examples of case study in management

Top 40 Most Popular Case Studies of 2017

We generated a list of the 40 most popular Yale School of Management case studies in 2017 by combining data from our publishers, Google analytics, and other measures of interest and adoption. In compiling the list, we gave additional weight to usage outside Yale

We generated a list of the 40 most popular Yale School of Management case studies in 2017 by combining data from our publishers, Google analytics, and other measures of interest and adoption. In compiling the list, we gave additional weight to usage outside Yale.

Case topics represented on the list vary widely, but a number are drawn from the case team’s focus on healthcare, asset management, and sustainability. The cases also draw on Yale’s continued emphasis on corporate governance, ethics, and the role of business in state and society. Of note, nearly half of the most popular cases feature a woman as either the main protagonist or, in the case of raw cases where multiple characters take the place of a single protagonist, a major leader within the focal organization. While nearly a fourth of the cases were written in the past year, some of the most popular, including Cadbury and Design at Mayo, date from the early years of our program over a decade ago. Nearly two-thirds of the most popular cases were “raw” cases - Yale’s novel, web-based template which allows for a combination of text, documents, spreadsheets, and videos in a single case website.

Read on to learn more about the top 10 most popular cases followed by a complete list of the top 40 cases of 2017.  A selection of the top 40 cases are available for purchase through our online store . 

#1 - Coffee 2016

Faculty Supervision: Todd Cort

Coffee 2016 asks students to consider the coffee supply chain and generate ideas for what can be done to equalize returns across various stakeholders. The case draws a parallel between coffee and wine. Both beverages encourage connoisseurship, but only wine growers reap a premium for their efforts to ensure quality.  The case describes the history of coffee production across the world, the rise of the “third wave” of coffee consumption in the developed world, the efforts of the Illy Company to help coffee growers, and the differences between “fair” trade and direct trade. Faculty have found the case provides a wide canvas to discuss supply chain issues, examine marketing practices, and encourage creative solutions to business problems. 

#2 - AXA: Creating New Corporate Responsibility Metrics

Faculty Supervision: Todd Cort and David Bach

The case describes AXA’s corporate responsibility (CR) function. The company, a global leader in insurance and asset management, had distinguished itself in CR since formally establishing a CR unit in 2008. As the case opens, AXA’s CR unit is being moved from the marketing function to the strategy group occasioning a thorough review as to how CR should fit into AXA’s operations and strategy. Students are asked to identify CR issues of particular concern to the company, examine how addressing these issues would add value to the company, and then create metrics that would capture a business unit’s success or failure in addressing the concerns.

#3 - IBM Corporate Service Corps

Faculty Supervision: David Bach in cooperation with University of Ghana Business School and EGADE

The case considers IBM’s Corporate Service Corps (CSC), a program that had become the largest pro bono consulting program in the world. The case describes the program’s triple-benefit: leadership training to the brightest young IBMers, brand recognition for IBM in emerging markets, and community improvement in the areas served by IBM’s host organizations. As the program entered its second decade in 2016, students are asked to consider how the program can be improved. The case allows faculty to lead a discussion about training, marketing in emerging economies, and various ways of providing social benefit. The case highlights the synergies as well as trade-offs between pursuing these triple benefits.

#4 - Cadbury: An Ethical Company Struggles to Insure the Integrity of Its Supply Chain

Faculty Supervision: Ira Millstein

The case describes revelations that the production of cocoa in the Côte d’Ivoire involved child slave labor. These stories hit Cadbury especially hard. Cadbury's culture had been deeply rooted in the religious traditions of the company's founders, and the organization had paid close attention to the welfare of its workers and its sourcing practices. The US Congress was considering legislation that would allow chocolate grown on certified plantations to be labeled “slave labor free,” painting the rest of the industry in a bad light. Chocolate producers had asked for time to rectify the situation, but the extension they negotiated was running out. Students are asked whether Cadbury should join with the industry to lobby for more time?  What else could Cadbury do to ensure its supply chain was ethically managed?

#5 - 360 State Real Options

Faculty Supervision: Matthew Spiegel

In 2010 developer Bruce Becker (SOM ‘85) completed 360 State Street, a major new construction project in downtown New Haven. Just west of the apartment building, a 6,000-square-foot pocket of land from the original parcel remained undeveloped. Becker had a number of alternatives to consider in regards to the site. He also had no obligation to build. He could bide his time. But Becker worried about losing out on rents should he wait too long. Students are asked under what set of circumstances and at what time would it be most advantageous to proceed?

#6 - Design at Mayo

Faculty Supervision: Rodrigo Canales and William Drentell

The case describes how the Mayo Clinic, one of the most prominent hospitals in the world, engaged designers and built a research institute, the Center for Innovation (CFI), to study the processes of healthcare provision. The case documents the many incremental innovations the designers were able to implement and the way designers learned to interact with physicians and vice-versa.

In 2010 there were questions about how the CFI would achieve its stated aspiration of “transformational change” in the healthcare field. Students are asked what would a major change in health care delivery look like? How should the CFI's impact be measured? Were the center's structure and processes appropriate for transformational change? Faculty have found this a great case to discuss institutional obstacles to innovation, the importance of culture in organizational change efforts, and the differences in types of innovation.

This case is freely available to the public.

#7 - Ant Financial

Faculty Supervision: K. Sudhir in cooperation with Renmin University of China School of Business

In 2015, Ant Financial’s MYbank (an offshoot of Jack Ma’s Alibaba company) was looking to extend services to rural areas in China by providing small loans to farmers. Microloans have always been costly for financial institutions to offer to the unbanked (though important in development) but MYbank believed that fintech innovations such as using the internet to communicate with loan applicants and judge their credit worthiness would make the program sustainable. Students are asked whether MYbank could operate the program at scale? Would its big data and technical analysis provide an accurate measure of credit risk for loans to small customers? Could MYbank rely on its new credit-scoring system to reduce operating costs to make the program sustainable?

#8 - Business Leadership in South Africa’s 1994 Reforms

Faculty Supervision: Ian Shapiro

This case examines the role of business in South Africa's historic transition away from apartheid to popular sovereignty. The case provides a previously untold oral history of this key moment in world history, presenting extensive video interviews with business leaders who spearheaded behind-the-scenes negotiations between the African National Congress and the government. Faculty teaching the case have used the material to push students to consider business’s role in a divided society and ask: What factors led business leaders to act to push the country's future away from isolation toward a "high road" of participating in an increasingly globalized economy? What techniques and narratives did they use to keep the two sides talking and resolve the political impasse? And, if business leadership played an important role in the events in South Africa, could they take a similar role elsewhere?

#9 - Shake Shack IPO

Faculty Supervision: Jake Thomas and Geert Rouwenhorst

From an art project in a New York City park, Shake Shack developed a devoted fan base that greeted new Shake Shack locations with cheers and long lines. When Shake Shack went public on January 30, 2015, investors displayed a similar enthusiasm. Opening day investors bid up the $21 per share offering price by 118% to reach $45.90 at closing bell. By the end of May, investors were paying $92.86 per share. Students are asked if this price represented a realistic valuation of the enterprise and if not, what was Shake Shack truly worth? The case provides extensive information on Shake Shack’s marketing, competitors, operations and financials, allowing instructors to weave a wide variety of factors into a valuation of the company.

#10 - Searching for a Search Fund Structure

Faculty Supervision: AJ Wasserstein

This case considers how young entrepreneurs structure search funds to find businesses to take over. The case describes an MBA student who meets with a number of successful search fund entrepreneurs who have taken alternative routes to raising funds. The case considers the issues of partnering, soliciting funds vs. self-funding a search, and joining an incubator. The case provides a platform from which to discuss the pros and cons of various search fund structures.

40 Most Popular Case Studies of 2017

Click on the case title to learn more about the dilemma. A selection of our most popular cases are available for purchase via our online store .

How to write a case study — examples, templates, and tools

It’s a marketer’s job to communicate the effectiveness of a product or service to potential and current customers to convince them to buy and keep business moving. One of the best methods for doing this is to share success stories that are relatable to prospects and customers based on their pain points, experiences, and overall needs.

That’s where case studies come in. Case studies are an essential part of a content marketing plan. These in-depth stories of customer experiences are some of the most effective at demonstrating the value of a product or service. Yet many marketers don’t use them, whether because of their regimented formats or the process of customer involvement and approval.

A case study is a powerful tool for showcasing your hard work and the success your customer achieved. But writing a great case study can be difficult if you’ve never done it before or if it’s been a while. This guide will show you how to write an effective case study and provide real-world examples and templates that will keep readers engaged and support your business.

In this article, you’ll learn:

What is a case study?

How to write a case study, case study templates, case study examples, case study tools.

A case study is the detailed story of a customer’s experience with a product or service that demonstrates their success and often includes measurable outcomes. Case studies are used in a range of fields and for various reasons, from business to academic research. They’re especially impactful in marketing as brands work to convince and convert consumers with relatable, real-world stories of actual customer experiences.

The best case studies tell the story of a customer’s success, including the steps they took, the results they achieved, and the support they received from a brand along the way. To write a great case study, you need to:

• Celebrate the customer and make them — not a product or service — the star of the story.
• Craft the story with specific audiences or target segments in mind so that the story of one customer will be viewed as relatable and actionable for another customer.
• Write copy that is easy to read and engaging so that readers will gain the insights and messages intended.
• Follow a standardized format that includes all of the essentials a potential customer would find interesting and useful.
• Support all of the claims for success made in the story with data in the forms of hard numbers and customer statements.

Case studies are a type of review but more in depth, aiming to show — rather than just tell — the positive experiences that customers have with a brand. Notably, 89% of consumers read reviews before deciding to buy, and 79% view case study content as part of their purchasing process. When it comes to B2B sales, 52% of buyers rank case studies as an important part of their evaluation process.

Telling a brand story through the experience of a tried-and-true customer matters. The story is relatable to potential new customers as they imagine themselves in the shoes of the company or individual featured in the case study. Showcasing previous customers can help new ones see themselves engaging with your brand in the ways that are most meaningful to them.

Besides sharing the perspective of another customer, case studies stand out from other content marketing forms because they are based on evidence. Whether pulling from client testimonials or data-driven results, case studies tend to have more impact on new business because the story contains information that is both objective (data) and subjective (customer experience) — and the brand doesn’t sound too self-promotional.

Case studies are unique in that there’s a fairly standardized format for telling a customer’s story. But that doesn’t mean there isn’t room for creativity. It’s all about making sure that teams are clear on the goals for the case study — along with strategies for supporting content and channels — and understanding how the story fits within the framework of the company’s overall marketing goals.

Here are the basic steps to writing a good case study.

1. Identify your goal

Start by defining exactly who your case study will be designed to help. Case studies are about specific instances where a company works with a customer to achieve a goal. Identify which customers are likely to have these goals, as well as other needs the story should cover to appeal to them.

The answer is often found in one of the buyer personas that have been constructed as part of your larger marketing strategy. This can include anything from new leads generated by the marketing team to long-term customers that are being pressed for cross-sell opportunities. In all of these cases, demonstrating value through a relatable customer success story can be part of the solution to conversion.

2. Choose your client or subject

Who you highlight matters. Case studies tie brands together that might otherwise not cross paths. A writer will want to ensure that the highlighted customer aligns with their own company’s brand identity and offerings. Look for a customer with positive name recognition who has had great success with a product or service and is willing to be an advocate.

