Article

International Journal of Qualitative Methods

Volume 19: 1–17
Organizational Ethnographic Case Studies: ª The Author(s) 2020
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Toward a New Generative In-Depth DOI: 10.1177/1609406920926904
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Qualitative Methodology for Health Care
Research?

Élizabeth Côté-Boileau1,2 , Isabelle Gaboury3, Mylaine Breton4,

and Jean-Louis Denis5,6

Abstract
A growing body of literature suggests combining organizational ethnography and case study design as a new methodology for
investigating complex organizational phenomena in health care contexts. However, the arguments supporting the potential of
organizational ethnographic case studies to improve the process and increase the impact of qualitative research in health care is
currently underdeveloped. In this article, we aim to explore the methodological potentialities and limitations of combining
organizational ethnography and case study to conduct in-depth empirical health care research. We conducted a scoping review,
systematically investigating seven bibliographic databases to search, screen, and select empirical articles that employed organi-
zational ethnographic case study to explore organizational phenomena in health care contexts. We screened 573 papers, then
completed full-text review of 74 papers identified as relevant based on title and abstract. A total of 18 papers were retained for
analysis. Data were extracted and synthesized using a two-phase descriptive and inductive thematic analysis. We then developed a
methodological matrix that positions how the impact, contextualization, credibility, and depth of this combined methodology
interact to increase the generative power of in-depth qualitative empirical research in health care. Our review reveals that
organizational ethnographic case studies have their own distinct methodological identity in the wider domain of qualitative health
care research. We argue that by accelerating the research process, enabling various sources of reflexivity, and spreading the depth
and contextualization possibilities of empirical investigation of complex organizational phenomena, this combined methodology
may stimulate greater academic dynamism and increase the impact of research. Organizational ethnographic case studies appear
as a new in-depth qualitative methodology that both challenges and improves the conventional ways we study the lives of
organizations and the experiences of actors within the interconnected realms of health care.

Keywords
organizational ethnography, case study, in-depth research, qualitative methods, health care research

1
Health Sciences Research, Faculty of Medicine and Health Sciences, University
of Sherbrooke, Quebec, Canada
Introduction 2
Fonds de recherche du Québec - Santé, Montréal, Quebec, Canada
3
Department of Family Medicine, Faculty of Medicine and Health Sciences,
Organizational ethnography is currently attracting increased Charles-Le Moyne Hospital Research Center, University of Sherbrooke,
interest in social and organization studies (Aguinis et al., Quebec, Canada
4
2019; Berthod et al., 2018; Bryman & Buchanan, 2018; Ham- Department of Community Health Sciences, Faculty of Medicine and Health
mersley, 2018; Prévost & Roy, 2015; Van Maanen, 2002, Sciences, Charles-Le Moyne Hospital Research Center, University of
Sherbrooke, Quebec, Canada
2006). According to Berthod et al. (2018, p. 1), this methodo- 5
Health Administration Department, School of Public Health, University of
logical approach is “regularly pushed to the fore as one of the Montreal, Quebec, Canada
most revered approaches to qualitative research.” While there 6
University of Montreal Hospital Research Center, Quebec, Canada
is currently no consensus of the definition of ethnography per
se in social and organizational sciences, authors define organi- Corresponding Author:
Élizabeth Côté-Boileau, Health Sciences Research, Faculty of Medicine and
zational ethnography as the study of human lives in organiza- Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
tions, with a particular focus on the social culture underlying J1K 2R1.
the processes of organizing (Rosen, 1991; Van Maanen, 2002; Email: elizabeth.cote-boileau@usherbrooke.ca

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2 International Journal of Qualitative Methods
Ybema et al., 2009). This methodological approach is particu-
larly helpful in studying organizational practices, policies, pro-
cesses, and dynamics (Bikker et al., 2017; Brant et al., 2018;
Estabrooks et al., 2008; Liberati et al., 2015; Oliffe, 2005;
Thomson, 2011; Cruz & Higginbottom, 2013). It aims to
understand the experience of organizational actors in their nat-
ural context, with a particular interest in processes involved in
shaping organizational culture (Cunliffe, 2010; Fine et al.,
2009; Hammersley & Atkinson, 2007; Van Maanen, 2011).
In recent qualitative studies that apply organizational ethno-
graphic approaches in health care contexts, we observe an
emerging methodological practice that combines organiza-
tional ethnography with case study design. This development
has led scholars to question whether combining these
approaches palliates the weaknesses and reinforces the
strengths seen in each methodology, potentially improving the
process and increasing the impact of qualitative health care
research.
While previous research has focused separately on the meth-
odological legitimacy of new forms of organizational ethno-
graphy and case study designs applied to health care research,
little is known about why and when it is better to combine these
two approaches (Baxter & Jack, 2008; Bryman & Buchanan,
2018; Carolan et al., 2016; Fine et al., 2009; Hammersley,
2018; Lambert et al., 2011; Ybema et al., 2009; Yin, 2009).
Rodgers et al.’s (2016) methodological framework for organi-
zational case studies provides methodological standards (13
items) for health care researcher who seeks to mobilize this
methodology, has considerably contributed to advance the
methodological conversation on this combined approach.
Although the authors discuss the ethnographic origins of orga-
nizational case studies, they do not go so far as to propose, or
argue, the combination of organizational ethnography and case
study per se for health research (Rodgers et al., 2016). The lack
of scientific benchmarks to support the choice of an appropriate
study design represents a significant challenge to health care
scholars. The aim of this article is to explore the methodologi-
cal potentialities and limitations of combining organizational
ethnography and case study approaches to conduct in-depth
empirical research in health care. We begin by reviewing exist-
ing scholarship on what constitutes organizational ethnography
and case study research before diving into their combination
(see Table 1).
What Is Organizational Ethnography?
There is currently no consensus on the definition of ethnogra-
phy (Cunliffe, 2010; Hammersley, 2018; Hammersley &
Atkinson, 2007; Rouleau, 2013; Van Maanen, 2006). Accord-
ing to Hammersley (2018, p. 1), delineating ethnography is
difficult as this approach is often confused with broader quali-
tative research designs, interpretative approaches, fieldwork
studies, and case study research. In addition, applications of
ethnography draw on different epistemological, ontological,
and ethical perspectives (Hammersley, 2018; Reeves et al.,
2017; Ryan, 2017). This feeds ongoing debate over whether
ethnography is a methodology, a theoretical approach, or both
(Nugus & Forero, 2011; Thomson, 2011). In general, ethno-
graphy is the “study of human lives” in natural contexts (Ham-
mersley & Atkinson, 2007, p. 1). The concept of culture is
central (Clifford & Marcus, 1986). More specifically, organi-
zational ethnography refers to the study of human lives in
organizations, with a particular focus on the social culture
underlying the processes of organizing (Rosen, 1991; Van
Maanen, 2002; Ybema et al., 2009). It is especially interested
in the organization and its materialization through human or
nonhuman forms, including individuals, institutions, norms,
processes, interactions, artifacts, and more (Dooley & Van de
Ven, 1999; Fine et al., 2009; Hulst et al., 2017; Rosen, 1991;
Cruz & Higginbottom, 2013; Yanow et al., 2009; Ybema et al.,
2009). According to Fine et al. (2009, p. 602), organizational
ethnography is an anthropological approach used since the
1950s to study “power, politics, informal relations, and resis-
tance within organizations.”
What Is Case Study Research?
Challenges in defining the traditional case study approach arise
from the confrontation between paradigms (Wahyuni, 2012),
classic authors (Baxter & Jack, 2008), quantitative and quali-
tative approaches (Creswell, 2007; Villarreal Larrinaga, 2016),
and empirical and theoretical applications (Aczel, 2015; Luck
et al., 2006; Prévost & Roy, 2015). According to Prévost and
Roy (2015, p. 135), the case study design is the “the most
difficult type of research to define.” Yin (2014, p. 2) highlights
the irony of scholars who characterize case study as a soft
approach when it is so complex to understand and adequately
apply. According to Yin (2014, p. 16), two main characteristics
define a case study: (a) the investigation of “a contemporary
phenomenon in a real context” and (b) “unclear boundaries
between the context and the phenomenon of interest.” In sum,
case study is a form of empirical and theoretical social inves-
tigation dedicated to the study of contemporary phenomena in
natural contexts (Ridder, 2017; Stake, 1983; Yin, 2014).
What About Organizational Ethnographic Case Studies?
To the best of our knowledge, no study has yet provided a
methodological definition of organizational ethnographic case
study. As well, new adaptive forms of organizational ethnogra-
phy have emerged in recent years such as focused ethnography,
multisite ethnography, interorganizational ethnography, and
rapid ethnography (Atherton et al., 2018; Beneito-Montagut
et al., 2017; Berthod et al., 2018; Bikker et al., 2017; Falzon,
2016). These organizational ethnographic variations are often
applied in combination with case study designs.
Focused Ethnography
Bikker et al. (2017, p.1) define focused ethnography as “a form
of applied and pragmatic ethnography that explores a specific
social phenomenon as it occurs in everyday life.” Many
 Table 1. Description of Organizational Ethnographic and Case Study Designs.
Methodological aspects Organizational Ethnography Case Study

