hospitalized (and perhaps ventilated) for severe acute covid-19. As mass vaccination reduced the severity of acute covid-19 for most people, the patient population in all clinics progressively shifted to include fewer “post-ICU [intensive care unit]” patients (in whom respiratory symptoms almost always dominated), and more people referred by their general practitioners or other secondary care specialties who had not been hospitalized for their acute covid-19 infection, and in whom fatigue, brain fog and palpitations were often the most troubling symptoms. Despite these similarities, the ten clinics had very different histories, geographical and material settings, staffing structures, patient pathways and case mix, as Table 1 illustrates. Below, we give more detail on three example sites.

Site C was established as a generalist “assessment-only” service by a general practitioner with an interest in infectious diseases. It is led jointly by that general practitioner and an occupational therapist, assisted by a wide range of other professionals including speech and language therapy, dietetics, clinical psychology and community-based physical therapy and occupational therapy. It has close links with a chronic fatigue service and a pain clinic that have been running in the locality for over 20 years. The clinic, which is entirely virtual (staff consult either from home or from a small side office in the community trust building), is physically located in a low-rise building on the industrial outskirts of a large town, sharing office space with various community-based health and social care services. Following a 1-h telephone consultation by one of the clinical leads, each patient is discussed at the MDT and then either discharged back to their general practitioner with a detailed management plan or referred on to one of the specialist services. This arrangement evolved to address a particular problem in this locality—that many patients with long covid were being referred by their general practitioner to multiple specialties (e.g. respiratory, neurology, fatigue), leading to a fragmented patient experience, unnecessary specialist assessments and wasteful duplication. The generalist assessment by telephone is oriented to documenting what is often a complex illness narrative (including pre-existing physical and mental comorbidities) and working with the patient to prioritize which symptoms or problems to pursue in which order.

Site E, in a well-regarded inner-city teaching hospital, had been set up in 2020 by a respiratory physician. Its initial ethos and rationale had been “respiratory follow-up”, with strong emphasis on monitoring lung damage via repeated imaging and lung function tests and in ensuring that patients received specialist physical therapy to “re-learn” efficient breathing techniques. Over time, this site has tried to accommodate a more multi-system assessment, with the introduction of a consultant-led infectious disease clinic for patients without a dominant respiratory component, reflecting the shift towards a more fatigue-predominant case mix. At the time of our fieldwork, each patient was seen in turn by a physician, psychologist, occupational therapist and respiratory physical therapist (half an hour each) before all four staff reconvened in a face-to-face MDT meeting to form a plan for each patient. But whilst a wide range of patients with diverse symptoms were discussed at these meetings, there remained a strong focus on respiratory pathology (e.g. tracking improvements in lung function and ensuring that coexisting asthma was optimally controlled).

Site F, one of the first long covid clinics in UK, was set up by a rehabilitation consultant who had been drafted to work on the ICU during the first wave of covid-19 in early 2020. He had a longstanding research interest in whole-patient rehabilitation, especially the assessment and management of chronic fatigue and pain. From the outset, clinic F was more oriented to rehabilitation, including vocational rehabilitation to help patients return to work. There was less emphasis on monitoring lung function or pursuing respiratory comorbidities. At the time of our fieldwork, clinic F offered both a community-based service (“tier 2”) led by an occupational therapist, supported by a respiratory physical therapist and psychologist, and a hospital-based service (“tier 3”) led by the rehabilitation consultant, supported by a wider MDT. Staff in both tiers emphasized that each patient needs a full physical and mental assessment and help to set and work towards achievable goals, whilst staying within safe limits so as to avoid post-exertional symptom exacerbation. Because of the research interest of the lead physician, clinic F adapted well to the growing numbers of patients with fatigue and quickly set up research studies on this cohort [ 84 ].

Details of the other seven sites are shown in Table 1 . Broadly speaking, sites B, E, G and H aligned with the “respiratory follow-up” model and sites F and I aligned with the “rehabilitation” model. Sites A and J had a high-volume, multi-tiered service whose community tier aligned with the “holistic GP assessment” model (site C above) and which also offered a hospital-based, rehabilitation-focused tier. The small service in Scotland (site D) had evolved from an initial respiratory focus to become part of the infectious diseases (ME/CFS) service; Lyme disease (another infectious disease whose sequelae include chronic fatigue) was also prevalent in this region.