The client should also match up with the identified target audience. Whichever company or individual is selected should be a reflection of other potential customers who can see themselves in similar circumstances, having the same problems and possible solutions.

Some of the most compelling case studies feature customers who:

• Switch from one product or service to another while naming competitors that missed the mark.
• Experience measurable results that are relatable to others in a specific industry.
• Represent well-known brands and recognizable names that are likely to compel action.
• Advocate for a product or service as a champion and are well-versed in its advantages.

Whoever or whatever customer is selected, marketers must ensure they have the permission of the company involved before getting started. Some brands have strict review and approval procedures for any official marketing or promotional materials that include their name. Acquiring those approvals in advance will prevent any miscommunication or wasted effort if there is an issue with their legal or compliance teams.

3. Conduct research and compile data

Substantiating the claims made in a case study — either by the marketing team or customers themselves — adds validity to the story. To do this, include data and feedback from the client that defines what success looks like. This can be anything from demonstrating return on investment (ROI) to a specific metric the customer was striving to improve. Case studies should prove how an outcome was achieved and show tangible results that indicate to the customer that your solution is the right one.

This step could also include customer interviews. Make sure that the people being interviewed are key stakeholders in the purchase decision or deployment and use of the product or service that is being highlighted. Content writers should work off a set list of questions prepared in advance. It can be helpful to share these with the interviewees beforehand so they have time to consider and craft their responses. One of the best interview tactics to keep in mind is to ask questions where yes and no are not natural answers. This way, your subject will provide more open-ended responses that produce more meaningful content.

4. Choose the right format

There are a number of different ways to format a case study. Depending on what you hope to achieve, one style will be better than another. However, there are some common elements to include, such as:

• An engaging headline
• A subject and customer introduction
• The unique challenge or challenges the customer faced
• The solution the customer used to solve the problem
• The results achieved
• Data and statistics to back up claims of success
• A strong call to action (CTA) to engage with the vendor

It’s also important to note that while case studies are traditionally written as stories, they don’t have to be in a written format. Some companies choose to get more creative with their case studies and produce multimedia content, depending on their audience and objectives. Case study formats can include traditional print stories, interactive web or social content, data-heavy infographics, professionally shot videos, podcasts, and more.

5. Write your case study

We’ll go into more detail later about how exactly to write a case study, including templates and examples. Generally speaking, though, there are a few things to keep in mind when writing your case study.

• Be clear and concise. Readers want to get to the point of the story quickly and easily, and they’ll be looking to see themselves reflected in the story right from the start.
• Provide a big picture. Always make sure to explain who the client is, their goals, and how they achieved success in a short introduction to engage the reader.
• Construct a clear narrative. Stick to the story from the perspective of the customer and what they needed to solve instead of just listing product features or benefits.
• Leverage graphics. Incorporating infographics, charts, and sidebars can be a more engaging and eye-catching way to share key statistics and data in readable ways.
• Offer the right amount of detail. Most case studies are one or two pages with clear sections that a reader can skim to find the information most important to them.
• Include data to support claims. Show real results — both facts and figures and customer quotes — to demonstrate credibility and prove the solution works.

6. Promote your story

Marketers have a number of options for distribution of a freshly minted case study. Many brands choose to publish case studies on their website and post them on social media. This can help support SEO and organic content strategies while also boosting company credibility and trust as visitors see that other businesses have used the product or service.

Marketers are always looking for quality content they can use for lead generation. Consider offering a case study as gated content behind a form on a landing page or as an offer in an email message. One great way to do this is to summarize the content and tease the full story available for download after the user takes an action.

Sales teams can also leverage case studies, so be sure they are aware that the assets exist once they’re published. Especially when it comes to larger B2B sales, companies often ask for examples of similar customer challenges that have been solved.

Now that you’ve learned a bit about case studies and what they should include, you may be wondering how to start creating great customer story content. Here are a couple of templates you can use to structure your case study.

Template 1 — Challenge-solution-result format

• Start with an engaging title. This should be fewer than 70 characters long for SEO best practices. One of the best ways to approach the title is to include the customer’s name and a hint at the challenge they overcame in the end.
• Create an introduction. Lead with an explanation as to who the customer is, the need they had, and the opportunity they found with a specific product or solution. Writers can also suggest the success the customer experienced with the solution they chose.
• Present the challenge. This should be several paragraphs long and explain the problem the customer faced and the issues they were trying to solve. Details should tie into the company’s products and services naturally. This section needs to be the most relatable to the reader so they can picture themselves in a similar situation.
• Share the solution. Explain which product or service offered was the ideal fit for the customer and why. Feel free to delve into their experience setting up, purchasing, and onboarding the solution.
• Explain the results. Demonstrate the impact of the solution they chose by backing up their positive experience with data. Fill in with customer quotes and tangible, measurable results that show the effect of their choice.
• Ask for action. Include a CTA at the end of the case study that invites readers to reach out for more information, try a demo, or learn more — to nurture them further in the marketing pipeline. What you ask of the reader should tie directly into the goals that were established for the case study in the first place.

Template 2 — Data-driven format

• Start with an engaging title. Be sure to include a statistic or data point in the first 70 characters. Again, it’s best to include the customer’s name as part of the title.
• Create an overview. Share the customer’s background and a short version of the challenge they faced. Present the reason a particular product or service was chosen, and feel free to include quotes from the customer about their selection process.
• Present data point 1. Isolate the first metric that the customer used to define success and explain how the product or solution helped to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Present data point 2. Isolate the second metric that the customer used to define success and explain what the product or solution did to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Present data point 3. Isolate the final metric that the customer used to define success and explain what the product or solution did to achieve this goal. Provide data points and quotes to substantiate the claim that success was achieved.
• Summarize the results. Reiterate the fact that the customer was able to achieve success thanks to a specific product or service. Include quotes and statements that reflect customer satisfaction and suggest they plan to continue using the solution.
• Ask for action. Include a CTA at the end of the case study that asks readers to reach out for more information, try a demo, or learn more — to further nurture them in the marketing pipeline. Again, remember that this is where marketers can look to convert their content into action with the customer.

While templates are helpful, seeing a case study in action can also be a great way to learn. Here are some examples of how Adobe customers have experienced success.

Juniper Networks

One example is the Adobe and Juniper Networks case study , which puts the reader in the customer’s shoes. The beginning of the story quickly orients the reader so that they know exactly who the article is about and what they were trying to achieve. Solutions are outlined in a way that shows Adobe Experience Manager is the best choice and a natural fit for the customer. Along the way, quotes from the client are incorporated to help add validity to the statements. The results in the case study are conveyed with clear evidence of scale and volume using tangible data.

The story of Lenovo’s journey with Adobe is one that spans years of planning, implementation, and rollout. The Lenovo case study does a great job of consolidating all of this into a relatable journey that other enterprise organizations can see themselves taking, despite the project size. This case study also features descriptive headers and compelling visual elements that engage the reader and strengthen the content.

Tata Consulting

When it comes to using data to show customer results, this case study does an excellent job of conveying details and numbers in an easy-to-digest manner. Bullet points at the start break up the content while also helping the reader understand exactly what the case study will be about. Tata Consulting used Adobe to deliver elevated, engaging content experiences for a large telecommunications client of its own — an objective that’s relatable for a lot of companies.

Case studies are a vital tool for any marketing team as they enable you to demonstrate the value of your company’s products and services to others. They help marketers do their job and add credibility to a brand trying to promote its solutions by using the experiences and stories of real customers.

When you’re ready to get started with a case study:

• Think about a few goals you’d like to accomplish with your content.
• Make a list of successful clients that would be strong candidates for a case study.
• Reach out to the client to get their approval and conduct an interview.
• Gather the data to present an engaging and effective customer story.

Adobe can help

There are several Adobe products that can help you craft compelling case studies. Adobe Experience Platform helps you collect data and deliver great customer experiences across every channel. Once you’ve created your case studies, Experience Platform will help you deliver the right information to the right customer at the right time for maximum impact.

To learn more, watch the Adobe Experience Platform story .

Keep in mind that the best case studies are backed by data. That’s where Adobe Real-Time Customer Data Platform and Adobe Analytics come into play. With Real-Time CDP, you can gather the data you need to build a great case study and target specific customers to deliver the content to the right audience at the perfect moment.

Watch the Real-Time CDP overview video to learn more.

Finally, Adobe Analytics turns real-time data into real-time insights. It helps your business collect and synthesize data from multiple platforms to make more informed decisions and create the best case study possible.

Request a demo to learn more about Adobe Analytics.

https://business.adobe.com/blog/perspectives/b2b-ecommerce-10-case-studies-inspire-you

https://business.adobe.com/blog/basics/business-case

https://business.adobe.com/blog/basics/what-is-real-time-analytics

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HBS Case Selections

Innovation at Moog Inc.

• Brian J. Hall
• Ashley V. Whillans
• Davis Heniford
• Dominika Randle
• Caroline Witten

Innovation at Google Ads: The Sales Acceleration and Innovation Labs (SAIL) (A)

• Linda A. Hill
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Juan Valdez: Innovation in Caffeination

• Michael I. Norton
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UGG Steps into the Metaverse

• Shunyuan Zhang
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Metaverse Wars

• David B. Yoffie
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Roblox: Virtual Commerce in the Metaverse

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Timnit Gebru: "SILENCED No More" on AI Bias and The Harms of Large Language Models

• Tsedal Neeley
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Hugging Face: Serving AI on a Platform

• Shane Greenstein
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SmartOne: Building an AI Data Business

• Karim R. Lakhani
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Honeywell and the Great Recession (A)

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Target: Responding to the Recession

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Hometown Foods: Changing Price Amid Inflation

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Elon Musk's Big Bets

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Elon Musk: Balancing Purpose and Risk

• Shikhar Ghosh
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Tesla's CEO Compensation Plan

• Krishna G. Palepu
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China Rapid Finance: The Collapse of China's P2P Lending Industry

• William C. Kirby
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• John P. McHugh

Forbidden City: Launching a Craft Beer in China

• Christopher A. Bartlett
• Carole Carlson

Booking.com

• Stefan Thomke
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Innovation at Uber: The Launch of Express POOL

• Chiara Farronato
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Racial Discrimination on Airbnb (A)

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GitLab and the Future of All-Remote Work (A)

• Prithwiraj Choudhury
• Emma Salomon

TCS: From Physical Offices to Borderless Work

Creating a virtual internship at goldman sachs.

• Iavor Bojinov

Unilever's Response to the Future of Work

• William R. Kerr
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AT&T, Retraining, and the Workforce of Tomorrow

• Joseph B. Fuller
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Leading Change in Talent at L'Oreal

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Eve Hall: The African American Investment Fund in Milwaukee

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United Housing - Otis Gates

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The Home Depot: Leadership in Crisis Management

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The Great East Japan Earthquake (B): Fast Retailing Group's Response

• Hirotaka Takeuchi
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• Kate Schoch
• Sergey Vartanov

Insurer of Last Resort?: The Federal Financial Response to September 11

• David A. Moss
• Sarah Brennan

Under Armour

• Rory McDonald
• Clayton M. Christensen
• Daniel West
• Jonathan E. Palmer
• Tonia Junker

Hunley, Inc.: Casting for Growth

• John A. Quelch
• James T. Kindley

Bitfury: Blockchain for Government

• Mitchell B. Weiss
• Elena Corsi

Deutsche Bank: Pursuing Blockchain Opportunities (A)

• Lynda M. Applegate
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Maersk: Betting on Blockchain

• Scott Johnson

Yum! Brands

• Jordan Siegel
• Christopher Poliquin

Bharti Airtel in Africa

• Tanya Bijlani

Li & Fung 2012

• F. Warren McFarlan
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Sony and the JK Wedding Dance

• John Deighton
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United Breaks Guitars

David dao on united airlines.