Definition The study of human lives in organizations, with a particular focus on the social The study of contemporary phenomena in natural contexts, when the boundaries between phenomenon and context are not clearly evident, and in which
culture underlying the processes of organizing (Rosen, 1991; Van Maanen, multiple sources of evidence are used (Ridder, 2012; Stake, 1995; Yin, 2003, 2009).
2002; Ybema et al., 2009).
Purpose To understand the experience of organizational actors with respect to a given To socially investigate how and/or why a contemporary phenomenon unfolds in natural contexts, while the researcher has little control over behaviors/events
organizational or social phenomenon from multiple points of view and with surrounding the empirical setting of the study (Yin, 2014).
a particular focus on reflexivity (Berthod et al., 2018;
Fine et al., 2009; Hammersley & Atkinson, 2007).
Epistemology  Interpretativism: Supports that knowledge and reality are relative to  Positivism: Supports that reality exists and is objectively constructed beyond the human mind. Reality is reached through scientific quantitative
one’s subjective perception. Truth is socially constructed and culturally deduction of the observation of a phenomena (Aczel, 2015, p. 16; Riccucci, 2010, p. 47).
bounded (Riccucci, 2010, p. 47)  Realism: Supports that reality exists independently of the human mind. Reality may be reached through scientific and nonscientific sources of
knowledge (Aczel, 2015, p. 16).
 Constructivism: Supports that reality is socially constructed and that truth is relative to one’s subjective perspective (Baxter & Jack, 2008, p. 545).
Approaches  Native ethnography is a subcategory of autoethnography, where the Stake (1983, 1995): Yin (2014):
research is conducted by someone who is not a professional Designs: Purposes: Designs:
anthropologist and who is studying their home community  Intrinsic aims to exploit the  Descriptive aims to describe  Single aims to better understand
(Abdulrehman, 2017, p. 157). peculiarity of a case in order to reach a an event or phenomenon in a unique or rare phenomenon.
 Netnography is an ethnographic-adapted online research method, deeper its natural context.  Multiple aims to identify the
which aims to explore the social practices and interactions in understanding of a given phenomenon.  Exploratory aims to explore recurrences and divergences
contemporary digital worlds (Beneito-Montagut et al., 2017;  Instrumental aims to use one particular in greater depth a little-known phenomenon. underlying the construction
Keim-Malpass et al., 2014). case to  Explanatory aims to identify of a given phenomenon,
 Ethnography of events is an ethnographic-adapted method that focuses understand another phenomenon; the causal relationships that using similar or different cases.
on socially constructed events to uncover the role of cultural interest explain a phenomenon.  Holistic aims to capture the
structures in shaping organizational life through time is therefore not focused on the case itself, essence of a phenomenon
(Dooley & Van de Ven, 1999). but on the phenomenon per se. as a whole.
 Multisite ethnography is an ethnographic-adapted method that study  Collective replicates the instrumental case  Embedded aims to understand
social phenomena that cannot be explained by focusing on a single study, only on a larger scale. a phenomenon through cases
site (Bikker et al., 2017; Marcus, 2011; 2012; Molloy et al., 2017). nested in various empirical contexts.
 Interorganizational ethnography is an ethnographic-adapted method
that study social and organizational phenomenon that manifests
beyond organizational boundaries (Berthod et al., 2018; Bryman
& Buchanan, 2018).
 Rapid ethnography consists of applying the traditional organizational
ethnographic approach in a compressed manner over time
(Vindrola-Padros & Vindrola-Padros, 2017).
 Team-based ethnography consists of applying the traditional organizational
ethnographic approach with multiple fieldworkers and valuing each
fieldworkers’ reflexivity in the research process (Jarzabkowski et al., 2015).
 Autoethnography is an ethnographic-adapted method that focuses on the
researcher’s own experience. Self is the source of the data in the form
of writing down the day-to-day concrete details of life (Benoot & Bilsen, 2016,
p. 483; Kempster & Parry, 2018).
 Critical ethnography differs from conventional ethnography in that conventional
ethnographers’ study culture for the purpose of describing it, whereas critical
ethnographers do so to change it (Thomson, 2011, p. 12).
 Institutional ethnography is an ethnographic-adapted method that aims to
explore the institutionalization of social interactions within institutionalized
organizational contexts (Ng et al., 2017).
 Focused ethnography is an ethnographic-adapted method, which pragmatically
applies ethnography over a short period of time, and conceptually focuses
on a single organizational or social phenomena (Atherton et al., 2018;
Cruz & Higginbottom, 2013).