The patient experience

Whilst the 10 participating clinics were very diverse in staffing, ethos and patient flows, the 29 patient interviews described remarkably consistent clinic experiences. Almost all identified the biggest problem to be the extended wait of several months before they were seen and the limited awareness (when initially referred) of what long covid clinics could provide. Some talked of how they cried with relief when they finally received an appointment. When the quality improvement collaborative was initially established, waiting times and bottlenecks were patients’ the top priority for quality improvement, and this ranking was shared by clinic staff, who were very aware of how much delays and uncertainties in assessment and treatment compounded patients’ suffering. This issue resolved to a large extent over the study period in all clinics as the referral backlog cleared and the incidence of new cases of long covid fell [ 85 ]; it will be covered in more detail in a separate publication.

Most patients in our sample were satisfied with the care they received when they were finally seen in clinic, especially how they finally felt “heard” after a clinician took a full history. They were relieved to receive affirmation of their experience, a diagnosis of what was wrong and reassurance that they were believed. They were grateful for the input of different members of the multidisciplinary teams and commented on the attentiveness, compassion and skill of allied professionals in particular (“she was wonderful, she got me breathing again”—patient BIR145 talking about a physical therapist). One or two patient participants expressed confusion about who exactly they had seen and what advice they had been given, and some did not realize that a telephone assessment had been an actual clinical consultation. A minority expressed disappointment that an expected investigation had not been ordered (one commented that they had not had any blood tests at all). Several had assumed that the help and advice from the long covid clinic would continue to be offered until they were better and were disappointed that they had been discharged after completing the various courses on offer (since their clinic had been set up as an “assessment only” service).

In the next sections, we give examples of topics raised in the quality improvement collaborative and how they were addressed.

Example quality topic 1: Outcome measures

The first topic considered by the quality improvement collaborative was how (that is, using which measures and metrics) to assess and monitor patients with long covid. In the absence of a validated biomarker, various symptom scores and quality of life scales—both generic and disease-specific—were mooted. Site F had already developed and validated a patient-reported outcome measure (PROM), the C19-YRS (Covid-19 Yorkshire Rehabilitation Scale) and used it for both research and clinical purposes [ 86 ]. It was quickly agreed that, for the purposes of generating comparative research findings across the ten clinics, the C19-YRS should be used at all sites and completed by patients three-monthly. A commercial partner produced an electronic version of this instrument and an app for patient smartphones. The quality improvement collaborative also agreed that patients should be asked to complete the EUROQOL EQ5D, a widely used generic health-related quality of life scale [ 87 ], in order to facilitate comparisons between long covid and other chronic conditions.

In retrospect, the discussions which led to the unopposed adoption of these two measures as a “quality” initiative in clinical care were somewhat aspirational. A review of progress at a subsequent quality improvement meeting revealed considerable variation among clinics, with a wide variety of measures used in different clinics to different degrees. Reasons for this variation were multiple. First, although our patient advisory group were keen that we should gather as much data as possible on the patient experience of this new condition, many clinic patients found the long questionnaires exhausting to complete due to cognitive impairment and fatigue. In addition, whilst patients were keen to answer questions on symptoms that troubled them, many had limited patience to fill out repeated surveys on symptoms that did not trouble them (“it almost felt as if I’ve not got long covid because I didn’t feel like I fit the criteria as they were laying it out”—patient SAL001). Staff assisted patients in completing the measures when needed, but this was time-consuming (up to 45 min per instrument) and burdensome for both staff and patients. In clinics where a high proportion of patients required assistance, staff time was the rate-limiting factor for how many instruments got completed. For some patients, one short instrument was the most that could be asked of them, and the clinician made a judgement on which one would be in their best interests on the day.

The second reason for variation was that the clinical diagnosis and management of particular features, complications and comorbidities of long covid required more nuance than was provided by these relatively generic instruments, and the level of detail sought varied with the specialist interest of the clinic (and the clinician). The modified C19-YRS [ 88 ], for example, contained 19 items, of which one asked about sleep quality. But if a patient had sleep difficulties, many clinicians felt that these needed to be documented in more detail—for example using the 8-item Epworth Sleepiness Scale, originally developed for conditions such as narcolepsy and obstructive sleep apnea [ 89 ]. The “Epworth score” was essential currency for referrals to some but not all specialist sleep services. Similarly, the C19-YRS had three items relating to anxiety, depression and post-traumatic stress disorder, but in clinics where there was a strong focus on mental health (e.g. when there was a resident psychologist), patients were usually invited to complete more specific tools (e.g. the Patient Health Questionnaire 9 [ 90 ], a 9-item questionnaire originally designed to assess severity of depression).