• Benjamin Edelman
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Marketing Reading: Digital Marketing

• Joseph Davin

Social Strategy at Nike

• Mikolaj Jan Piskorski
• Ryan Johnson

The Tate's Digital Transformation

Social strategy at american express, mellon financial and the bank of new york.

• Carliss Y. Baldwin
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The Walt Disney Company and Pixar, Inc.: To Acquire or Not to Acquire?

• Juan Alcacer
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Dow's Bid for Rohm and Haas

• Benjamin C. Esty

Finance Reading: The Mergers and Acquisitions Process

• John Coates

Apple: Privacy vs. Safety? (A)

• Henry W. McGee
• Nien-he Hsieh
• Sarah McAra

Sidewalk Labs: Privacy in a City Built from the Internet Up

• Leslie K. John

Data Breach at Equifax

• Suraj Srinivasan
• Quinn Pitcher
• Jonah S. Goldberg

Apple's Core

• Noam Wasserman

Design Thinking and Innovation at Apple

• Barbara Feinberg

Apple Inc. in 2012

• Penelope Rossano

Iz-Lynn Chan at Far East Organization (Abridged)

• Anthony J. Mayo
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Barbara Norris: Leading Change in the General Surgery Unit

• Boris Groysberg
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Adobe Systems: Working Towards a "Suite" Release (A)

• David A. Thomas
• Lauren Barley
• Jan W. Rivkin

Starbucks Coffee Company: Transformation and Renewal

• Nancy F. Koehn
• Kelly McNamara
• Nora N. Khan
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JCPenney: Back in Business

• K. Shelette Stewart
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Home Nursing of North Carolina

Castronics, llc, gemini investors, angie's list: ratings pioneer turns 20.

• Robert J. Dolan

Basecamp: Pricing

• Frank V. Cespedes
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J.C. Penney's "Fair and Square" Pricing Strategy

J.c. penney's 'fair and square' strategy (c): back to the future.

• Jose B. Alvarez

Osaro: Picking the best path

• James Palano
• Bastiane Huang

HubSpot and Motion AI: Chatbot-Enabled CRM

• Thomas Steenburgh

GROW: Using Artificial Intelligence to Screen Human Intelligence

• Ethan S. Bernstein
• Paul D. McKinnon
• Paul Yarabe

Arup: Building the Water Cube

• Robert G. Eccles
• Amy C. Edmondson
• Dilyana Karadzhova

(Re)Building a Global Team: Tariq Khan at Tek

Managing a global team: greg james at sun microsystems, inc. (a).

• Thomas J. DeLong

Organizational Behavior Reading: Leading Global Teams

Ron ventura at mitchell memorial hospital.

• Heide Abelli

Anthony Starks at InSiL Therapeutics (A)

• Gary P. Pisano
• Vicki L. Sato

Wolfgang Keller at Konigsbrau-TAK (A)

• John J. Gabarro

The 2010 Chilean Mining Rescue (A)

• Faaiza Rashid

IDEO: Human-Centered Service Design

• Ryan W. Buell
• Andrew Otazo
• Benjamin Jones
• Alexis Brownell

David Neeleman: Flight Path of a Servant Leader (A)

• Matthew D. Breitfelder

Coach Hurley at St. Anthony High School

• Scott A. Snook
• Bradley C. Lawrence

Shapiro Global

• Michael Brookshire
• Monica Haugen
• Michelle Kravetz
• Sarah Sommer

Kathryn McNeil (A)

• Joseph L. Badaracco Jr.
• Jerry Useem

Carol Fishman Cohen: Professional Career Reentry (A)

• Myra M. Hart
• Robin J. Ely
• Susan Wojewoda

Alex Montana at ESH Manufacturing Co.

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16 case study examples (+ 3 templates to make your own)

I like to think of case studies as a business's version of a resume. It highlights what the business can do, lends credibility to its offer, and contains only the positive bullet points that paint it in the best light possible.

Imagine if the guy running your favorite taco truck followed you home so that he could "really dig into how that burrito changed your life." I see the value in the practice. People naturally prefer a tried-and-true burrito just as they prefer tried-and-true products or services.

To help you showcase your success and flesh out your burrito questionnaire, I've put together some case study examples and key takeaways.

What is a case study?

A case study is an in-depth analysis of how your business, product, or service has helped past clients. It can be a document, a webpage, or a slide deck that showcases measurable, real-life results.

For example, if you're a SaaS company, you can analyze your customers' results after a few months of using your product to measure its effectiveness. You can then turn this analysis into a case study that further proves to potential customers what your product can do and how it can help them overcome their challenges.

It changes the narrative from "I promise that we can do X and Y for you" to "Here's what we've done for businesses like yours, and we can do it for you, too."

16 case study examples 

While most case studies follow the same structure, quite a few try to break the mold and create something unique. Some businesses lean heavily on design and presentation, while others pursue a detailed, stat-oriented approach. Some businesses try to mix both.

There's no set formula to follow, but I've found that the best case studies utilize impactful design to engage readers and leverage statistics and case details to drive the point home. A case study typically highlights the companies, the challenges, the solution, and the results. The examples below will help inspire you to do it, too.

1. .css-1l9i3yq-Link[class][class][class][class][class]{all:unset;box-sizing:border-box;-webkit-text-fill-color:currentColor;cursor:pointer;}.css-1l9i3yq-Link[class][class][class][class][class]{all:unset;box-sizing:border-box;-webkit-text-decoration:underline;text-decoration:underline;cursor:pointer;-webkit-transition:all 300ms ease-in-out;transition:all 300ms ease-in-out;outline-offset:1px;-webkit-text-fill-color:currentColor;outline:1px solid transparent;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='ocean']{color:#3d4592;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='ocean']:hover{color:#2b2358;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='ocean']:focus{color:#3d4592;outline-color:#3d4592;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='white']{color:#fffdf9;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='white']:hover{color:#a8a5a0;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='white']:focus{color:#fffdf9;outline-color:#fffdf9;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='primary']{color:#3d4592;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='primary']:hover{color:#2b2358;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='primary']:focus{color:#3d4592;outline-color:#3d4592;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='secondary']{color:#fffdf9;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='secondary']:hover{color:#a8a5a0;}.css-1l9i3yq-Link[class][class][class][class][class][data-color='secondary']:focus{color:#fffdf9;outline-color:#fffdf9;}.css-1l9i3yq-Link[class][class][class][class][class][data-weight='inherit']{font-weight:inherit;}.css-1l9i3yq-Link[class][class][class][class][class][data-weight='normal']{font-weight:400;}.css-1l9i3yq-Link[class][class][class][class][class][data-weight='bold']{font-weight:700;} Volcanica Coffee and AdRoll

People love a good farm-to-table coffee story, and boy am I one of them. But I've shared this case study with you for more reasons than my love of coffee. I enjoyed this study because it was written as though it was a letter.

In this case study, the founder of Volcanica Coffee talks about the journey from founding the company to personally struggling with learning and applying digital marketing to finding and enlisting AdRoll's services.

It felt more authentic, less about AdRoll showcasing their worth and more like a testimonial from a grateful and appreciative client. After the story, the case study wraps up with successes, milestones, and achievements. Note that quite a few percentages are prominently displayed at the top, providing supporting evidence that backs up an inspiring story.

Takeaway: Highlight your goals and measurable results to draw the reader in and provide concise, easily digestible information.

2. Taylor Guitars and Airtable

This Airtable case study on Taylor Guitars comes as close as one can to an optimal structure. It features a video that represents the artistic nature of the client, highlighting key achievements and dissecting each element of Airtable's influence.

It also supplements each section with a testimonial or quote from the client, using their insights as a catalyst for the case study's narrative. For example, the case study quotes the social media manager and project manager's insights regarding team-wide communication and access before explaining in greater detail.

Takeaway: Highlight pain points your business solves for its client, and explore that influence in greater detail.

3. EndeavourX and Figma

My favorite part of Figma's case study is highlighting why EndeavourX chose its solution. You'll notice an entire section on what Figma does for teams and then specifically for EndeavourX.

It also places a heavy emphasis on numbers and stats. The study, as brief as it is, still manages to pack in a lot of compelling statistics about what's possible with Figma.

Takeaway: Showcase the "how" and "why" of your product's differentiators and how they benefit your customers.

4. ActiveCampaign and Zapier

Zapier's case study leans heavily on design, using graphics to present statistics and goals in a manner that not only remains consistent with the branding but also actively pushes it forward, drawing users' eyes to the information most important to them. 

The graphics, emphasis on branding elements, and cause/effect style tell the story without requiring long, drawn-out copy that risks boring readers. Instead, the cause and effect are concisely portrayed alongside the client company's information for a brief and easily scannable case study.

Takeaway: Lean on design to call attention to the most important elements of your case study, and make sure it stays consistent with your branding.

5. Ironclad and OpenAI

In true OpenAI fashion, this case study is a block of text. There's a distinct lack of imagery, but the study features a narrated video walking readers through the product.

The lack of imagery and color may not be the most inviting, but utilizing video format is commendable. It helps thoroughly communicate how OpenAI supported Ironclad in a way that allows the user to sit back, relax, listen, and be impressed. 

Takeaway: Get creative with the media you implement in your case study. Videos can be a very powerful addition when a case study requires more detailed storytelling.

6. Shopify and GitHub

GitHub's case study on Shopify is a light read. It addresses client pain points and discusses the different aspects its product considers and improves for clients. It touches on workflow issues, internal systems, automation, and security. It does a great job of representing what one company can do with GitHub.

To drive the point home, the case study features colorful quote callouts from the Shopify team, sharing their insights and perspectives on the partnership, the key issues, and how they were addressed.

Takeaway: Leverage quotes to boost the authoritativeness and trustworthiness of your case study. 

7 . Audible and Contentful

Contentful's case study on Audible features almost every element a case study should. It includes not one but two videos and clearly outlines the challenge, solution, and outcome before diving deeper into what Contentful did for Audible. The language is simple, and the writing is heavy with quotes and personal insights.

This case study is a uniquely original experience. The fact that the companies in question are perhaps two of the most creative brands out there may be the reason. I expected nothing short of a detailed analysis, a compelling story, and video content. 

Takeaway: Inject some brand voice into the case study, and create assets that tell the story for you.

8 . Zoom and Asana

Asana's case study on Zoom is longer than the average piece and features detailed data on Zoom's growth since 2020. Instead of relying on imagery and graphics, it features several quotes and testimonials. 

It's designed to be direct, informative, and promotional. At some point, the case study reads more like a feature list. There were a few sections that felt a tad too promotional for my liking, but to each their own burrito.

Takeaway: Maintain a balance between promotional and informative. You want to showcase the high-level goals your product helped achieve without losing the reader.

9 . Hickies and Mailchimp

I've always been a fan of Mailchimp's comic-like branding, and this case study does an excellent job of sticking to their tradition of making information easy to understand, casual, and inviting.

It features a short video that briefly covers Hickies as a company and Mailchimp's efforts to serve its needs for customer relationships and education processes. Overall, this case study is a concise overview of the partnership that manages to convey success data and tell a story at the same time. What sets it apart is that it does so in a uniquely colorful and brand-consistent manner.