(continued)

3
4
Table 1. (continued)
Methodological aspects Organizational Ethnography Case Study

Unit of analysis  In organizational ethnography, units of analysis can constitute units  In case study research, cases can constitute units of analysis, but not necessarily (Crowe et al., 2011). According to Miles and Huberman (2014 in
of observation, but not necessarily. The unit of analysis refers to the entity Baxter & Jack, 2008, p. 545), the case is delimitated by the researcher and may constitutes “any phenomenon occurring in a delimited context.” The
that frames what is being analyzed and to which the research inferences unit of analysis refers to the entity that frames what is being analyzed and to which the research inferences are going to be based on. The work is to
are going to be based on. The unit of observation (e.g., organizational discourse) put boundaries on the case(s) and (e.g., organizations) on the unit(s) of analysis (e.g., organizational processes).
is the item that is observed and collected to investigate the unit(s) of analysis  Possible units of analysis: individuals, organizations, time period, context, processes, practices, interactions, artifacts, and so on
(e.g., organizational practices).
 Possible units of analysis: Individuals, organizations, time period, context,
processes, practices, interactions, artifacts, etc.
Data collection  Triangulation of multiple data sources.  Triangulation of multiple data sources.
 Mainly qualitative methods.  Mainly qualitative methods.
 Mainly observations ! field notes.
Data analysis  Mainly inductive approaches.  Inductive and deductive approaches.
 Reflexivity is fundamental.  Intra- and intercases.
Stake (1983, 1995): Categorical Yin (2014):
aggregation and direct interpretation  Pattern matching “compares an empirically based pattern—that is,
as analytical techniques. one based on the findings from the case study—with a predicted
one made before data collection” (Yin, 2014, p. 143).
 Explanation building “analyzes the case study data by building an
explanation about the case” (Yin, 2014, p. 147).
 Temporal series “conducts a time-series analysis, directly
analogous to the time-series analysis conducted in experiments
and quasi-experiments” (Yin, 2014, p. 150).
 Logic models “stipulates and operationalizes a complex chain
of occurrences or events over an extended period of time”
(Yin, 2014, p. 155).
 Cross-synthesis “can be performance whether the individual
case studies have previously been conducted as independent
research studies or as predesigned part of the same study,
in which the technique treats each individual case study
as a separate study” (Yin, 2014, p. 164).
Côté-Boileau et al.
scholars argue that focused ethnography is particularly suited
to study health care services, offering a legitimate approach to
exploring various types of context, organizational cultures and
subcultures, groups of actors, and sets of practices (Atherton
et al., 2018; Bikker et al., 2017; Brant et al., 2018; Cruz &
Higginbottom, 2013). Focused ethnography is distinguished
from traditional ethnographic approaches as it is pragmatically
applied, conceptually focused on a single organizational or
social phenomenon, and fieldwork is conducted intensely over
a short period of time (Bikker et al., 2017; Cruz & Higginbot-
tom, 2013). Focused ethnography is often applied in more than
one empirical site.
Multisite Ethnography
Multisite ethnography is defined by Flazon (2016, p. 1) as “the
study of social phenomena that cannot be explained by focus-
ing on a single site.” Given that health care systems and orga-
nizations often span multiple territorial boundaries, multisite
ethnography is increasingly used to capture social or organiza-
tional phenomena that emerge and manifest in multiple settings
simultaneously (Falzon, 2016; Marcus, 2011, 2012; Molloy
et al., 2017). The goal of multisite ethnography is to better
understand how processes, cultures, identities, and interactions
flow simultaneously through different contexts in health care
settings (Falzon, 2016; Molloy et al., 2017). This methodology
is often empirically applied by multiple field researchers in
several sites (Marcus, 2011; Yanow et al., 2009; Ybema
et al., 2009). Molloy et al. (2017, p. 24) consider that, as yet,
“multi-sited ethnography does not provide a strategy for
designing studies.”
Interorganizational Ethnography
Interorganizational ethnography has increasingly emerged as a
new form of social inquiry useful in studying social and organi-
zational phenomena that manifest beyond organizational
boundaries (Berthod et al., 2018; Van Maanen, 2011). This type
of organizational ethnography requires researchers to explore
phenomena in pluralistic settings and multiple organizational
forms, both explicit and tacit, such as “events, language, rituals,
institutions, behaviours, artefacts, and interactions” (Berthod
et al., 2018, p. 2). The main goal is to explore interorganizational
relations in all their forms, which involves paying attention to
organizational boundaries (i.e., cognitive, geographic, hier-
archic) that influence the context and ways in which organiza-
tional actors create and maintain relationships (Berthod et al.,
2018). While interorganizational ethnography and multisite eth-
nography present some methodological overlap, there are dif-
ferences in purpose: Interorganizational ethnography focuses on
uncovering the interorganizational interactions that underlie a
given social or organizational phenomenon, while multisite eth-
nography emphasizes contextualizing the social or organiza-
tional phenomenon per se, which develops simultaneously in
pluralistic settings (Berthod et al., 2018; Molloy et al., 2017).
5
Rapid Ethnography
Rapid ethnography consists of applying the traditional organi-
zational ethnographic approach in a compressed manner
(Vindrola-Padros & Vindrola-Padros, 2017). In their systema-
tic review, Vindrola-Padros and Vindrola-Padros (2017) argue
that there is no consistent definition of rapid ethnography used
in health care research. However, the authors provide five defi-
nitional criteria, which can be summarized as a densified appli-
cation of ethnography that aims to explore “relevant social,
cultural and behavioral information and focuses on human
experiences and practices,” with a particular emphasis on the
reflexivity of the research process (Vindrola-Padros &
Vindrola-Padros, 2017, p. 19).
While there is increased interest in adaptive forms of orga-
nizational ethnography drawing on case study designs, few
attempts have been made to investigate the advantages of com-
bining these two approaches (Atherton et al., 2018; Beneito-
Montagut et al., 2017; Bikker et al., 2017; Brant et al., 2018;
Fine et al., 2009; Morgan-Trimmer & Wood, 2016). The need
for clearer guidance in selecting appropriate methodologies to
study questions in health care research led to a scoping review
of the literature to explore the methodological potentialities
and limitations of organizational ethnographic case studies.
Method
In conducting this scoping review, we used Arksey and O’Mal-
ley’s (2005) framework, which involves five stages: (a) iden-
tify the research question, (b) identify relevant articles, (c)
select articles, (d) analyze the data from the articles, and (e)
collect, summarize, and report the results. This method
appeared relevant as it applies to a broad range of topics and
disciplines in the health care field (Arksey & O’Malley, 2005).
Our goal was not to assess the quality of papers. We essentially
extracted data with the objective of identifying methodological
potentialities and limitations raised in organizational ethno-
graphic case studies.
Search Strategy
The search strategy was developed to answer the following
research question: “What are the methodological potentialities
and limitations of organizational ethnographic case studies
used in health care research?” The search strategy involved
various sources, including “search engines, electronic data-
bases, reference lists, hand-searching of key journals, existing
networks, relevant organisations and conferences” (Smith
et al., 2016, p. 696). Searches were conducted on two search
engines (EBSCOhost and Google Scholar) and seven databases
(CINAHL, Academic Search Complete, Business Complete
Source, PsycINFO, SocINDEX, MEDLINE, EconLit, and
ERIC) using the following search terms: organizational ethno-
graph* OR organizational ethnograph* AND case stud* AND
health OR health care. The first 10 pages of results from each
search were examined (Arksey & O’Malley, 2005). In addition,
6 International Journal of Qualitative Methods

CINHAL, Academic Search Complete, Buisness Complete Source, PsycINFO,

Electronic search
SocINDEX, MEDLINE, EconLit, ERIC (N = 573)