The third reason for variation was custom and practice. Ethnographic visits revealed that paper copies of certain instruments were routinely stacked on clinicians’ desks in outpatient departments and also (in some cases) handed out by administrative staff in waiting areas so that patients could complete them before seeing the clinician. These familiar clinic artefacts tended to be short (one-page) instruments that had a long tradition of use in clinical practice. They were not always fit for purpose. For example, the Nijmegen questionnaire was developed in the 1980s to assess hyperventilation; it was validated against a longer, “gold standard” instrument for that condition [ 91 ]. It subsequently became popular in respiratory clinics to diagnose or exclude breathing pattern disorder (a condition in which the normal physiological pattern of breathing becomes replaced with less efficient, shallower breathing [ 92 ]), so much so that the researchers who developed the instrument published a paper to warn fellow researchers that it had not been validated for this purpose [ 93 ]. Whilst a validated 17-item instrument for breathing pattern disorder (the Self-Evaluation of Breathing Questionnaire [ 94 ]) does exist, it is not in widespread clinical use. Most clinics in LOCOMOTION used Nijmegen either on all patients (e.g. as part of a comprehensive initial assessment, especially if the service had begun as a respiratory follow-up clinic) or when breathing pattern disorder was suspected.

In sum, the use of outcome measures in long covid clinics was a compromise between standardization and contingency. On the one hand, all clinics accepted the need to use “validated” instruments consistently. On the other hand, there were sometimes good reasons why they deviated from agreed practice, including mismatch between the clinic’s priorities as a research site, its priorities as a clinical service, and the particular clinical needs of a patient; the clinic’s—and the clinician’s—specialist focus; and long-held traditions of using particular instruments with which staff and patients were familiar.

Example quality topic 2: Postural orthostatic tachycardia syndrome (POTS)

Palpitations (common in long covid) and postural orthostatic tachycardia syndrome (POTS, a disproportionate acceleration in heart rate on standing, the assumed cause of palpitations in many long covid patients) was the top priority for quality improvement identified by our patient advisory group. Reflecting discussions and evidence (of various kinds) shared in online patient communities, the group were confident that POTS is common in long covid patients and that many cases remain undetected (perhaps misdiagnosed as anxiety). Their request that all long covid patients should be “screened” for POTS prompted a search for, and synthesis of, evidence (which we published in the BMJ [ 95 ]). In sum, that evidence was sparse and contested, but, combined with standard practice in specialist clinics, broadly supported the judicious use of the NASA Lean Test [ 96 ]. This test involves repeated measurements of pulse and blood pressure with the patient first lying and then standing (with shoulders resting against a wall).

The patient advisory group’s request that the NASA Lean Test should be conducted on all patients met with mixed responses from the clinics. In site F, the lead physician had an interest in autonomic dysfunction in chronic fatigue and was keen; he had already published a paper on how to adapt the NASA Lean Test for self-assessment at home [ 97 ]. Several other sites were initially opposed. Staff at site E, for example, offered various arguments:

The test is time-consuming, labor-intensive, and takes up space in the clinic which has an opportunity cost in terms of other potential uses;

The test is unvalidated and potentially misleading (there is a high incidence of both false negative and false positive results);

There is no proven treatment for POTS, so there is no point in testing for it;

It is a specialist test for a specialist condition, so it should be done in a specialist clinic where its benefits and limitations are better understood;

Objective testing does not change clinical management since what we treat is the patient’s symptoms (e.g. by a pragmatic trial of lifestyle measures and medication);

People with symptoms suggestive of dysautonomia have already been “triaged out” of this clinic (that is, identified in the initial telephone consultation and referred directly to neurology or cardiology);

POTS is a manifestation of the systemic nature of long covid; it does not need specific treatment but will improve spontaneously as the patient goes through standard interventions such as active pacing, respiratory physical therapy and sleep hygiene;

Testing everyone, even when asymptomatic, runs counter to the ethos of rehabilitation, which is to “de-medicalize” patients so as to better orient them to their recovery journey.

When clinics were invited to implement the NASA Lean Test on a consecutive sample of patients to resolve a dispute about the incidence of POTS (from “we’ve only seen a handful of people with it since the clinic began” to “POTS is common and often missed”), all but one site agreed to participate. The tertiary POTS centre linked to site H was already running the NASA Lean Test as standard on all patients. Site C, which operated entirely virtually, passed the work to the referring general practitioner by making this test a precondition for seeing the patient; site D, which was largely virtual, sent instructions for patients to self-administer the test at home.

The NASA Lean Test study has been published separately [ 98 ]. In sum, of 277 consecutive patients tested across the eight clinics, 20 (7%) had a positive NASA Lean Test for POTS and a further 28 (10%) a borderline result. Six of 20 patients who met the criteria for POTS on testing had no prior history of orthostatic intolerance. The question of whether this test should be used to “screen” all patients was not answered definitively. But the experience of participating in the study persuaded some sceptics that postural changes in heart rate could be severe in some long covid patients, did not appear to be fully explained by their previously held theories (e.g. “functional”, anxiety, deconditioning), and had likely been missed in some patients. The outcome of this particular quality improvement cycle was thus not a wholescale change in practice (for which the evidence base was weak) but a more subtle increase in clinical awareness, a greater willingness to consider testing for POTS and a greater commitment to contribute to research into this contested condition.