Takeaway: Be concise to provide as much value in as little text as possible.

10. NVIDIA and Workday

The gaming industry is notoriously difficult to recruit for, as it requires a very specific set of skills and experience. This case study focuses on how Workday was able to help fill that recruitment gap for NVIDIA, one of the biggest names in the gaming world.

Though it doesn't feature videos or graphics, this case study stood out to me in how it structures information like "key products used" to give readers insight into which tools helped achieve these results.

Takeaway: If your company offers multiple products or services, outline exactly which ones were involved in your case study, so readers can assess each tool.

11. KFC and Contentful

I'm personally not a big KFC fan, but that's only because I refuse to eat out of a bucket. My aversion to the bucket format aside, Contentful follows its consistent case study format in this one, outlining challenges, solutions, and outcomes before diving into the nitty-gritty details of the project.

Say what you will about KFC, but their primary product (chicken) does present a unique opportunity for wordplay like "Continuing to march to the beat of a digital-first drum(stick)" or "Delivering deep-fried goodness to every channel."

Takeaway: Inject humor into your case study if there's room for it and if it fits your brand. 

12. Intuit and Twilio

Twilio does an excellent job of delivering achievements at the very beginning of the case study and going into detail in this two-minute read. While there aren't many graphics, the way quotes from the Intuit team are implemented adds a certain flair to the study and breaks up the sections nicely.

It's simple, concise, and manages to fit a lot of information in easily digestible sections.

Takeaway: Make sure each section is long enough to inform but brief enough to avoid boring readers. Break down information for each section, and don't go into so much detail that you lose the reader halfway through.

13. Spotify and Salesforce

Salesforce created a video that accurately summarizes the key points of the case study. Beyond that, the page itself is very light on content, and sections are as short as one paragraph.

I especially like how information is broken down into "What you need to know," "Why it matters," and "What the difference looks like." I'm not ashamed of being spoon-fed information. When it's structured so well and so simply, it makes for an entertaining read.

Takeaway: Invest in videos that capture and promote your partnership with your case study subject. Video content plays a promotional role that extends beyond the case study in social media and marketing initiatives .

14. Benchling and Airtable

Benchling is an impressive entity in its own right. Biotech R&D and health care nuances go right over my head. But the research and digging I've been doing in the name of these burritos (case studies) revealed that these products are immensely complex. 

And that's precisely why this case study deserves a read—it succeeds at explaining a complex project that readers outside the industry wouldn't know much about.

Takeaway: Simplify complex information, and walk readers through the company's operations and how your business helped streamline them.

15. Chipotle and Hubble

The concision of this case study is refreshing. It features two sections—the challenge and the solution—all in 316 words. This goes to show that your case study doesn't necessarily need to be a four-figure investment with video shoots and studio time. 

Sometimes, the message is simple and short enough to convey in a handful of paragraphs.

Takeaway: Consider what you should include instead of what you can include. Assess the time, resources, and effort you're able and willing to invest in a case study, and choose which elements you want to include from there.

16. Hudl and Zapier

I may be biased, but I'm a big fan of seeing metrics and achievements represented in branded graphics. It can be a jarring experience to navigate a website, then visit a case study page and feel as though you've gone to a completely different website.

The Zapier format provides nuggets of high-level insights, milestones, and achievements, as well as the challenge, solution, and results. My favorite part of this case study is how it's supplemented with a blog post detailing how Hudl uses Zapier automation to build a seamless user experience.

The case study is essentially the summary, and the blog article is the detailed analysis that provides context beyond X achievement or Y goal.

Takeaway: Keep your case study concise and informative. Create other resources to provide context under your blog, media or press, and product pages.

3 case study templates

Now that you've had your fill of case studies (if that's possible), I've got just what you need: an infinite number of case studies, which you can create yourself with these case study templates.

Case study template 1

If you've got a quick hit of stats you want to show off, try this template. The opening section gives space for a short summary and three visually appealing stats you can highlight, followed by a headline and body where you can break the case study down more thoroughly. This one's pretty simple, with only sections for solutions and results, but you can easily continue the formatting to add more sections as needed.

Case study template 2

For a case study template with a little more detail, use this one. Opening with a striking cover page for a quick overview, this one goes on to include context, stakeholders, challenges, multiple quote callouts, and quick-hit stats. 

Case study template 3

Whether you want a little structural variation or just like a nice dark green, this template has similar components to the last template but is designed to help tell a story. Move from the client overview through a description of your company before getting to the details of how you fixed said company's problems.

Tips for writing a case study

Examples are all well and good, but you don't learn how to make a burrito just by watching tutorials on YouTube without knowing what any of the ingredients are. You could , but it probably wouldn't be all that good.

Writing a good case study comes down to a mix of creativity, branding, and the capacity to invest in the project. With those details in mind, here are some case study tips to follow:

Have an objective: Define your objective by identifying the challenge, solution, and results. Assess your work with the client and focus on the most prominent wins. You're speaking to multiple businesses and industries through the case study, so make sure you know what you want to say to them.

Focus on persuasive data: Growth percentages and measurable results are your best friends. Extract your most compelling data and highlight it in your case study.

Use eye-grabbing graphics: Branded design goes a long way in accurately representing your brand and retaining readers as they review the study. Leverage unique and eye-catching graphics to keep readers engaged. 

Simplify data presentation: Some industries are more complex than others, and sometimes, data can be difficult to understand at a glance. Make sure you present your data in the simplest way possible. Make it concise, informative, and easy to understand.

Use automation to drive results for your case study

A case study example is a source of inspiration you can leverage to determine how to best position your brand's work. Find your unique angle, and refine it over time to help your business stand out. Ask anyone: the best burrito in town doesn't just appear at the number one spot. They find their angle (usually the house sauce) and leverage it to stand out.

In fact, with the right technology, it can be refined to work better . Explore how Zapier's automation features can help drive results for your case study by making your case study a part of a developed workflow that creates a user journey through your website, your case studies, and into the pipeline.

Case study FAQ

Got your case study template? Great—it's time to gather the team for an awkward semi-vague data collection task. While you do that, here are some case study quick answers for you to skim through while you contemplate what to call your team meeting.

What is an example of a case study?

An example of a case study is when a software company analyzes its results from a client project and creates a webpage, presentation, or document that focuses on high-level results, challenges, and solutions in an attempt to showcase effectiveness and promote the software.

How do you write a case study?

To write a good case study, you should have an objective, identify persuasive and compelling data, leverage graphics, and simplify data. Case studies typically include an analysis of the challenge, solution, and results of the partnership.

What is the format of a case study?

While case studies don't have a set format, they're often portrayed as reports or essays that inform readers about the partnership and its results. 

Related reading:

How Hudl uses automation to create a seamless user experience

How to make your case studies high-stakes—and why it matters

How experts write case studies that convert, not bore

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Hachem Ramki

Hachem is a writer and digital marketer from Montreal. After graduating with a degree in English, Hachem spent seven years traveling around the world before moving to Canada. When he's not writing, he enjoys Basketball, Dungeons and Dragons, and playing music for friends and family.

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Blog Graphic Design

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.

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. 

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.

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.

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.

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.

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.

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.

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.

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.

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:

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:

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.

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.

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.

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.

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:

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.

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?

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• Knowledge Base

Methodology

• What Is a Case Study? | Definition, Examples & Methods

What Is a Case Study? | Definition, Examples & Methods

Published on May 8, 2019 by Shona McCombes . Revised on November 20, 2023.

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, 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 .

Table of contents

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 analyze the case, other interesting articles.

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

TipIf your research is more practical in nature and aims to simultaneously investigate an issue as you solve it, consider conducting action research instead.

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.

Example of an outlying case studyIn the 1960s the town of Roseto, Pennsylvania was discovered to have extremely low rates of heart disease compared to the US average. It became an important case study for understanding previously neglected causes of heart disease.

However, you can also choose a more common or representative case to exemplify a particular category, experience or phenomenon.

Example of a representative case studyIn the 1920s, two sociologists used Muncie, Indiana as a case study of a typical American city that supposedly exemplified the changing culture of the US at the time.

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.

Example of a mixed methods case studyFor a case study of a wind farm development in a rural area, you could collect quantitative data on employment rates and business revenue, collect qualitative data on local people’s perceptions and experiences, and analyze local and national media coverage of the development.

The aim is to gain as thorough an understanding as possible of the case and its context.

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Professional editors proofread and edit your paper by focusing on:

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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 analyze 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.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

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Top 20 Project Management Case Studies [With Examples]

Project management case study analyses showcase and compare real-life project management processes and systems scenarios. These studies shed light on the common challenges that project managers encounter on a daily basis. This helps project managers develop effective strategies, overcome obstacles, and achieve successful results. 

By leveraging project management case studies , organisations can optimise their operations by providing insights into the most effective approaches. With effective implementation of these case studies, strategies, and methodologies, ensuring successful project completion is achievable.

Criteria for Selection of Top 20 Case Studies

The top 20 case studies are selected based on significance, impact, challenges, project management strategies, and overall success. They provide diverse insights and lessons for project managers and organisations.

1. The Sydney Opera House Project

The Sydney Opera House Project is an iconic example of project management case studies as it faced multiple challenges during its construction phase. Despite facing leadership changes, budget overruns, and design failures, the project persevered and was completed in 1973, a decade later than planned. The Opera House stands as a symbol of perseverance and successful project management in the face of humankind.

2. The Airbus A380 Project

The Airbus A380 Project is a project management case study showcasing the challenges encountered during developing and producing the world’s largest commercial aircraft. The project experienced massive delays and impacted costs of more than $6 billion, with several issues arising from the manufacturing and delivery process, outsourcing, and project coordination. 

However, the Airbus A380 was successfully launched through carefully planned project management strategies, delivering a world-class aircraft that met customer expectations.

3. The Panama Canal Expansion Project 

The Panama Canal Expansion Project serves as a compelling case study, illustrating the management’s encounters in expanding the capacity of the Panama Canal. The project included multiple stakeholders, technological innovations, environmental concerns, and safety challenges. 

4. The Boston Central Artery/Tunnel Project

The Boston Central Artery/Tunnel Project serves as a project management case study of a large-scale underground tunnel construction project. It successfully addressed traffic congestion and was completed in 2007. The project was completed in 2007, with numerous hurdles delaying progress like complexity, technology failure, ballooning budgets, media scrutiny, etc.

5. The London 2012 Olympics Project

The London 2012 Olympics Project stands as a successful project management case study, showcasing the management of a large-scale international sporting event. This project involved the construction of a new sports infrastructure, event logistics and security concerns. The project was successfully accomplished, delivering a world-class event that captivated the audience.

6. The Hoover Dam Bypass Project

The Hoover Dam Bypass Project was a construction project in the United States of America that intended to alleviate traffic from the Hoover Dam by building a new bridge. Completed in 2010, the bridge spans across the Colorado River, connecting Arizona and Nevada and offers a safer and more efficient route for motorists.

7. The Golden Gate Bridge Seismic Retrofit Project

The Golden Gate Bridge Seismic Retrofit Project is a case study example constructed in San Francisco, California. Its objective was to enhance the bridge’s resilience against earthquakes and aftershocks. Completed in 2012, the project included the installation of shock absorbers and other seismic upgrades to ensure the bridge’s safety and functionality in the event of a major earthquake.