Non-eletonic Bibliographies, hand-searching of key journals, exisng networks,text books,

search relevant conference material (N = 73)

Search results
N = 646
combined

Arcles screened by
N = 74
tle and abstract

Ethnographic case studies (N = 39), Qualitave

Arcles excluded N = 56 studies using ethnographic methods (N = 11), Auto-
ethnographic case study (N = 4)
Arcles included for
N = 18
charng

Figure 1. Flowchart of the scoping review process.

we explored reference lists, hand-searched six specific journals Data Analysis

(International Journal of Qualitative Methods, International
Journal of Social Research Methodology, Organizational
Research Methods, Methodological Innovation, Journal of
Organizational Ethnography, and Journal of Contemporary
Ethnography) and reviewed conference and educational mate-
rials. The search strategy was applied between July and
December 2018. Articles were retained if they (a) were pub-
lished in English or French, (b) were specific to health care
contexts, (c) and explicitly or implicitly adopted organizational
ethnographic case study designs.
Search Outcomes
Figure 1 illustrates the flowchart of the scoping review process,
drawing on Smith et al. (2016, p. 698). The use of search terms
in electronic databases led to 573 articles. Additional nonelec-
tronic research through bibliographies, hand searching of key
journals, textbooks, and relevant material added 73 articles,
including mostly methodological papers (n ¼ 52). We filtered
articles by title and abstract according to their fit with our
research question, retaining 74 articles for full-text screening,
of which 56 were excluded.
Papers were excluded on full-text screening when their
methodological design did not fit the purpose of our review.
Most of these were identified as ethnographic case studies (n ¼
39) but were not specifically organizational ethnographies. We
also found many qualitative studies using case study design and
ethnographic techniques (n ¼ 11), mostly observation, without
identifying as organizational ethnographic case studies.
Finally, the authors identified a few studies as autoethno-
graphic case studies, where the organizational component was
not embedded in the methodological design (n ¼ 4). Tables 2
and 3 present data extracted from all 18 articles, charted using
inductive thematic analysis.
We used a two-phase analytical approach to extract and synthe-
size data from selected papers. First, descriptive analysis was
used to categorize papers according to (a) author(s) and title,
(b) research question/objectives, (c) study design, (d) case
study selection/definition, (e) rationale for using the methodol-
ogy, (f) data collection methods, (g) data analysis methods, (h)
duration of fieldwork, (i) reflexivity, (j) methodological poten-
tialities, and (k) methodological limitations. Second, we con-
ducted an inductive thematic subanalysis of the methodological
potentialities and limitations raised in each article, which led us
to identify four methodological themes that embedded both the
potentialities and limitations of organizational ethnographic
case studies in health care contexts: (a) research process, (b)
data sources, collection, and analysis, (c) credibility, and (d)
impact of research. Each of these four themes embeds specific
subthemes.
Descriptive and inductive thematic analyses were per-
formed by the first author and were refined and validated
through peer review by members of the research team (all three
coauthors). Following each of three review cycles (submitted in
the form of charting tables December 14, 2018, April 14, 2019,
and October 6, 2019), the first author revised and refined the
outcomes of the scoping review according to the feedback
provided by the coauthors (Côté-Boileau et al., 2019, p. 3).
Following this validation cycle, while it was not among the
initial study objectives, recurrent insights emerging from anal-
ysis of the data allowed the research team (all authors) to
inductively develop a matrix (see Figure 2) to describe the
“methodological ‘winning combination’ of organizational eth-
nographic case study for in-depth qualitative health care
research,” according to the four methodological characteristics
mobilized to chart the selected literature for the scoping
review. The development of the matrix unfolded into three
steps: First, the first author inductively emerged individual
Côté-Boileau et al. 7

methodological strengths respectively to organizational ethno-

Vindrola- Bikker

(2017) (2017)
Ruelland Small Swinglehurst Greenhalgh Padros et al.

X
graphy and case study designs. According to this analysis, the

Vindrola-
first author inductively emerged the combined methodological

Padros
and

X
strengths of organizational ethnographic case studies. Second,
all authors met (October 16, 2019) to refine and validate the

Swinglehurst
results of this first inductive analysis. Third, all authors indivi-

(2015)
and

X
dually drew associations between (a) the four methodological
characteristics and the individual methodological strengths of
the two respective designs and (b) the individual methodologi-

(2015) (2009) et al. (2010)

cal strengths of the two respective designs and their combined

X
methodological strengths. All authors met (November 5, 2019)
to refine and validate the final associations. All authors agreed

X
that a new category emerged as what constitutes the “increased
methodological power” of organizational ethnographic case
studies applied in health care research.

X
McCourt McCourt McCourt

(2018)
et al.

X
Results

Table 2. Charting Tables of Selected Articles: Methodological Potentialities of Organizational Ethnographic Case Studies.

(2014)
et al.
While there is a significant body of research on the general

X
strengths and weaknesses of qualitative research applied in
health care, our review shows that specific potentialities (see

(2015) (2017) (2006) (2012)

et al.

X
Table 2) and limitations (see Table 3) arise from the combina-
tion of organizational ethnographic and case study research
et al. Bruni

X
designs. In the following section, we aim to explain why these
methodological specificities are meaningful for scholars
Lalleman Liberati Molloy

X
X

X
wishing to undertake organizational ethnographic case studies
in empirical health care contexts?
et al.

X
Methodological Potentialities of Organizational
(2015)
et al.

X
Ethnographic Case Studies Applied in Health Care
Research
Kerosuo
(2010)

Research process. Organizational ethnography is distinguished X

by the depth, authenticity, and richness of knowledge it assem-
Conte Greenhalgh Greenhalgh Greenhalgh

(2018)
et al.

bles and generates (Bikker et al., 2017; Bruni, 2006; Conte

X

et al., 2017; Lalleman et al., 2015; McCourt et al., 2018;

McCourt et al., 2014; Small, 2009; Swinglehurst & Green-
(2009)

halgh, 2015; Swinglehurst et al., 2010; Vindrola-Padros &

et al.

Vindrola-Padros, 2017). Moreover, organizational ethno-

graphic approaches allow researchers access to unbounded
organizational processes (e.g., organizational learning) that
(2008)
et al.

display either intra- or interorganizationally beyond tangible

(e.g., geographic) boundaries, which often present in health
(2017)
et al.

care organizations (Falzon, 2016). Case study research, for its

X

part, is distinguished from other qualitative designs by the deep

interactions between sites

Flexibility of research process

Active role of the researcher

In-depth contextualization of

empowering knowledge

contextualization of contemporary phenomena it provides.

practices, and routines
Access to tacit knowledge
Multilevel of contexts and
(boundless) multisited

Theoretical development
processes, meanings,
Potentialities

(reflexivity enables
interorganizational

Case study research offers temporal, material, activity-based

Timely actionable and
Multiple data sources
Multiple fieldworkers
Dynamics underlying

and contextual parameters to define cases, as “any

phenomenon

credibility)

phenomenon occurring in a delimited context” (Baxter & Jack,

2008, p. 545). Case study designs allow researchers to reveal
contemporary phenomena based on similarities and differences
Methodological

between settings (cases), but also between competing social

and analysis
Data sources,
collection,

research

contexts, which are also highly characteristic of health care

Categories

process

Credibility

Impact of
Research

settings. Given these advantages, our review suggests that com-

bining organizational ethnography and case study designs to
8
Table 3. Charting Tables of Selected Articles: Methodological Limitations of Organizational Ethnographic Case Studies.