More generally, the POTS audit prompted some clinicians to recognize the value of quality improvement in novel clinical areas. One physician who had initially commented that POTS was not seen in their clinic, for example, reflected:

“ Our clinic population is changing. […] Overall there’s far fewer post-ICU patients with ECMO [extra-corporeal membrane oxygenation] issues and far more long covid from the community, and this is the bit our clinic isn’t doing so well on. We’re doing great on breathing pattern disorder; neuro[logists] are helping us with the brain fogs; our fatigue and occupational advice is ok but some of the dysautonomia symptoms that are more prevalent in the people who were not hospitalized – that’s where we need to improve .” -Respiratory physician, site G (from field visit 6.6.23)

Example quality topic 3: Management of fatigue

Fatigue was the commonest symptom overall and a high priority among both patients and clinicians for quality improvement. It often coexisted with the cluster of neurocognitive symptoms known as brain fog, with both conditions relapsing and remitting in step. Clinicians were keen to systematize fatigue management using a familiar clinical framework oriented around documenting a full clinical history, identifying associated symptoms, excluding or exploring comorbidities and alternative explanations (e.g. poor sleep patterns, depression, menopause, deconditioning), assessing how fatigue affects physical and mental function, implementing a program of physical and cognitive therapy that was sensitive to the patient’s condition and confidence level, and monitoring progress using validated patient-reported outcome measures and symptom diaries.

The underpinning logic of this approach, which broadly reflected World Health Organization guidance [ 99 ], was that fatigue and linked cognitive impairment could be a manifestation of many—perhaps interacting—conditions but that a whole-patient (body and mind) rehabilitation program was the cornerstone of management in most cases. Discussion in the quality improvement collaborative focused on issues such as whether fatigue was so severe that it produced safety concerns (e.g. in a person’s job or with childcare), the pros and cons of particular online courses such as yoga, relaxation and mindfulness (many were viewed positively, though the evidence base was considered weak), and the extent to which respiratory physical therapy had a crossover impact on fatigue (systematic reviews suggested that it may do, but these reviews also cautioned that primary studies were sparse, methodologically flawed, and heterogeneous [ 100 , 101 ]). They also debated the strengths and limitations of different fatigue-specific outcome measures, each of which had been developed and validated in a different condition, with varying emphasis on cognitive fatigue, physical fatigue, effect on daily life, and motivation. These instruments included the Modified Fatigue Impact Scale; Fatigue Severity Scale [ 102 ]; Fatigue Assessment Scale; Functional Assessment Chronic Illness Therapy—Fatigue (FACIT-F) [ 103 ]; Work and Social Adjustment Scale [ 104 ]; Chalder Fatigue Scale [ 105 ]; Visual Analogue Scale—Fatigue [ 106 ]; and the EQ5D [ 87 ]. In one clinic (site F), three of these scales were used in combination for reasons discussed below.

Some clinicians advocated melatonin or nutritional supplements (such as vitamin D or folic acid) for fatigue on the grounds that many patients found them helpful and formal placebo-controlled trials were unlikely ever to be conducted. But neurostimulants used in other fatigue-predominant conditions (e.g. brain injury, stroke), which also lacked clinical trial evidence in long covid, were viewed as inappropriate in most patients because of lack of evidence of clear benefit and hypothetical risk of harm (e.g. adverse drug reactions, polypharmacy).

Whilst the patient advisory group were broadly supportive of a whole-patient rehabilitative approach to fatigue, their primary concern was fatiguability , especially post-exertional symptom exacerbation (PESE, also known as “crashes”). In these, the patient becomes profoundly fatigued some hours or days after physical or mental exertion, and this state can last for days or even weeks [ 107 ]. Patients viewed PESE as a “red flag” symptom which they felt clinicians often missed and sometimes caused. They wanted the quality improvement effort to focus on ensuring that all clinicians were aware of the risks of PESE and acted accordingly. A discussion among patients and clinicians at a quality improvement collaborative meeting raised a new research hypothesis—that reducing the number of repeated episodes of PESE may improve the natural history of long covid.