8. The Hong Kong-Zhuhai-Macau Bridge Project

The Hong Kong-Zhuhai-Macau Bridge Project is a massive case study that intends to connect Hong Kong, Zhuhai and Macau with a bridge-tunnel system of 55 kilometres. Completed in 2018, the project required massive funds, investments and innovative engineering solutions, providing a new transport link and boosting regional connectivity.

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9. The Panama Papers Investigation Project

The Panama Papers Investigation Project is a global case study of journalistic investigations into offshore tax havens. It involved leaked documents from Mossack Fonseca, a Panamanian law firm. Coordinated by the International Consortium of Investigative Journalists, the project resulted in major political and financial repercussions worldwide, garnering widespread media attention.

10. The Apple iPhone Development Project

The Apple iPhone Development Project started in 2004, aiming to create a groundbreaking mobile device. In 2007, the iPhone transformed the industry with its innovative touchscreen interface, sleek design, and advanced features. This project involved significant research, development, marketing, and supply chain management investments.

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11. The Ford Pinto Design and Launch Project

The Ford Pinto Design and Launch Project was a developmental project intended to create an affordable, fuel-efficient subcompact car. Launched in 1971, because of its fuel tank design, it became infamous for safety issues. The project was rigged for ethical and safety concerns, lawsuits, and recalls.

12. The Deepwater Horizon Oil Spill Response Project

The Deepwater Horizon Oil Spill Response Project was a response to the largest oil spill in US history, caused by an offshore drilling rig explosion in 2010. This crisis response project utilised a waterfall project management approach, where the project team followed a pattern of planning, executing, monitoring, and closing phases. 

13. The NASA Challenger Space Shuttle Disaster Project

  The NASA Challenger Disaster Project was a tragic space exploration mission in 1986, resulting in the loss of all seven crew members. Extensive investigations revealed design and safety flaws as the cause. This disaster prompted NASA to address decision-making processes and improve safety cultures.

14. The Three Gorges Dam Project

  The Three Gorges Dam Project was a large-scale infrastructure project developed in China that aimed to build the world’s largest hydroelectric dam on the Yangtze River. Completed in 2012, it encountered environmental, social, and engineering challenges. The dam currently offers power generation, flood control, and improved navigation, but it has also resulted in ecological and cultural consequences.

15. The Big Dig Project in Boston

The Big Dig Project was a transportation infrastructure project in Boston, Massachusetts, intended to replace an old elevated highway with a newer tunnel system. Completed in 2007, it serves as one of the most complex and costly construction endeavours in US history. Despite facing many delays, cost overruns and engineering challenges, the project successfully improved traffic flow and urban aesthetics but also resulted in accidents, lawsuits, and financial burdens.

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16. The Uber Disruptive Business Model Project

  The Uber Disruptive Business Model Project was a startup that introduced a new ride business model that disrupted the taxi-cab industry by connecting riders with drivers via a mobile app. Launched in 2010, this project required innovative technology, marketing and regulatory strategies and faced legal actions and ethical challenges related to labour, safety, and competition. Uber has since then dominated the market with its ride-sharing business plan.

17. The Netflix Original Content Development Project

The Netflix Original Content Development Project was an initiative created to launch its original content for its platform. This launch by the online streaming giant in 2012 was a huge success for the company. The project required huge investments in content creation, distribution and marketing and resulted in award-winning shows and films that redefined the entire entertainment industry’s business model.

18. The Tesla Electric Car Project

The Tesla Electric Car Project was a revolutionary project that aimed to compete for its electric vehicles with gasoline-powered vehicles. The project required a strong project management plan that incorporated innovation, sustainability, and stakeholder engagement, resulting in the successful launch of the Tesla Roadster in 2008 and subsequent models. Tesla has one-handedly revolutionised the entire automobile industry on its own. 

19. The Johnson & Johnson Tylenol Crisis Management Project:

The Johnson & Johnson Tylenol Crisis Management Project was a case study in crisis management in 1982. The project required quick and effective decision-making skills, stakeholder communication, and ethical leadership in response to the tampering of Tylenol capsules that led to deaths. 

20. The Airbnb Online Marketplace Platform Project  

The Airbnb Online Marketplace Platform Project was a startup that created an online platform which connected travellers with hosts offering short-term rental accommodations in flights. The project required innovative technology, user experience design and stakeholder management. Airbnb’s success has led to the disruption of the hospitality industry and inspired many other project case study examples of sharing economy platforms.

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Future developments in project management.

Future developments in project management include all the insights on the increased use of artificial intelligence, agile methodologies, hybrid project management approaches, and emphasis on sustainability and social responsibility, along with many more developing ideas that will address the evolving market innovations. 

Key Takeaways from the Case Studies

The project management case study examples illustrate real-life examples and the importance of project management in achieving project success. The cases show the use of innovative technologies, tools, techniques, stakeholder engagement, crisis management, and agile methodologies. 

Project Management also highlights the role of ethical leadership and social responsibility in project management. To learn more and more about case studies, upGrad, India’s leading education platform, has offered an Advanced General Management Program from IMT Ghaziabad that will equip you with in-demand management skills to keep up with the changing trends!

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Frequently Asked Questions (FAQs)

Project Management is extensive planning, executing, monitoring and closing of a project before its deadline. Project management ensures accuracy and efficiency across all organs of a project, right from its inception to its completion.

Project Management case studies are real-life examples of projects to put an insight into all the tools, techniques and methodologies it provides.

The role of a project manager is to ensure that all day-to-day responsibilities are being met by the resources deployed in a certain project. They have the authority to manage as well as lead the functioning members as well.

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Writing A Case Study

Case Study Examples

Brilliant Case Study Examples and Templates For Your Help

15 min read

People also read

A Complete Case Study Writing Guide With Examples

Simple Case Study Format for Students to Follow

Understand the Types of Case Study Here

It’s no surprise that writing a case study is one of the most challenging academic tasks for students. You’re definitely not alone here!

Most people don't realize that there are specific guidelines to follow when writing a case study. If you don't know where to start, it's easy to get overwhelmed and give up before you even begin.

Don't worry! Let us help you out!

We've collected over 25 free case study examples with solutions just for you. These samples with solutions will help you win over your panel and score high marks on your case studies.

So, what are you waiting for? Let's dive in and learn the secrets to writing a successful case study.

• 1. An Overview of Case Studies
• 2. Case Study Examples for Students
• 3. Business Case Study Examples
• 4. Medical Case Study Examples
• 5. Psychology Case Study Examples 
• 6. Sales Case Study Examples
• 7. Interview Case Study Examples
• 8. Marketing Case Study Examples
• 9. Tips to Write a Good Case Study

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!

Having said that, we do understand that some of you might be having a hard time writing compelling case studies.

But worry not! Our expert case study writing service is here to take all your case-writing blues away! 

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47 case interview examples (from McKinsey, BCG, Bain, etc.)

One of the best ways to prepare for   case interviews  at firms like McKinsey, BCG, or Bain, is by studying case interview examples. 

There are a lot of free sample cases out there, but it's really hard to know where to start. So in this article, we have listed all the best free case examples available, in one place.

The below list of resources includes interactive case interview samples provided by consulting firms, video case interview demonstrations, case books, and materials developed by the team here at IGotAnOffer. Let's continue to the list.

• McKinsey examples
• BCG examples
• Bain examples
• Deloitte examples
• Other firms' examples
• Case books from consulting clubs
• Case interview preparation

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

1. mckinsey case interview examples.

• Beautify case interview (McKinsey website)
• Diconsa case interview (McKinsey website)
• Electro-light case interview (McKinsey website)
• GlobaPharm case interview (McKinsey website)
• National Education case interview (McKinsey website)
• Talbot Trucks case interview (McKinsey website)
• Shops Corporation case interview (McKinsey website)
• Conservation Forever case interview (McKinsey website)
• McKinsey case interview guide (by IGotAnOffer)
• McKinsey live case interview extract (by IGotAnOffer) - See below

2. BCG case interview examples

• Foods Inc and GenCo case samples  (BCG website)
• Chateau Boomerang written case interview  (BCG website)
• BCG case interview guide (by IGotAnOffer)
• Written cases guide (by IGotAnOffer)
• BCG live case interview with notes (by IGotAnOffer)
• BCG mock case interview with ex-BCG associate director - Public sector case (by IGotAnOffer)
• BCG mock case interview: Revenue problem case (by IGotAnOffer) - See below

3. Bain case interview examples

• CoffeeCo practice case (Bain website)
• FashionCo practice case (Bain website)
• Associate Consultant mock interview video (Bain website)
• Consultant mock interview video (Bain website)
• Written case interview tips (Bain website)
• Bain case interview guide   (by IGotAnOffer)
• Bain case mock interview with ex-Bain manager (below)

4. Deloitte case interview examples

• Engagement Strategy practice case (Deloitte website)
• Recreation Unlimited practice case (Deloitte website)
• Strategic Vision practice case (Deloitte website)
• Retail Strategy practice case  (Deloitte website)
• Finance Strategy practice case  (Deloitte website)
• Talent Management practice case (Deloitte website)
• Enterprise Resource Management practice case (Deloitte website)
• Footloose written case  (by Deloitte)
• Deloitte case interview guide (by IGotAnOffer)

5. Accenture case interview examples

• Case interview workbook (by Accenture)
• Accenture case interview guide (by IGotAnOffer)

6. OC&C case interview examples

• Leisure Club case example (by OC&C)
• Imported Spirits case example (by OC&C)

7. Oliver Wyman case interview examples

• Wumbleworld case sample (Oliver Wyman website)
• Aqualine case sample (Oliver Wyman website)
• Oliver Wyman case interview guide (by IGotAnOffer)

8. A.T. Kearney case interview examples

• Promotion planning case question (A.T. Kearney website)
• Consulting case book and examples (by A.T. Kearney)
• AT Kearney case interview guide (by IGotAnOffer)

9. Strategy& / PWC case interview examples

• Presentation overview with sample questions (by Strategy& / PWC)
• Strategy& / PWC case interview guide (by IGotAnOffer)

10. L.E.K. Consulting case interview examples

• Case interview example video walkthrough   (L.E.K. website)
• Market sizing case example video walkthrough  (L.E.K. website)

11. Roland Berger case interview examples

• Transit oriented development case webinar part 1  (Roland Berger website)
• Transit oriented development case webinar part 2   (Roland Berger website)
• 3D printed hip implants case webinar part 1   (Roland Berger website)
• 3D printed hip implants case webinar part 2   (Roland Berger website)
• Roland Berger case interview guide   (by IGotAnOffer)

12. Capital One case interview examples

• Case interview example video walkthrough  (Capital One website)
• Capital One case interview guide (by IGotAnOffer)

13. Consulting clubs case interview examples

• Berkeley case book (2006)
• Columbia case book (2006)
• Darden case book (2012)
• Darden case book (2018)
• Duke case book (2010)
• Duke case book (2014)
• ESADE case book (2011)
• Goizueta case book (2006)
• Illinois case book (2015)
• LBS case book (2006)
• MIT case book (2001)
• Notre Dame case book (2017)
• Ross case book (2010)
• Wharton case book (2010)

Practice with experts

Using case interview examples is a key part of your interview preparation, but it isn’t enough.

At some point you’ll want to practise with friends or family who can give some useful feedback. However, if you really want the best possible preparation for your case interview, you'll also want to work with ex-consultants who have experience running interviews at McKinsey, Bain, BCG, etc.

If you know anyone who fits that description, fantastic! But for most of us, it's tough to find the right connections to make this happen. And it might also be difficult to practice multiple hours with that person unless you know them really well.