Vindrola-
Padros
Swinglehurst and
Conte Greenhalgh Greenhalgh Greenhalgh Lalleman Liberati Molloy McCourt McCourt McCourt Swinglehurst and Vindrola- Bikker
Methodological et al. et al. et al. et al. Kerosuo et al. et al. et al. Bruni et al. et al. et al. Ruelland Small et al. Greenhalgh Padros et al.
Categories Limitations (2017) (2008) (2009) (2018) (2010) (2015) (2015) (2017) (2006) (2012) (2014) (2018) (2015) (2009) (2010) (2015) (2017)c (2017)

Research Time/energy of relational X X X X X X

process work (continuously
negotiating access to the
field)
Training and skills of X X X
fieldworkers
Ambiguity of researcher’s X X X X
role
Ethical gray zones X X X X
Data sources, Define cases and units of X X X X
collection, analysis
and analysis Saturation X X
Credibility Lack of methodological X X X
benchmarks
Validity of case sampling X
strategies
Validity of fieldwork X X X X X X
Influence of emotional X X
dynamics
Impact of Generalization of results X X X X X X
research (less depth within than
across cases)
Lack of dissemination X
strategy
Getting institutional X X
support
Côté-Boileau et al.
Methdological Categories Individual Methodological strenghts
Organizational
Ethnogtaphy
Reflexivity as a Data
Source & Data Collection
Technique
Negociating Access to the
Research Process Field as a Data Source
Depth & Immersion into
Organizational Lives
Access to Various Levels
of Tacit Knowledge &
Organizational « Secrets »
Data Sources,
Build Trusting and
Collection Generative Relationships
& Analysis with Participants
Case Study
Credibility
Conextualizes Boundless
& Multi-sited Phenomenon
Values Triangulation of
Multiple & Various Data
Impact of Sources
Research Provides a Variety of
Research Designs &
Purposes
Enables Timely Actionable
Knowledge Production
Provides Dissemination
Strategies
Figure 2. Methodological matrix of organizational ethnographic case studies for in-depth qualitative health care research.
study health care phenomena offers methodological
reinforcement.
Merging organizational ethnography and case study offers
an opportunity to access an in-depth contextualization of inter-
organizational (unbounded) multisite phenomena in various
health care contexts. Greenhalgh et al. (2009), Greenhalgh
et al. (2018), and Greenhalgh et al. (2008) have shown on
numerous occasions that organizational ethnographic case
studies provide unique tools to dissect how organizational pro-
cesses in health care interact across multiple levels of context
within and between sites and how these interactions produce
organizational effects. While qualitative approaches generally
allow a wide range of units of analysis (e.g., actors, behaviors,
meanings, logics, processes, practices, routines, interactions,
artifacts, contexts, boundaries), the in-depth immersion in mul-
tiple contexts and settings when undertaking organizational
ethnographic case studies offers an exclusive opportunity to
9
Combined Methodological
Increased Methodological Power
strenghts
Organizational
Ethnographic
Case Study
In-depth Closeness to
Competing Organizational
Lives
Increases the Credibility
of the Research
Situated & Shared
Reflexive Experiences of
Multiple Field Workers
Timely, Actionable &
Contextualized
Knowledge Production
Increases the Potential
Impact of the Research
Contextualized Multi-level
Interactions & Variations
capture the organizational forms and effects of tacit knowledge
that inhabit health care organizations. According to Cruz and
Higginbottom (2013, p. 42), such studies “are holistic and have
the ability to capture dimensions of the social world that are
covert and tacit.” Combining the methodologies appears to
provide a meaningful advantage for exploring the unexpressed
yet significant knowledge that shapes organizational life in
health care (Buchanan & Bryman, 2009; Hammersley, 2018).
Data collection. The triangulation of multiple data sources (e.g.,
observation, interviews, institutional documents, artifacts) is a
methodological strength sought in all qualitative approaches to
enhance both the credibility of the process and the impact of
research. In organizational ethnography, the researcher is the
main data collection instrument and aims to disturb the empiri-
cal field as little as possible (Fine et al., 2009; Van Hulst et al.,
2017; Van Maanen, 2002; Yanow et al., 2009; Ybema et al.,
10
2009). Ethnographic scholars therefore navigate the field with
very little control over the research process. The aim of non-
interference also explains why nonparticipant observation is
traditionally the most valued data collection technique in eth-
nographic research (Atkinson & Hammersley, 1998). In case
study approaches, researchers are encouraged to adapt their
degree of control over the research process to the research goal
(Yin, 2003, 2009, 2014). Combining organizational ethnogra-
phy and case study can thus help structure the data collection
process (e.g., identifying a priori moments of observation and
units of analysis according to the research question) while still
not disturbing or influencing the empirical field (e.g., focusing
on observation as the primary data collection technique; Bikker
et al., 2017; Molloy et al., 2017). Because organizational eth-
nographic case study designs in health care are often applied in
multiple settings, data collection is usually conducted in teams
with multiple field researchers (Beneito-Montagut et al., 2017;
Bikker et al., 2017; Jarzabkowski et al., 2015). Combining
these two methodologies appears to provide a meaningful
advantage by structuring and accelerating the empirical
research process without compromising the depth and quality
of data.
Data analysis. While qualitative research is by definition a thor-
ough and creative process, the combination of organizational
ethnographic and case study designs takes the “flexibility” of
qualitative data analysis to another level. Organizational ethno-
graphic researchers traditionally mobilize an inductive analy-
tical approach, which is often an unstructured process.
According to Hammersley and Atkinson (2007, p. 3), “Data
analysis involves the interpretation of the meanings, functions
and consequences of human actions and institutional practices,
and how these take place in micro and macro contexts.” Case
studies support both inductive and deductive analysis as well as
intra- and intercase analytic strategies (Gerring, 2006; Stake,
1983, 1995; Yin, 2014). In a combined approach, analysis may
be structured while preserving the flexibility proper to organi-
zational ethnography (Bruni, 2006; Lalleman et al., 2015;
McCourt et al., 2012; Swinglehurst & Greenhalgh, 2015; Swin-
glehurst et al., 2010). Working with cases and delimited units
of analysis helps researchers conduct data collection alongside
analysis by means of an organized database, opening opportu-
nities for multi-context analysis, in-depth intracase analysis,
and intercase comparative analysis. Moreover, case study
approaches offer several analytical techniques (e.g., matrices,
conceptual mapping, diagrams) that can be used to expand the
possibilities for analyzing ethnographic data (Miles et al.,
2013; Prévost & Roy, 2015). Combining these two methodol-
ogies appears to provide a meaningful advantage to accelerate
and enrich data analysis over the course of data collection,
extract the maximum out of massive ethnographic data pools,
and make sense of research findings.
Credibility. Our scoping review suggests that the active role of
the researcher and the emphasis on reflexivity in organizational
ethnographic case studies may enhance the credibility of this
International Journal of Qualitative Methods
design. Berthod et al. (2018) argue that the richness of the
researcher’s experience in the field is more important than the
length of time spent on site. The fact that organizational ethno-
graphic case studies often involve multiple sites provides an
opportunity to access and integrate the various reflexive experi-
ences of multiple fieldworkers to inform and enrich the
research (Bruni, 2006; Greenhalgh et al., 2008; McCourt
et al., 2012; Molloy et al., 2017). Moreover, Prévost and Roy
(2015) suggest that the quality of case sampling in organiza-
tional ethnographic case studies enhances methodological
credibility. Both methodological approaches value a multipli-
city of subjective perspectives as a source of credibility. While