These tensions around fatigue management played out differently in different clinics. In site C (the GP-led virtual clinic run from a community hub), fatigue was viewed as one manifestation of a whole-patient condition. The lead general practitioner used the metaphor of untangling a skein of wool: “you have to find the end and then gently pull it”. The underlying problem in a fatigued patient, for example, might be an undiagnosed physical condition such as anaemia, disturbed sleep, or inadequate pacing. These required (respectively) the chronic fatigue service (comprising an occupational therapist and specialist psychologist and oriented mainly to teaching the techniques of goal-setting and pacing), a “tiredness” work-up (e.g. to exclude anaemia or menopause), investigation of poor sleep (which, not uncommonly, was due to obstructive sleep apnea), and exploration of mental health issues.

In site G (a hospital clinic which had evolved from a respiratory service), patients with fatigue went through a fatigue management program led by the occupational therapist with emphasis on pacing, energy conservation, avoidance of PESE and sleep hygiene. Those without ongoing respiratory symptoms were often discharged back to their general practitioner once they had completed this; there was no consultant follow-up of unresolved fatigue.

In site F (a rehabilitation clinic which had a longstanding interest in chronic fatigue even before the pandemic), active interdisciplinary management of fatigue was commenced at or near the patient’s first visit, on the grounds that the earlier this began, the more successful it would be. In this clinic, patients were offered a more intensive package: a similar occupational therapy-led fatigue course as those in site G, plus input from a dietician to advise on regular balanced meals and caffeine avoidance and a group-based facilitated peer support program which centred on fatigue management. The dietician spoke enthusiastically about how improving diet in longstanding long covid patients often improved fatigue (e.g. because they had often lost muscle mass and tended to snack on convenience food rather than make meals from scratch), though she agreed there was no evidence base from trials to support this approach.

Pursuing local quality improvement through MDTs

Whilst some long covid patients had “textbook” symptoms and clinical findings, many cases were unique and some were fiendishly complex. One clinician commented that, somewhat paradoxically, “easy cases” were often the post-ICU follow-ups who had resolving chest complications; they tended to do well with a course of respiratory physical therapy and a return-to-work program. Such cases were rarely brought to MDT meetings. “Difficult cases” were patients who had not been hospitalized for their acute illness but presented with a months- or years-long history of multiple symptoms with fatigue typically predominant. Each one was different, as the following example (some details of which have been fictionalized to protect anonymity) illustrates.

The MDT is discussing Mrs Fermah, a 65-year-old homemaker who had covid-19 a year ago. She has had multiple symptoms since, including fluctuating fatigue, brain fog, breathlessness, retrosternal chest pain of burning character, dry cough, croaky voice, intermittent rashes (sometimes on eating), lips going blue, ankle swelling, orthopnoea, dizziness with the room spinning which can be triggered by stress, low back pain, aches and pains in the arms and legs and pins and needles in the fingertips, loss of taste and smell, palpitations and dizziness (unclear if postural, but clear association with nausea), headaches on waking, and dry mouth. She is somewhat overweight (body mass index 29) and admits to low mood. Functionally, she is mostly confined to the house and can no longer manage the stairs so has begun to sleep downstairs. She has stumbled once or twice but not fallen. Her social life has ceased and she rarely has the energy to see her grandchildren. Her 70-year-old husband is retired and generally supportive, though he spends most evenings at his club. Comorbidities include glaucoma which is well controlled and overseen by an ophthalmologist, mild club foot (congenital) and stage 1 breast cancer 20 years ago. Various tests, including a chest X-ray, resting and exercise oximetry and a blood panel, were normal except for borderline vitamin D level. Her breathing questionnaire score suggests she does not have breathing pattern disorder. ECG showed first-degree atrioventricular block and left axis deviation. No clinician has witnessed the blue lips. Her current treatment is online group respiratory physical therapy; a home visit is being arranged to assess her climbing stairs. She has declined a psychologist assessment. The consultant asks the nurse who assessed her: “Did you get a feel if this is a POTS-type dizziness or an ENT-type?” She sighs. “Honestly it was hard to tell, bless her.”—Site A MDT

This patient’s debilitating symptoms and functional impairments could all be due to long covid, yet “evidence-based” guidance for how to manage her complex suffering does not exist and likely never will exist. The question of which (if any) additional blood or imaging tests to do, in what order of priority, and what interventions to offer the patient will not be definitively answered by consulting clinical trials involving hundreds of patients, since (even if these existed) the decision involves weighing this patient’s history and the multiple factors and uncertainties that are relevant in her case. The knowledge that will help the MDT provide quality care to Mrs Fermah is case-based knowledge—accumulated clinical experience and wisdom from managing and deliberating on multiple similar cases. We consider case-based knowledge further in the “ Discussion ”.