Here's the good news. We've already made the connections for you. We’ve created a coaching service where you can do mock case interviews 1-on-1 with ex-interviewers from MBB firms . Start scheduling sessions today!

The IGotAnOffer team

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Explore the Levels of Change Management

9 Successful Change Management Examples For Inspiration

Updated: February 9, 2024

Published: January 3, 2024

Welcome to our guide on change management examples, pivotal for steering through today's dynamic business terrain. Immerse yourself in the transformative power of change management, a tool for resilience, growth, innovation, and employee morale enhancement.

This guide equips you with strategies to promote an innovative, adaptable work environment and boost employee morale for lasting organizational success.

Uncover diverse types of change management with Prosci's established methodology and explore real-world examples that illustrate these principles in action.

What is Change Management?

Change management is a strategy for guiding an organization and its people through change. It goes beyond top-down orders, involving employees at all levels. This people-focused approach encourages everyone to participate actively, helping them adapt and use changes in their everyday work.

Effective change management aligns closely with a company's culture, values, and beliefs.

When change fits well with these cultural aspects, it feels more natural and is easier for employees to adopt. This contributes to smoother transitions and leads to more successful and lasting organizational changes.

Why is Change Management Important?

Change management is pivotal in guiding organizations through transitions, ensuring impactful and long-lasting results.

For example, a $28B electronic components and services company with 18,000 employees realized the importance of enhancing its processes. They knew to adopt more streamlined, efficient approaches, known as Lean initiatives .

However, they encountered challenges because they needed a more structured method for effectively managing the human aspects of these changes.

The company formed a specialized group focused on change to address their challenges and initiate key projects. These projects aligned with their culture of innovation and precision, which helped ensure that the changes were well-received and effectively implemented within the organization.

Matching change management to an organization's unique style and structure contributes to more effective transformations and strengthens the business for future challenges.

What Are the Main Types of Change Management?

Discover Prosci's change management models: from individual application and organizational strategies to enterprise-wide integration and effective portfolio management, all are vital for transformative success.

Individual change management

At Prosci, we understand that change begins with the individual.

The Prosci ADKAR ® Model ( Awareness, Desire, Knowledge, Ability and Reinforcement ) is expertly designed to equip change leaders with tools and strategies to engage your team.

This model is a framework that will guide and support you in confidently navigating and adapting to new changes.

Organizational change management

In organizational change management , we focus on the core elements of your company to fully understand and address each aspect of the change.

Our approach involves creating tailored strategies and detailed plans that benefit you and manage you to manage challenges effectively, which include:

• Clear communication
• Strong leadership support
• Personalized coaching
• Practical training

Our strategies are specifically aimed at meeting the diverse needs within your organization, ensuring a smooth and well-supported transition for everyone involved.

Enterprise change management capability

At the enterprise level, change management becomes an embedded practice, a core competency woven throughout the organization.

When you implement change capabilities:

• Employees know what to ask during change to reach success
• Leaders and managers have the training and skills to guide their teams during change
• Organizations consistently apply change management to initiatives
• Organizations embed change management in roles, structures, processes, projects and leadership competencies

It's a tactical effort to integrate change management into the very DNA of an organization—nurturing a culture that's ready and able to adapt to any change.

Change portfolio management

While distinct from project-level change management, managing a change portfolio is vital for an organization to stay flexible and responsive.

9 Dynamic Change Management Success Stories to Revolutionize Your Business

Prosci case studies reveal how diverse organizations spanning different sectors address and manage change.  These cases illustrate how change management can provide transformative solutions from healthcare to finance:

1. Hospital system

A major healthcare organization implemented an extensive enterprise resource planning (ERP) system and adapted to healthcare reform. This case study highlights overcoming significant challenges through strategic change management:

Industry: Healthcare Revenue: $3.7 billion Employees: 24,000 Facilities: 11 hospitals

Major changes:

• Implemented a new ERP system across all hospitals
• Prepared for healthcare reform

Challenges:

• Managing significant, disruptive changes
• Difficulty in gaining buy-in for change management
• Align with culture: Strategically implemented change management to support staff, reflecting the hospital's core value of caring for people
• Focus on a key initiative: Applied change management in the electronic health record system implementation
• Integrate with existing competencies: Recognized change leadership as crucial at various leadership levels

This example shows that when change management matches a healthcare organization's values, it can lead to successful and smooth transitions.

2. Transportation department

A state government transportation department leveraged change management to effectively manage business process improvements amid funding and population challenges. This highlights the value of comprehensive change management in a public sector setting:

Industry: State Government Transportation Revenue: $1.3 billion Employees: 3,000 Challenges:

• Reduced funding
• Growing population
• Increasing transportation needs

Initiative:

• Major business process improvement

Hurdles encountered:

• Change fatigue
• Need for widespread employee adoption
• Focus on internal growth
• Implemented change management in process improvement

This department's experience teaches us the vital role of change management in successfully navigating government projects with multiple challenges.

3. Pharmaceuticals

A global pharmaceutical company navigated post-merger integration challenges. Using a proactive change management approach, they addressed resistance and streamlined operations in a competitive industry:

Industry: Pharma (Global Biopharmaceutical Company) Revenue: $6 billion Number of employees: 5,000

Recent activities: Experienced significant merger and acquisition activity

• Encountered resistance post-implementation of SAP (Systems, Applications and Products in Data Processing)
• They found themselves operating in a purely reactive mode
• Align with your culture: In this Lean Six Sigma-focused environment, where measurement is paramount, the ADKAR Model's metrics were utilized as the foundational entry point for initiating change management processes.

This company's journey highlights the need for flexible and responsive change management.

4. Home fixtures

A home fixtures manufacturing company’s response to the recession offers valuable insights on effectively managing change. They focused on aligning change management with their disciplined culture, emphasizing operational efficiency:

Industry: Home Fixtures Manufacturing Revenue: $600 million Number of employees: 3,000

Context: Facing the lingering effects of the recession

Necessity: Need to introduce substantial changes for more efficient operations

Challenge: Change management was considered a low priority within the company

• Align with your culture: The company's culture, characterized by discipline in projects and processes, ensured that change management was implemented systematically and disciplined.

This company’s experience during the recession proves that aligning change with company culture is key to overcoming tough times.

5. Web services

A web services software company transformed its culture and workspace.  They integrated change management into their IT strategy to overcome resistance and foster innovation:

Industry : Web Services Software Revenue : $3.3 billion Number of employees : 10,000

Initiatives : Cultural transformation; applying an unassigned seating model

Challenges : Resistance in IT project management

• Focus on a key initiative: Applied change management in workspace transformation
• Go where the energy is:  Establishing a change management practice within its IT department, developing self-service change management tools, and forming thoughtful partnerships
• I ntegrate with existing competencies:  "Leading change" was essential to the organization's newly developed leadership competency model.

This case demonstrates the importance of weaving change management into the fabric of tech companies, especially for cultural shifts.

6. Security systems

A high-tech security company effectively managed a major restructuring.  They created a change network that shifted change management from HR to business processes:

Industry : High-Tech (Security Systems) Revenue : $10 billion Number of employees: 57,000

Major changes : Company separation; division into three segments

Challenge : No unified change management approach

• Formed a network of leaders from transformation projects
• Go where the energy is:  Shifted change management from HR to business processes
• Integrate with existing competencies:  Included principles of change management in the training curriculum for the project management boot camp.
• Treat growing your capability like a change:  Executive roadshow launch to gain support for enterprise-wide change management

This company’s innovative approach to restructuring shows h ow reimagining change management can lead to successful outcomes.

7. Clothing store

A major clothing retailer’s journey to unify its brand model.  They overcame siloed change management through collaborative efforts and a community-driven approach:

Industry : Retail (Clothing Store) Revenue : $16 billion Number of employees : 141,000

Major change initiative : Strategic unification of the brand operating model

Historical challenge : Traditional management of change in siloes

• Build a change network :  This retailer established a community of practice for change management, involving representatives from autonomous units to foster consensus on change initiatives.

The story of this retailer illustrates how collaborative efforts in change management can unify and strengthen a brand in the retail world.

A major Canadian bank initiative to standardize change management across its organization.  They established a Center of Excellence and tailored communities of practice for effective change:

Industry : Financial Services (Canadian Bank) Revenue : $38 billion Number of employees : 78,000

Current state : Absence of enterprise-wide change management standards

Challenge :

• Employees, contractors, and consultants using individual methods for change management
• Reliance on personal knowledge and experience to deploy change management strategies
• Build a change network:  The bank established a Center of Excellence and created federated communities of practice within each business unit, aiming to localize and tailor change management efforts.

This bank’s journey in standardizing change management offers valuable insights for large organizations looking to streamline their processes.

9. Municipality

You can learn from a Canadian municipality’s significant shift to enhance client satisfaction. They integrated change management across all levels to achieve profound organizational change and improved public service:

Industry : Municipal Government (Canadian Municipality) Revenue : $1.9 billion Number of employees : 3,000

New mandate:

• Implementing a new deliberate vision focusing on each individual’s role in driving client satisfaction

Nature of shift : 

• A fundamental change within the public institution

Scope of impact :

•  It affected all levels, from leadership to front-line staff

Solution : 

• Treat growing your capability like a change: Change leaders promoted awareness and cultivated a desire to adopt change management as a standard enterprise-wide practice.

The municipality's strategy shows us how effective change management can significantly improve public services and organizational efficiency.

6 Tactics for Growing Enterprise Change Management Capability

Prosci's exploration with 10 industry leaders uncovered six primary tactics for enterprise change growth , demonstrating a "universal theme, unique application" approach.

This framework goes beyond standard procedures, focusing on developing a deep understanding and skill in managing change. It offers transformative tactics, guiding organizations towards excelling in adapting to change.  Here, we uncover these transformative tactics, guiding organizations toward mastery of change.

1. Align with Your culture

Organizational culture profoundly influences how change management should be deployed.

Recognizing whether your organization leans towards traditional practices or innovative approaches is vital. This understanding isn't just about alignment; it's an opportunity to enhance and sometimes shift your cultural environment.

When effectively combined with an organization's unique culture, change management can greatly enhance key initiatives. This leads to widespread benefits beyond individual projects and promotes overall growth and development within the organization.

Embrace this as a fundamental tool to strengthen and transform your company's cultural fabric.

2. Focus on key initiatives

In the early phase of developing change management capabilities, selecting noticeable projects with executive backing is important.

This helps demonstrate the real-world impact of change management, making it easier for employees and leadership to understand its benefits. This strategy helps build support and maintain the momentum of change management initiatives within your organization.

Focus on capturing and sharing these successes to encourage buy-in further and underscore the importance of change management in achieving organizational goals.

3. Build a change network

Building change capability isn't just about a few advocates but creating a network of change champions across your organization.

This network, essential in spreading the message and benefits of change management, varies in composition but is universally crucial. It could include departmental practitioners, business unit leaders, or a mix of roles working together to enhance awareness, credibility, and a shared purpose.

Our Best Practices in Change Management study shows that 45% of organizations leverage such networks. These groups boost the effectiveness of change management and keep it moving forward.

4. Go where the energy is

To build change capabilities throughout an organization effectively, the focus should be on matching the organization's current readiness rather than just pushing new methods.

Identify and focus on parts of your organization that are ready for change. Align your change initiatives with these sectors. Involve senior leaders and those enthusiastic about change to naturally generate demand for these transformations.

Showcasing successful initiatives encourages a collaborative culture of change, making it an organic part of your organization's growth.