reflexivity and sampling strategies feature in other qualitative
approaches, the powerful complementarity between contextua-
lized sources of data and reflexivity achieved by combining
organizational ethnography and case study reinforces the cred-
ibility of the research process.
Impact of research. Given that data analysis in organizational
ethnographic research is iterative, thorough and long, many
scholars consider it difficult to generate timely and actionable
knowledge with this methodology. This challenge is especially
important in health care organizations that are characterized as
rapidly changing environments (Côté-Boileau et al., 2019). The
organizational needs and concerns that motivated acceptance
of an ethnographic research project may well change before
research is complete. As well, the researcher is expected to
maintain a degree of “neutrality” and reflexivity while
immersed in the field. These factors make it challenging to
engage in knowledge transfer activities during the research
process, as data have yet to be analyzed, and such activities
create ambiguity around the researcher’s role (Hammersley,
2018; Liberati et al., 2015). However, the empathic closeness
to organizational life that scholars develop enables trust-
building to generate partnerships with stakeholders. The case
study approach helps to delimit and accelerate fieldwork,
allowing findings to be communicated in a timely manner to
meet stakeholders’ needs. Some authors also argue that com-
bining case study with organizational ethnographic design
enhances the capacity to generalize results, given that it enables
deep exploration of multiple social contexts within and
between organizations (Berthod et al., 2018; Bikker et al.,
2017; Falzon, 2016; Marcus, 2011, 2012; Molloy et al.,
2017). In addition, case study methodologies provide tech-
niques for empowering research participants in knowledge
transfer. Along with enhancing the impact of research, combin-
ing the two methodologies allows for more significant theore-
tical development. The importance placed on in-depth
investigation and understanding of a phenomenon in its natural
context in ethnographic studies, coupled with the rigor around
units of analysis and sampling strategies in case study research,
increases theoretical potential. Combining these two methodol-
ogies appears to provide a meaningful advantage in terms of
both knowledge transfer and theoretical development to
increase the impact of research in health care organizations.
Côté-Boileau et al.
The analysis presented above reveals important potential-
ities in combining case study and organizational ethnography
approaches in the health care context. In this next section, we
will address findings from the scoping review that point to
limitations this hybrid methodology implies for health care
researchers.
Methodological Limitations of Organizational
Ethnographic Case Studies Applied in Health Care
Research
Research process. The immersion of researchers in empirical
fields is a methodological foundation and strength in organiza-
tional ethnography but raises challenges when combined with
case studies. Immersion requires that the researcher first gains
access to the field. Several scholars describe accessing the field
in ethnographic studies as a continuous “time-emotions-
energy-consuming” negotiation (Alcadipani & Hodgson,
2009; Bell, 2010; Bengry-Howell & Griffin, 2012; Bruni,
2006; Enguix, 2014). This process requires trust between
researchers and organizational stakeholders. Moreover, given
the plurality and size of health care organizations, the gate-
keepers with whom a researcher negotiates access may not
even be among the actors involved or “affected” (e.g.,
observed, interviewed) by the research (Hammersley, 2018;
Vindrola-Padros & Vindrola-Padros, 2017). In organizational
ethnographic case studies involving multiples settings and con-
ducted by multiple fieldworkers, it may be more difficult to
establish and maintain trusting relationships. As well, signifi-
cant time and resources are required to train fieldworkers (Bik-
ker et al., 2017; Greenhalgh et al., 2008; Vindrola-Padros &
Vindrola-Padros, 2017). These considerations challenge the
feasibility of organizational ethnographic case studies but also
raise issues around the researcher’s role.
Having multiple fieldworkers collecting data simultane-
ously or sequentially complicates the role of researchers as
either “insiders or outsiders” to the organizations they study
(Berthod et al., 2018; Bikker et al., 2017; Bruni, 2006; Marcus,
2011; McCourt et al., 2012; Molloy et al., 2017). Variations in
trust and emotional roller coasters enter the equation (Benoot &
Bilsen, 2016), and ethical gray zones appear.
In addition to complicating ethical issues related to the
informed consent of participants in ethnographic approaches,
organizational ethnographic case studies require that potential
bias be controlled in not one, but several fieldworkers. Field-
workers immersed in health care organizations are exposed to
organizational realities, power struggles, personal distress, and
more (Alcadipani & Hodgson, 2009; Enguix, 2014; Fine &
Shulman, 2009). It can become hard not to “advocate” for the
people facing the difficulties witnessed (Hammersley, 2018).
According to Ybema et al. (2009, p. 187), “ethnographers are
often motivated to give a voice to participants, but they cannot
reveal information that could harm the organization.” It is
challenging for scholars to ensure that their passage in an out
of research fields is ethical (Swinglehurst et al., 2010).
11
Combining the two methodologies presents a disadvantage
by lengthening and complicating the process of negotiating
access to the fields, managing the researcher’s role, and addres-
sing ethical issues.
Data collection and analysis. While the triangulation of data
sources through organizational ethnographic case study
research is a methodological strength, exploiting the mass of
data generated must be approached carefully. It is easy to
become overwhelmed and “get lost” in the forest of data (Bax-
ter & Jack, 2008; Fine et al., 2009). Moreover, numerous
empirical studies suggest that combining organizational ethno-
graphy with case studies can induce confusion between units
and levels of analysis and cases (Bruni, 2006; Greenhalgh et al.,
2018; Greenhalgh et al., 2008; Swinglehurst et al., 2010). The
dispersion and diversity of health care organizations raise chal-
lenges for fieldwork, given that organizational cultures, iden-
tities, and processes are no longer “geographically” bounded.
Cruz and Higginbottom (2013, p. 42) considers that,
The fluidity of boundaries in ethnographic health care research
may be regarded as a lack of exactitude and robustness by those
who view ethnography from a positivistic perspective, which is
underpinned by objectivity rather than subjectivity.
While merging case study with organizational ethnography can
help to build on the socio-contextual characteristics of sites to
empirically delimit the study of organizational phenomena, it
remains difficult to distinguish plural and dynamic units and
levels of analysis. Researchers may be unsure about “what to
observe” and “what to document” during the empirical process,
especially if an inductive approach to analysis is anticipated
(Prévost & Roy, 2015), and the process is demanding in terms
or iterations and time (Bikker et al., 2017). Reducing data
during analysis also raises issues. According to Van Maanen
(1979, p. 439), “assuming an ethnographic position does not
guarantee at all that you will collect precise and theoretically
viable data, no matter how much time you spend on the field.”
This challenge refers to debate around empirical and theoreti-
cal saturation in ethnographic methodologies, and organiza-
tional ethnographic case studies offer no clear solution (Fine
et al., 2009; Ybema et al., 2009; Yin, 2014). Combining these
two methodologies appears to create a disadvantage by adding
complexity to the analytic objects (cases, units and levels of
analysis) that interact and compete and to the possibility of
reaching saturation in data analysis.
Credibility. One obvious but significant challenge in establishing
the credibility of organizational ethnographic case studies is the
lack of methodological benchmarks that define this design. It is
difficult to ensure the validity of both case sampling strategies