Summary of key findings

This study has shown that a quality improvement collaborative of UK long covid clinics made some progress towards standardizing assessment and management in some topics, but some variation remained. This could be explained in part by the fact that different clinics had different histories and path dependencies, occupied a different place in the local healthcare ecosystem, served different populations, were differently staffed, and had different clinical interests. Our patient advisory group and clinicians in the quality improvement collaborative broadly prioritized the same topics for improvement but interpreted them somewhat differently. “Quality” long covid care had multiple dimensions, relating to (among other things) service set-up and accessibility, clinical provision appropriate to the patient’s need (including options for referral to other services locally), the human qualities of clinical and support staff, how knowledge was distributed across (and accessible within) the system, and the accumulated collective wisdom of local MDTs in dealing with complex cases (including multiple kinds of specialist expertise as well as relational knowledge of what was at stake for the patient). Whilst both staff and patients were keen to contribute to the quality improvement effort, the burden of measurement was evident: multiple outcome measures, used repeatedly, were resource-intensive for staff and exhausting for patients.

Strengths and limitations of this study

To our knowledge, we are the first to report both a quality improvement collaborative and an in-depth qualitative study of clinical work in long covid. Key strengths of this work include the diverse sampling frame (with sites from three UK jurisdictions and serving widely differing geographies and demographics); the use of documents, interviews and reflexive interpretive ethnography to produce meaningful accounts of how clinics emerged and how they were currently organized; the use of philosophical concepts to analyse data on how MDTs produced quality care on a patient-by-patient basis; and the close involvement of patient co-researchers and coauthors during the research and writing up.

Limitations of the study include its exclusive UK focus (the external validity of findings to other healthcare systems is unknown); the self-selecting nature of participants in a quality improvement collaborative (our patient advisory group suggested that the MDTs observed in this study may have represented the higher end of a quality spectrum, hence would be more likely than other MDTs to adhere to guidelines); and the particular perspective brought by the researchers (two GPs, a physical therapist and one non-clinical person) in ethnographic observations. Hospital specialists or organizational scholars, for example, may have noticed different things or framed what they observed differently.

Explaining variation in long covid care

Sutherland and Levesque’s framework mentioned in the “ Background ” section does not explain much of the variation found in our study [ 70 ]. In terms of capacity, at the time of this study most participating clinics benefited from ring-fenced resources. In terms of evidence, guidelines existed and were not greatly contested, but as illustrated by the case of Mrs Fermah above, many patients were exceptions to the guideline because of complex symptomatology and relevant comorbidities. In terms of agency, clinicians in most clinics were passionately engaged with long covid (they were pioneers who had set up their local clinic and successfully bid for national ring-fenced resources) and were generally keen to support patient choice (though not if the patient requested tests which were unavailable or deemed not indicated).

Astma et al.’s list of factors that may explain variation in practice (see “ Background ”) includes several that may be relevant to long covid, especially that the definition of appropriate care in this condition remains somewhat contested. But lack of opportunity to discuss cases was not a problem in the clinics in our sample. On the contrary, MDT meetings in each locality gave clinicians multiple opportunities to discuss cases with colleagues and reflect collectively on whether and how to apply particular guidelines.

The key problem was not that clinicians disputed the guidelines for managing long covid or were unaware of them; it was that the guidelines were not self-interpreting . Rather, MDTs had to deliberate on the balance of benefits and harms in different aspects of individual cases. In patients whose symptoms suggested a possible diagnosis of POTS (or who suspected themselves of having POTS), for example, these deliberations were sometimes lengthy and nuanced. Should a test result that is not technically in the abnormal range but close to it be treated as diagnostic, given that symptoms point to this diagnosis? If not, should the patient be told that the test excludes POTS or that it is equivocal? If a cardiology opinion has stated firmly that the patient does not have POTS but the cardiologist is not known for their interest in this condition, should a second specialist opinion be sought? If the gold standard “tilt test” [ 108 ] for POTS (usually available only in tertiary centres) is not available locally, does this patient merit a costly out-of-locality referral? Should the patient’s request for a trial of off-label medication, reflecting discussions in an online support group, be honoured? These are the kinds of questions on which MDTs deliberated at length.

The fact that many cases required extensive deliberation does not necessarily justify variation in practice among clinics. But taking into account the clinics’ very different histories, set-up, and local referral pathways, the variation begins to make sense. A patient who is being assessed in a clinic that functions as a specialist chronic fatigue centre and attracts referrals which reflect this interest (e.g. site F in our sample) will receive different management advice from one that functions as a telephone-only generalist assessment centre and refers on to other specialties (site C in our sample). The wide variation in case mix, coupled with the fact that a different proportion of these cases were highly complex in each clinic (and in different ways), suggests that variation in practice may reflect appropriate rather than inappropriate care.