5. Integrate with existing competencies

Change management is a vital skill across various organizational roles.

Integrating it into competency models and job profiles is increasingly common, yet often lacks the necessary training and tools.

When change management skills expand beyond the experts, they become an integral part of the organization's culture—nurturing a solid foundation of effective change leadership.

This approach embeds change management deeper within the company and cultivates leaders who can support and sustain this essential practice.

6. Treat growing your capability like a change

Growing change capability is a transformative journey for your business and your employees. It demands a structured, strategic approach beyond telling your network that change is coming.

Applying the ADKAR Model universally and focusing on your organization's unique needs is pivotal. It's about building awareness, sparking a desire for change across the enterprise, and equipping employees with the knowledge and skills for effective, lasting change. 

Treating capability-building like a change ensures that change management becomes a core part of your organization's fabric, benefitting every team member.

These six tactics are powerful tools for enhancing your organization's ability to adapt and remain resilient in a rapidly changing business environment.

Comprehensive Insights From Change Management Examples

These diverse change management examples provide field-tested savvy and offer a window into how varied organizations successfully manage change.

Case studies , from healthcare reform to innovative corporate restructuring, exemplify how aligning with organizational culture, building strong change networks, and focusing on tactical initiatives can significantly impact change management outcomes.

This guide, enriched with real-world applications, enhances understanding and execution of effective change management, setting a benchmark for future transformations.

To learn more about partnering with Prosci for your next change initiative, discover Prosci's Advisory services and enterprise training options and consider practitioner certification .

Founded in 1994, Prosci is a global leader in change management. We enable organizations around the world to achieve change outcomes and grow change capability through change management solutions based on holistic, research-based, easy-to-use tools, methodologies and services.

See all posts from Prosci

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Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

Margae knox.

1 School of Public Health, University of California, Berkeley, Berkeley, California, USA

Emily E Esteban

2 Contra Costa Health Services, Martinez, California, USA

Elizabeth A Hernandez

Mark d fleming, nadia safaeinilli, amanda l brewster, associated data.

No data are available. Data are not publicly available to protect potentially sensitive information. For data inquiries, please contact the corresponding author.

Health systems are expanding efforts to address health and social risks, although the heterogeneity of early evidence indicates need for more nuanced exploration of how such programs work and how to holistically assess program success. This qualitative study aims to identify characteristics of success in a large-scale, health and social needs case management program from the perspective of interdisciplinary case managers.

Case management program for high-risk, complex patients run by an integrated, county-based public health system.

Participants

30 out of 70 case managers, purposively sampled to represent their interdisciplinary health and social work backgrounds. Interviews took place in March–November 2019.

Primary and secondary outcome measures

The analysis intended to identify characteristics of success working with patients.

Case managers described three characteristics of success working with patients: (1) establishing trust; (2) observing change in patients’ mindset or initiative and (3) promoting stability and independence. Cross-cutting these characteristics, case managers emphasised the importance of patients defining their own success, often demonstrated through individualised, incremental progress. Thus, moments of success commonly contrasted with external perceptions and operational or productivity metrics.

Conclusions

Themes emphasise the importance of compassion for complexity in patients’ lives, and success as a step-by-step process that is built over longitudinal relationships.

What is already known on this topic?

• Case management programs to support health and social needs have demonstrated promising yet mixed results. Underlying mechanisms and shared definitions of successful case management are underdeveloped.

What this study adds?

• Case managers emphasised building trust over time and individual, patient-defined objectives as key markers of success, a contrast to commonly used quantitative evaluation metrics.

How this study might affect research, practice or policy?

• Results suggest that lighter touch case management interventions face limitations without an established patient relationship. Results also support a need for alternative definitions of case management success including patient-centered measures such as trust in one’s case manager.

Introduction

Health system efforts to address both health and social needs are expanding. In the USA, some state Medicaid programmes are testing payments for non-medical services to address transportation, housing instability and food insecurity. Medicaid provides healthcare coverage for lower income individuals and families, jointly funded by federal and state governments. Similarly, social prescribing, or the linking of patients with social needs to community resources, is supported by the UK’s National Health Service and has also been piloted by Canada’s Alliance for Healthier Communities. 1

A growing evidence base suggests promising outcomes from healthcare interventions addressing social needs. In some contexts, case managers or navigators providing social needs assistance can improve health 2 and reduce costly hospital use. 3–5 Yet systematic reviews also report mixed results for measures of health and well-being, hospitalisation and emergency department use, and overall healthcare costs. 6–9 Notably, a randomised trial of the Camden Care Coalition programme for patients with frequent hospitalisations due to medically and socially complex needs 10 found no difference in 180-day readmission between patients assigned to a care transitions programme compared with usual hospital postdischarge care. In the care transition programme, patients received follow-up from a multidisciplinary team of nurses, social workers and community health workers. The team conducted home visits, scheduled and accompanied patients to follow-up outpatient visits, helped with managing medications, coached patients on self-care and connected patients with social services and behavioural healthcare. The usual care group received usual postdischarge care with limited follow-up. 11 This heterogeneity of early evidence indicates a need for more nuanced explorations of how social needs assistance programmes work, and how to holistically assess whether programmes are successful. 12 13

Social needs case management may lead to health and well-being improvements through multiple pathways involving both material and social support. 14 15 Improvements are often a long-term, non-linear process. 16 17 At the same time, quality measures specific to social needs assistance programmes currently remain largely undefined. Studies often analyse utilisation and cost outcomes but lack granularity on interim processes and markers of success.

In order to translate a complex and context-dependent intervention like social needs case management from one setting to another, these interim processes and outcomes need greater recognition. 18–20 Early efforts to refine complex care measures are underway and call out a need for person-centred and goal-concordant measures. 21 Further research on how frontline social needs case managers themselves define successes in their work could help leaders improve programme design and management and could also inform broader quality measure development efforts.

Our in-depth, qualitative study sought to understand how case managers defined success in their work with high-risk patients. Case managers were employed by CommunityConnect, a large-scale health and social needs care management programme that serves a mixed-age adult population with varying physical health, mental health and social needs. Each case manager’s workflow includes an individualised, regularly updated dashboard of operational metrics. It is unclear, however, whether or how these operational factors relate to patient success in a complex care programme. Thus, the case managers’ perspectives on defining success are critical for capturing how programmes work and identifying essential principles.

Study design and setting

In 2017, the Contra Costa County Health Services Department in California launched CommunityConnect, a case management programme to coordinate health, behavioural health and social services for County Medicaid patients with complex health and social conditions. The County Health Services Department serves approximately 15% (180 000) of Contra Costa’s nearly 1.2 million residents. CommunityConnect enrollees were selected based on a predictive model, which leveraged data from multiple county systems to identify individuals most likely to use hospital or emergency room services for preventable reasons. Enrollees are predominantly women (59%) and under age 40 (49%). Seventy-seven per cent of enrollees have more than one chronic condition, particularly hypertension (42%), mood disorders (40%) and chronic pain (35%). 22 Programme goals include improving beneficiary health and well-being through more efficient and effective use of resources.

Each case manager interviewed in this study worked full time with approximately 90 patients at a time. Case managers met patients in-person, ideally at least once a month for 1 year, although patients sometimes continue to receive ongoing support at the case manager’s discretion in cases of continued need. Overall, up to 6000 individuals at a time receive in-person case management services through CommunityConnect, with approximately 200–300 added and 200–300 graduated per month. At the time of the study, CommunityConnect employed approximately 70 case managers trained in various public health and social work disciplines (see table 1 , Interview Sample). Case managers and patients are matched based on an algorithm that prioritises mental health history, primary language and county region.

Interview sample

Although case managers bring unique experience from their respective discipline, all are expected to conduct similar case management services. Services included discussing any unmet social needs with patients, coordinating applicable resources and partnering with the patient and patient’s care team to improve physical and emotional health. The programme tracks hospital and emergency department utilisation as well as patient benefits such as food stamps, housing or transportation vouchers and continuous Medicaid coverage on an overall basis. Each case manager has access to an individualised dashboard that includes operational metrics such as new patients to contact, and frequency of patient contacts, timeliness for calling patients recently discharged from the hospital, whether patients have continuous Medicaid coverage, and completion of social risk screenings.

Study recruitment

Semistructured interviews were conducted with 30 field-based case managers as part of the programme’s evaluation and quality improvement process. Participants included four mental health clinical specialists, five substance abuse counsellors, six social workers, nine public health nurses, four housing support specialists and two community health worker specialists. Case managers were recruited by email and selected based on purposive sampling to reflect membership across disciplines and experience working with CommunityConnect for at least 1 year. Three case managers declined to participate. Interviews ended when data saturation was achieved. 23

Interview procedures

Interviews were conducted by five CommunityConnect evaluation staff members (including EEE), who received training and supervision from the evaluation director (EH), who also conducted interviews. The evaluation staff were bachelor and masters-level trained. The evaluation director was masters-level trained and held prior experience in healthcare quality and programme planning.

The evaluation team drafted the interview guide to ask about a variety of work processes and experiences with the goal of improving programme operations including staff and patient experiences. Specific questions analysed for this study were (1) how case managers define success with a patient and (2) examples where case managers considered work with patients a success.

Interviews took place in-person in private meeting rooms at case managers’ workplace from March 2019 – November 2019. Interviews lasted 60–90 min and only the interviewer and case manager were present. All interviewers were familiar with CommunityConnect yet did not have a prior relationship with case managers. Case managers did not receive compensation beyond their regular salary for participating in the study and were allowed to opt out of recruitment or end the interview early for any reason. All interviews were audio recorded, transcribed and entered into Nvivo V.12 for analysis.

Patient and public involvement

This project focused on case manager’s perspectives and thus did not directly involve patients. Rather, patients were involved through case manager recollections of experiences working with patients.

Data analysis

We used an integrated approach to develop an initial set of qualitative codes including deductive coding of programme processes and concepts, followed by inductive coding of how case managers defined success. All interviews were coded by two researchers experienced in qualitative research (EEE and MK). Themes were determined based on recurrence across interviews and illustrative examples and being described by more than one case manager type. The two researchers identified preliminary themes independently, then consulted with one another to achieve consensus on final themes. Themes and supporting quotes were then presented to the full author team to ensure collective agreement that key perspectives had been included. Preliminary results were also shared at a staff meeting attended by case managers and other staff as an opportunity for feedback on study findings. This manuscript addresses the Standards for Reporting Qualitative Research, 24 and the Consolidated Criteria for Reporting Qualitative Research checklist is provided as an appendix. 25

All case manager participants provided informed consent. Research procedures were approved by the Contra Costa Regional Medical Center and Health Centers Institutional Review Committee (Protocol 12-17-2018).

Case managers frequently and across multiple roles mentioned three characteristics of success when working with patients: (1) establishing trust; (2) fostering change in patients’ mindset or initiative and (3) promoting stability and independence. Across these characteristics, case managers expressed that success is patient-defined, with individualised and often incremental progress—a contrast with external perceptions of success and common operational or productivity metrics (see figure 1 ).

Illustration of key themes.

Success is establishing trust

Trusting relationships were the most widely noted characteristic of success. Trust was described as both a product of case managers’ consistent follow-up and helpfulness over time and a foundational step to enable progress on patient-centred goals. To build trust, case managers explained, patients must feel seen and heard, and understand the case managers’ desire to help: ‘Success is to know that she knows me very well…I look for her on the streets, and I’m waiting for her to call me back. Hopefully she knows that when she’s ready I will be there at least to provide that resource for her and so it’s that personal relationship that you build’ (Case manager 11, social worker). Case managers also highlighted the longitudinal relationship required to establish trust, distinguishing success as more than one-time information delivery or navigating bureaucratic processes to procure services.