and fieldwork techniques involved in this methodology (Bikker
et al., 2017; Bruni, 2006; McCourt et al., 2014; Molloy et al.,
2017; Swinglehurst et al., 2010; Vindrola-Padros & Vindrola-
Padros, 2017). Some authors argue that theoretical sampling in
organizational ethnographic case studies helps to increase
12
methodological validity (Fine et al., 2009; Goulding, 2005;
Palinkas et al., 2015). Critics question the legitimacy of field-
work in adapted ethnographic methodologies (e.g., multisite
ethnography, interorganizational ethnography, rapid ethnogra-
phy, team-based ethnography), considering this “disrespectful”
to the very foundations of this methodology; deep understanding
of the experience of organizational actors in their natural context
traditionally requires immersion of a single researcher in a spe-
cific field for a significant time period. While Berthod et al.
(2018, p. 17) argue, on the other hand, that “Obsession with
richness in data should not be the reason for conducting
ethnography” and that the duration of fieldwork should not be
considered a guarantee of methodological quality or analytic
saturation. We found no existing methodological counters to
this argument. There is increasing evidence that emotions influ-
ence ethnographic processes in health care research (Benoot &
Bilsen, 2016; Gelling, 2014; Hammersley, 2018; Lambert et al.,
2011; McCourt et al., 2012, p. 20122; Rosen, 1991; Simmons,
2007; Cruz & Higginbottom, 2013). Although emotions can be
accommodated through reflexivity, a multiplicity of fieldwor-
kers in organizational ethnographic case studies may spread the
effect of emotional dynamics across the research process. Com-
bining the two methodologies appears to present a disadvantage,
as there is a lack of methodological benchmarks to support the
credibility of this research design.
Impact of research. Questions around the generalizability of
results from qualitative research go beyond organizational eth-
nographic and case study research. However, as previously men-
tioned, authors have different views on whether the capacity to
generalize results is enhanced when organizational ethnography
and case study are combined. Prévost and Roy (2015) claim that
while organizational ethnographic case study offers the possi-
bility of deeply exploring organizational phenomena embedded
in various social contexts, it also harms intracase depth and
quality. In addition, given the lack of methodological bench-
marks to define organizational ethnographic case study, Bikker
et al. (2017) argue that it is difficult to find and/or design dis-
semination strategies appropriate to this combined methodol-
ogy. Our review reveals that authors sometimes find it
difficult to get support from universities and funding bodies for
this kind of research (Molloy et al., 2017; Vindrola-Padros &
Vindrola-Padros, 2017), given the duration of fieldwork, the
resources it requires and the difficulty of quickly generating and
disseminating results. Combining these two methodologies
appears to provide a meaningful disadvantage as it dilutes intra-
case analytical depth, even as it benefits deep intercase analysis.
Discussion
What Makes Organizational Ethnographic Case Study
the Right Choice for In-Depth Qualitative Empirical
Research in Health Care?
Our scoping review reveals that organizational ethnographic
case studies appear as an emerging in-depth qualitative
International Journal of Qualitative Methods
methodology for health care research, which involves specific
methodological potentialities and limitations. Drawing on our
scoping review, the following section aims to illustrate a meth-
odological matrix (see Figure 2) that can serve as a rationale for
health researchers who wish to investigate organizational phe-
nomena in real contexts.
In-Depth Closeness to Competing Organizational Lives
Molloy et al. (2017) argue that organizational ethnographic case
studies are a relevant and generative approach to deeply access
the coexisting social worlds that populate health care organiza-
tions. According to the authors, health care researchers who
embark in this methodology embrace a more active role in the
knowledge production process, as they “construct rather than
discover” empirical sites (Molloy et al., 2017, p. 5). In addition,
McCourt et al. (2014, p. 86) suggest that this combined metho-
dology “may often be important for generating hypotheses and
for investigating in more depth the ‘how’ and ‘why’ questions
posed in research around organisation of care.” To this end, in a
2018 study of real-world implementation of video outpatient
consultations at various institutional levels of the health care
system (macro, meso, and micro) in the UK, Greenhalgh et al.
(2018) show that using an organizational ethnographic case
study design allowed them to capture and understand the “messy
realities” of organizational life in health care. More precisely,
this specific design allowed researchers to reveal how various
institutional contexts interact and compete with each other
through the scaling of technological innovations. Kerosuo’s
(2010) study on how patients with multiple and chronic illnesses
experience interorganizational care reveals that organizational
ethnographic case studies offer a unique opportunity to access
several local experiences and understand how they connect to
produce different organizational effects in health care. To the
same point, Liberati et al. (2015) show that immersion in mul-
tiple social worlds through organizational ethnographic case
studies offered a unique opportunity for researchers to under-
stand how daily practices contributed to the local enactment of
patient centeredness. This study also demonstrates how deep
contact with multiple organizational lives helps reveal new
forms of agency (e.g., shared agency between human and nonhu-
man actors) in health care, calling for more research studying
organizational phenomena in health care from a sociomaterial
perspective. Bruni (2006) argues that health care services must
be studied as trajectories rather than discrete events, highlighting
the need for researchers to negotiate access to multiple field
sites. Researchers undertaking organizational ethnographic case
studies constantly move across social worlds, enabling them to
uncover situated patterns and relationships that underlie the cul-
tural construction of meaning and action in health care organi-
zations and build stronger analytical narratives (Bruni, 2006;
Swinglehurst & Greenhalgh, 2015). In sum, by combining orga-
nizational ethnography and case study, researchers access a pri-
vileged and deep closeness to competing organizational lives,
which, according to many scholars, also enables the generation
Côté-Boileau et al.
of timely actionable and contextualized knowledge to inform,
and transform, health care practices and policies.
Timely Actionable and Contextualized Knowledge
Production
Our scoping review finds that organizational ethnographic case
studies applied in health care contexts offer enabling methodo-
logical conditions to generate actionable and contextualized
knowledge in a timely manner during the research process. A
scoping review by Vindrola-Padros and Vindrola-Padros
(2017, p. 1) concludes that this kind of approach is especially
“appealing to the health care sector, where changing organisa-
tional climates and priorities require actionable findings at
strategic time points.” Likewise, Liberati et al.’s (2015) study
demonstrates that by capturing multiple contextualized sources
of data, organizational ethnographic case studies allow
researchers to disseminate findings as research progresses that
are valuable to participants and inform practices and decisions.
Bikker et al.’s (2017, p. 1) research on primary care general
practices in the UK also shows that organizational ethno-
graphic case studies applied in health care “provide timely
findings within the fast-moving context of health care policy
and research.” This combined methodology appears to offer
creative methodological and analytical entry points to under-
stand the social and cultural factors that shape health care
delivery, which enhances the richness of fieldwork and the
capacity to “generate findings that can inform changes in
healthcare practices in a timely manner” (Vindrola-Padros &
Vindrola-Padros, 2017, p. 2). By offering conditions that sup-