Our patient advisory group affirmed that many of the findings reported here resonated with their own experience, but they raised several concerns. These included questions about patient groups who may have been missed in our sample because they were rarely discussed in MDTs. The decision to take a case to MDT discussion is taken largely by a clinician, and there was evidence from online support groups that some patients’ requests for their case to be taken to an MDT had been declined (though not, to our knowledge, in the clinics participating in the LOCOMOTION study).

We began this study by asking “what is quality in long covid care?”. We initially assumed that this question referred to a generalizable evidence base, which we felt we could identify, and we believed that we could then determine whether long covid clinics were following the evidence base through conventional audits of structure, process, and outcome. In retrospect, these assumptions were somewhat naïve. On the basis of our findings, we suggest that a better (and more individualized) research question might be “to what extent does each patient with long covid receive evidence-based care appropriate to their needs?”. This question would require individual case review on a sample of cases, tracking each patient longitudinally including cross-referrals, and also interviewing the patient.

Nomothetic versus idiographic knowledge

In a series of lectures first delivered in the 1950s and recently republished [ 109 ], psychiatrist Dr Maurice O’Connor Drury drew on the later philosophy of his friend and mentor Ludwig Wittgenstein to challenge what he felt was a concerning trend: that the nomothetic (generalizable, abstract) knowledge from randomized controlled trials (RCTs) was coming to over-ride the idiographic (personal, situated) knowledge about particular patients. Based on Wittgenstein’s writings on the importance of the particular, Drury predicted—presciently—that if implemented uncritically, RCTs would result in worse, not better, care for patients, since it would go hand-in-hand with a downgrading of experience, intuition, subjective judgement, personal reflection, and collective deliberation.

Much conventional quality improvement methodology is built on an assumption that nomothetic knowledge (for example, findings from RCTs and systematic reviews) is a higher form of knowing than idiographic knowledge. But idiographic, case-based reasoning—despite its position at the very bottom of evidence-based medicine’s hierarchy of evidence [ 110 ]—is a legitimate and important element of medical practice. Bioethicist Kathryn Montgomery, drawing on Aristotle’s notion of praxis , considers clinical practice to be an example of case-based reasoning [ 111 ]. Medicine is governed not by hard and fast laws but by competing maxims or rules of thumb ; the essence of judgement is deciding which (if any) rule should be applied in a particular circumstance. Clinical judgement incorporates science (especially the results of well-conducted research) and makes use of available tools and technologies (including guidelines and decision-support algorithms that incorporate research findings). But rather than being determined solely by these elements, clinical judgement is guided both by the scientific evidence and by the practical and ethical question “what is it best to do, for this individual, given these circumstances?”.

In this study, we observed clinical management of, and MDT deliberations on, hundreds of clinical cases. In the more straightforward ones (for example, recovering pneumonitis), guideline-driven care was not difficult to implement and such cases were rarely brought to the MDT. But cases like Mrs Fermah (see last section of “ Results ”) required much discussion on which aspects of which guideline were in the patient’s best interests to bring into play at any particular stage in their illness journey.

Conclusions

One systematic review on quality improvement collaboratives concluded that “ [those] reporting success generally addressed relatively straightforward aspects of care, had a strong evidence base and noted a clear evidence-practice gap in an accepted clinical pathway or guideline” (page 226) [ 60 ]. The findings from this study suggest that to the extent that such collaboratives address clinical cases that are not straightforward, conventional quality improvement methods may be less useful and even counterproductive.

The question “what is quality in long covid care?” is partly a philosophical one. Our findings support an approach that recognizes and values idiographic knowledge —including establishing and protecting a safe and supportive space for deliberation on individual cases to occur and to value and draw upon the collective learning that occurs in these spaces. It is through such deliberation that evidence-based guidelines can be appropriately interpreted and applied to the unique needs and circumstances of individual patients. We suggest that Drury’s warning about the limitations of nomothetic knowledge should prompt a reassessment of policies that rely too heavily on such knowledge, resulting in one-size-fits-all protocols. We also cautiously hypothesize that the need to centre the quality improvement effort on idiographic rather than nomothetic knowledge is unlikely to be unique to long covid. Indeed, such an approach may be particularly important in any condition that is complex, unpredictable, variable in presentation and clinical course, and associated with comorbidities.

Availability of data and materials

Selected qualitative data (ensuring no identifiable information) will be made available to formal research teams on reasonable request to Professor Greenhalgh at the University of Oxford, on condition that they have research ethics approval and relevant expertise. The quantitative data on NASA Lean Test have been published in full in a separate paper [ 98 ].

Abbreviations

Chronic fatigue syndrome

Intensive care unit

Jenny Ceolta-Smith

Julie Darbyshire

LOng COvid Multidisciplinary consortium Optimising Treatments and services across the NHS

Multidisciplinary team

Myalgic encephalomyelitis

Middle East Respiratory Syndrome

National Aeronautics and Space Association

Occupational therapy/ist

Post-exertional symptom exacerbation

Postural orthostatic tachycardia syndrome

Speech and language therapy

Severe Acute Respiratory Syndrome

Trisha Greenhalgh

United Kingdom

United States

World Health Organization

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Acknowledgements

We are grateful to clinic staff for allowing us to study their work and to patients for allowing us to sit in on their consultations. We also thank the funder of LOCOMOTION (National Institute for Health Research) and the patient advisory group for lived experience input.

This research is supported by National Institute for Health Research (NIHR) Long Covid Research Scheme grant (Ref COV-LT-0016).

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Trisha Greenhalgh, Julie L. Darbyshire & Emma Ladds

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Contributions

TG conceptualized the overall study, led the empirical work, supported the quality improvement meetings, conducted the ethnographic visits, led the data analysis, developed the theorization and wrote the first draft of the paper. JLD organized and led the quality improvement meetings, supported site-based researchers to collect and analyse data on their clinic, collated and summarized data on quality topics, and liaised with the patient advisory group. CL conceptualized and led the quality topic on POTS, including exploring reasons for some clinics’ reluctance to conduct testing and collating and analysing the NASA Lean Test data across all sites. EL assisted with ethnographic visits, data analysis, and theorization. JCS contributed lived experience of long covid and also clinical experience as an occupational therapist; she liaised with the wider patient advisory group, whose independent (patient-led) audit of long covid clinics informed the quality improvement prioritization exercise. All authors provided extensive feedback on drafts and contributed to discussions and refinements. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Trisha Greenhalgh .

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Ethics approval and consent to participate.

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS study is sponsored by the University of Leeds and approved by Yorkshire & The Humber—Bradford Leeds Research Ethics Committee (ref: 21/YH/0276) and subsequent amendments.

Patient participants in clinic were approached by the clinician (without the researcher present) and gave verbal informed consent for a clinically qualified researcher to observe the consultation. If they consented, the researcher was then invited to sit in. A written record was made in field notes of this verbal consent. It was impractical to seek consent from patients whose cases were discussed (usually with very brief clinical details) in online MDTs. Therefore, clinical case examples from MDTs presented in the paper are fictionalized cases constructed from multiple real cases and with key clinical details changed (for example, comorbidities were replaced with different conditions which would produce similar symptoms). All fictionalized cases were checked by our patient advisory group to check that they were plausible to lived experience experts.

Consent for publication

No direct patient cases are reported in this manuscript. For details of how the fictionalized cases were constructed and validated, see “Consent to participate” above.

Competing interests

TG was a member of the UK National Long Covid Task Force 2021–2023 and on the Oversight Group for the NICE Guideline on Long Covid 2021–2022. She is a member of Independent SAGE.

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Greenhalgh, T., Darbyshire, J.L., Lee, C. et al. What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography. BMC Med 22 , 159 (2024). https://doi.org/10.1186/s12916-024-03371-6

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6 Common Leadership Styles — and How to Decide Which to Use When

Rebecca Knight

Being a great leader means recognizing that different circumstances call for different approaches.

Research suggests that the most effective leaders adapt their style to different circumstances — be it a change in setting, a shift in organizational dynamics, or a turn in the business cycle. But what if you feel like you’re not equipped to take on a new and different leadership style — let alone more than one? In this article, the author outlines the six leadership styles Daniel Goleman first introduced in his 2000 HBR article, “Leadership That Gets Results,” and explains when to use each one. The good news is that personality is not destiny. Even if you’re naturally introverted or you tend to be driven by data and analysis rather than emotion, you can still learn how to adapt different leadership styles to organize, motivate, and direct your team.

Much has been written about common leadership styles and how to identify the right style for you, whether it’s transactional or transformational, bureaucratic or laissez-faire. But according to Daniel Goleman, a psychologist best known for his work on emotional intelligence, “Being a great leader means recognizing that different circumstances may call for different approaches.”

RK Rebecca Knight is a journalist who writes about all things related to the changing nature of careers and the workplace. Her essays and reported stories have been featured in The Boston Globe, Business Insider, The New York Times, BBC, and The Christian Science Monitor. She was shortlisted as a Reuters Institute Fellow at Oxford University in 2023. Earlier in her career, she spent a decade as an editor and reporter at the Financial Times in New York, London, and Boston.

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