port a fieldwork journey that is both thorough and structured
(e.g., delimiting empirical sites, cases, units of analysis), orga-
nizational ethnographic case studies also increase the potential
to build productive, yet sustainable, partnerships between
researchers and participants (Bikker et al., 2017; Bruni, 2006;
Molloy et al., 2017; Ruelland, 2015; Swinglehurst et al., 2010).
This methodology offers the opportunity to empower partici-
pants through the research process and therefore enables a joint
understanding to emerge between stakeholders, opening mean-
ingful avenues for empirical health care research.
Contextualized Multilevel Interactions and Variations
According to Molloy et al. (2017, p. 13), organizational ethno-
graphic case study “is more relevant to the interconnected
world of health and healthcare.” In their study on how popu-
lation health information management systems in Australia
intersect with health promotion practice, Conte et al. (2017)
show that the combined methodology provides particular con-
textual information on each empirical site that enabled
researchers to explore and understand the interactions and var-
iations within and across cases. The authors argue that this
methodological advantage enhances the capacity to generalize
results from organizational ethnographic case studies in health
care. Greenhalgh et al.’s (2008, p. 8) exploratory study of the
introduction of a centrally stored shared electronic patient
13
record in England found that organizational ethnographic case
study offered a context-sensitive research design that allowed
them to “document how interactions at these multiple levels
shape, enable, and constrain the introduction of technology
supported innovations in clinical care.” Kerosuo (2010) and
Liberati et al. (2015) likewise propose that this methodology
offers a unique entry into the complex interactions between
practices, technologies, professionals (collegiality), and power
boundaries that shape integrated care in public health systems.
In addition, McCourt et al. (2012), in their exploratory study of
organizational and professional issues that influence the quality
and safety of care in different birth settings in the UK, argue
that organizational ethnographic case studies offer a better
understanding of how organizational practices are shaped by
institutional relationships. Given that health care organizations
are highly pluralistic and institutionalized environments, the
authors point to the importance of looking at the experience
of organizational actors in relation to the institutional level
(context) in which processes, information flow, meaning, and
action unfold. Organizational ethnographic case studies appear
as a powerful methodology in this endeavor. Moreover, by
exploring the role of information and communication technol-
ogies in shaping collaborative work routines in the UK health
care system, Swinglehurst et al. (2010, p. 3) reveal that orga-
nizational ethnographic case study challenges ethnographic
paradigms by alternating the focus “between studying the work
of individuals within a particular routine, the overall routine,
and the wider organisational context, with reflexive awareness
of the dynamic interplay between parts and wholes.” The
authors call for more research using this methodology to
uncover the micro sources of influence at multiple levels that
underlie intra- and interorganizational phenomena in health
care settings. In short, organizational ethnographic case study
emerges as a powerful and innovative methodology to reveal
“how parts of the contemporary healthcare worlds interact and
operate” across levels in health care systems (Molloy et al.,
2017, p. 13).
Situated and Shared Reflexive Experiences of Multiple
Fieldworkers
The collective engagement of researchers and participants in
reflexivity can help disentangle and bring to surface the tacit
knowledge spread in everyday care practices and transform it into
actionable knowledge, namely a kind of knowledge that is ready to
be put into practice. (Liberati et al., 2015, p. 51)
In line with this statement from Liberati et al. (2015), our
scoping review shows that many authors highlight the signifi-
cant strength that comes from assembling the situated reflexive
experiences of multiple fieldworkers in organizational ethno-
graphic case studies. In addition to accelerating fieldwork, the
involvement of multiple fieldworkers increases the ability to
identify, acknowledge, and resolve contradictions between data
sources and reflexive experiences and thereby disrupt
14
assumptions and better understand the influence of intra- and
interorganizational characteristics in shaping organizational
phenomena (Bikker et al., 2017; Greenhalgh et al., 2009; Lib-
erati et al., 2015; Molloy et al., 2017; Ruelland, 2015). It essen-
tially helps to generate a more holistic understanding of a given
phenomenon. Moreover, given that collaboration is at the heart
of team-based ethnographic approaches, ongoing dialog
between multiple fieldworkers can provide practical and emo-
tional support throughout the research process and building
trust between research team members and research participants
(Bikker et al., 2017; Marcus, 2011). Bruni (2006) and Swin-
glehurst (2015) argue that the inherent and intrinsic relation-
ships between fieldworkers and sites help to build narratives
that address the local particularities of each empirical context.
The complementary situated reflexive experiences of multiple
fieldworkers enables organizational ethnographic case study to
track and recognize the dynamism of health care organizations
in meaningful and productive ways, rather than aiming to con-
trol it.
Conclusion
This scoping review makes it clear that organizational ethno-
graphic case studies have features that distinguish them from
the wider domain of qualitative health care research. By com-
bining organizational ethnographic approaches and case study
designs, health care researchers achieve greater depth, more
refined contextualization, and increased credibility and impact
in their empirical qualitative studies. Our review also reveals
that the specific potentialities and limitations raised by organi-
zational ethnographic case studies do not simply mirror each
other. The central methodological advantage of this approach is
in offering a unique opportunity to deeply explore, with mul-
tiple reflexive experiences, contextualized complex organiza-
tional phenomena in health care. The most significant
disadvantage lies in the current lack of methodological bench-
marks to support the validity of this methodology, which limits
support for the considerable resources it requires. This also
presents challenges for teaching the approach and encouraging
its use in health care research. However, our review leads us to
believe that by accelerating the pace of research, empowering
various sources of reflexivity, and increasing the depth of
empirical investigation of complex organizational phenomena,
this combined methodology might inform a new generative
agenda for qualitative research in health care. Moreover, in
response to Bryman and Buchanan’s (2018) critique of meth-
odological conservatism in organization studies, organizational
ethnographic case study may nourish a greater academic dyna-
mism to increase the impact of our research on the lives of
health care organizations, and most importantly, of the people
within them. An especially promising place for future research
using this combined methodology is in studying how the role
and impact of emergent technologies and innovations in health
care are shaped by competing social contexts along their jour-
ney through the complex interconnected worlds of health care.
International Journal of Qualitative Methods
Authors’ Note
While Susan Usher did not participate in the writing of the article per
se, her editing services were fundamental in the publication process of
this article.
Acknowledgment
The authors would like to thank Susan Usher for the edition of this
article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This
research received funding from the Fonds de recherche du
Québec—Santé for the period of September 2017 to August 2020,
as part of an ongoing doctoral study (file number 35869).
ORCID iD
Élizabeth Côté-Boileau https://orcid.org/0000-0002-7981-962X
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