Case managers also identified trust as foundational to provide better support for patients: ‘So they’re as honest with me as they can be. That way I have a clear understanding about realistically what I can do to help them coordinate their care or link them to services.’ (Case manager 2, mental health clinician specialist). Establishing trust was essential to improve communication with patients and produced an amplifying effect. That is, a case manager’s initial help and follow-up builds trust so that patients can be more open, and open communication helps the case manager know what specific services can be most useful. This positive feedback loop further cements trust and builds momentum for a longitudinal relationship.

Permission to have a home visit was mentioned as a valuable indicator of early success in building trust: ‘(Your home is) your sanctuary’, expressed one case manager (Case manager 29, public health nurse), acknowledging the vulnerability of opening one’s home to an outsider. For another case manager, regular home visits in the context of a trusting relationship made the case manager aware of and able to address a difficult situation: ‘Every time I was going to her home, I was noticing more and more gnats flying around… She said it’s because of the garbage…’ After establishing trust, the patient allowed the case manager access to the bedroom where the case manager uncovered numerous soiled diapers. The case manager arranged professional cleaning and sanitation through CommunityConnect, after which, ‘there was room for a dance floor in her bedroom. There was so much room, and the look on her face, it was almost as if her chest got proud, just in that day. She didn’t seem so burdened…So that’s a success’ (Case manager 4, substance abuse counsellor). Across multiple examples, case managers expressed trust as a critical element for effective patient partnerships.

However, the pathways to building trust are less clear cut. Quick wins through tangible support such as a transportation voucher to a medical appointment could help engage a patient initially. Yet case managers more frequently emphasised strategies based on relationships over time. Strategies included expressing empathy (putting yourself in the patient’s shoes), demonstrating respect (especially when the patient has experienced disrespect in other health system encounters), keeping appointments, following through on what you say you will do, calling to check in and ‘being there’. Overall, case managers expressed that trust lets patients know they are not alone and sets the stage for future success.

Success is fostering a change in patients’ mindset or initiative

Case managers described a change in patients’ mindset or initiative as evidence of further success. One case manager explained, ‘Really (success) could be a switch in mind state… If I can get someone to consider addressing an issue. Or just acknowledging an issue. That’s progress’ (Case manager 24, substance abuse counsellor). Another case manager spoke to the importance of mindset by stating, ‘what I try to do is not just change the surface of life’. This case manager elaborated, ‘You help (a patient) get their housing and they’re gonna lose it again, unless they change; something changes in their mindset, and then they see things differently.’ (Case manager 6, mental health clinician specialist). Some case managers suggested that the supportive resources they provide are only band-aid solutions if unaccompanied by a changed mindset to address root causes.

Case managers reported that shared goals and plans are essential, in contrast to solutions identified by case managers without patient involvement. ‘I can’t do everything for them’, expressed one case manager (Case manager 21, public health nurse), while others similarly acknowledged that imposing self-improvement goals or providing resources for which a patient may not be ready may be counterproductive. Rather, one case manager emphasised, ‘I think it’s really important to celebrate people’s ideas, their beliefs, their own goals and values’. (Case manager 4, substance abuse counsellor). As an example, the case manager applauded a patient’s ideas of getting a driver’s license and completing an education certificate. In summary, case managers viewed success as a two-way street where patient’s own ideas and motivation were essential for long-term impact.

Success is promoting stability and independence

Case managers also identified patients’ stability and independence as a characteristic of success. One case manager stated, ‘I define success as having them be more independent in their just manoeuvring the system…how they problem solve’ (Case manager 30, public health nurse). Relative to the other characteristics of success, stability and independence more closely built on resources and services coordinated or procured by the case manager. For example, CommunityConnect provides cell phones free-of-charge to patients who do not currently have a phone or continuous service, which has helped patients build a network beyond the case manager: ‘Once we get them that cell phone then they’re able to make a lot of connections … linking to services on their own. They actually become a lot more confident in themselves is what I’ve seen’. (Case manager 23, substance abuse counsellor). In another example, a case manager helped a patient experiencing complex health issues to reconcile and understand various medications. For this patient stability means, ‘when he does go into the emergency room, it’s needed. … even though he’s taking his medication like he’s supposed to… it’s just his health gets bad. So, yea I would say that one (is a success)’ (Case manager 8, social worker). Thus, stability represents maintained, improved well-being, supported by care coordination and resources, even while challenges may still be present.

As a step further, ‘Absolute success’, according to one case manager, ‘(is when a patient) drops off my caseload and I don’t hear from them, not because they’re not doing well but because they are doing well, because they are independent’ (Case manager 12, social worker). Patients may still need periodic help knowing who to contact but can follow through on their own. This independence may arise because patients have found personal support networks and other resources that allow them to rely less and less on the case manager. While not all patients reach this step of sustained independence and stability, it is an accomplishment programmatically and for case managers personally.

Success is patient-defined, built on individualised and incremental progress

Case managers widely recognised that success comes in different shapes and sizes, dependent on their patient’s situation. Irrespective of the primary concern, many identified the patient’s own judgement as the benchmark for success. One case manager explained, ‘I define success with my patients by they are telling me it was a success. It’s by their expression, it’s just not a success until they say it’s a success for them’ (Case manager 7, social worker). In a more specific example, a case manager highlighted checking in with a patient instead of assuming a change is successful: ‘It’s not just getting someone housed or getting someone income. Like the male who we’re working towards reconciliation with his parents… that’s a huge step but if he doesn’t feel good about it… then that’s not a success.’ The same case manager elaborated, ‘it’s really engaging with the knowing where the patient him or herself is at mentally, for me. Yeah. That’s a success’ (Case manager 18, homeless services specialist). This comment challenges the current paradigm where, for example, if a patient has a housing need and is matched to housing, then the case is a success. Rather, case managers viewed success as more than meeting a need but also reciprocal satisfaction from the patient.

Often, case managers valued individualised, even if seemingly small, achievements as successes: ‘Every person’s different you know. A success could be just getting up and brushing their teeth. Sometimes success is actually getting them out of the house or getting the care they need’ (Case manager 28, social worker). Another case manager echoed, ‘(Success) depends on where they’re at … it runs the gamut, you know, but they’re all successes’ (Case manager 10, public health nurse). CommunityConnect’s interdisciplinary focus was identified as an important facilitator for tailoring support to individualised client needs. In contrast with condition-specific case management settings, for example, a case manager with substance abuse training noted, ‘whether someone wants to address their substance use or not, they still have these other needs, and (with CommunityConnect) I can still provide assistance’ (Case manager 24).

However, the individualised and incremental successes are not well captured by common case management metrics. One case manager highlighted a tension between operational productivity metrics and patient success, noting, ‘I get it, that there has to be accountability. We’re out in the field, I mean people could really be doing just a whole lot of nothing… (Yet), for me I don’t find the success in the numbers. I don’t think people are a number. Oh, look I got a pamphlet for you, I’m dropping it off… I don’t think that that is what’s really going to make this programme successful’ (Case manager 8, social worker). One case manager mentioned change in healthcare utilisation as a marker of success, but more often, case managers offered stories of patient success that diverge from common programme measures. For example, one case manager observed, ‘The clear (successes) are nice: when you apply for Social Security and they get it that’s like a hurrah. And then there’s other times it’s just getting them to the dentist’ (Case manager 28, social worker). Another case manager elaborated, ‘It’s not always the big number—the how many people did I house this year. It’s the little stuff like the fact that this 58-year-old woman who believes she’s pregnant and has been living outside for years and years, a victim of domestic violence, has considered going inside. Like that is gigantic’ (Case manager 18, homeless services specialist). Overwhelmingly, case managers defined success through the interpersonal relationship with their patients within patients’ complex, daily life circumstances.

Case managers’ definitions of success focused on establishing trust, fostering patients change in mindset or initiative, and, for some patients, achieving independence and stability. Examples of success were commonly incremental and specific to an individual’s circumstances, contrasting with programmatic measures such as reduction in hospital or emergency department utilisation, benefits and other resources secured, or productivity expectations. Study themes heavily emphasise the interpersonal relationship that case managers have with patients and underscore the importance of patient-centred and patient-defined definitions of success over other outcome measures.

Our results complement prior work on clinic-based programmes for complex patients. For example, interdisciplinary staff in a qualitative study of an ambulatory intensive care centre also identified warm relationships between patients and staff as a marker of success. 26 In another study interviewing clinicians and leaders across 12 intensive outpatient programmes, three key facilitators of patient engagement emerged: (1) financial assistance and other resources to help meet basic needs, (2) working as a multi-disciplinary care team and (3) adequate time and resources to develop close relationships focused on patient goals. 27 Our results concur on the importance of a multi-disciplinary approach, establishing trusting relationships, and pursuing patient-centred goals. Our results diverge on the role of resources to meet basic needs. Case managers in our study indicated that while connections to social services benefits and other resources help initiate the case manager-patient relationship, lasting success involved longer-term relationships in which they supported patients in developing patients’ own goal setting skills and motivation.

An important takeaway from case managers’ definitions of success is the ‘how’ they go about their work, in contrast to the ‘what’ of particular care coordination activities. For example, case managers emphasise interpersonal approaches such as empathy and respect over specific processes and resource availability. Primary care clinicians, too, have expressed how standard HEDIS or CAHPS quality metrics fail to capture, and in some cases disincentivise, the intuitions in their work that are important for high quality care. 28 29 Complex care management programmes must also wrestle with this challenge of identifying standards without extinguishing underlying quality constructs.

Strengths and limitations

This study brings several strengths, including bringing to light the unique, unexplored perspective of case managers working on both health and social needs with patients facing diverse circumstances that contribute to high-risk of future hospital or emergency department utilisation. The fact that our study explores perspectives across an array of case manager disciplines is also a strength, however a limitation is that we are unable to distinguish how success differed by discipline based on smaller numbers of each discipline in this study sample. Other study limitations include generalisability to other settings, given that all case managers worked for a single large-scale social needs case management programme. Comments around productivity concerns or interdisciplinary perspectives on ways to support patients may be unique to the infrastructure or management of this organisation. In addition, at the time of the study, all case managers were able to meet with patients in-person; future studies may explore whether definitions of success change when interactions become virtual or telephonic as occurred amidst COVID-19 concerns.

This study is the first to our knowledge to inquire about holistic patient success from the perspective of case managers in the context of a social needs case management programme. The findings offer important implications for researchers as well as policy makers and managers who are designing complex case management programmes.

Our results identify patient-directed goals, stability and satisfaction, as aspects of social needs case management which are difficult to measure but nonetheless critical to fostering health and well-being. Case managers indicated these aspects are most likely to emerge through a longer-term connection with their patients. Thus, while resource-referral solutions may play an important role in addressing basic needs, 30 our findings suggest that weak patient–referrer rapport may be a limitation for such lighter touch interventions. The need for sustained rapport building is also one explanation why longer time horizons may be necessary to show outcome improvements in rigorous studies. 16

Relatedly, results point to trusting relationships as an under-recognised and understudied feature of social needs case management. Existing research finds that patients’ trust in their primary care physician is associated with greater self-reported medication adherence 31 along with health behaviours such as exercise and smoking cessation. 32 Similar quantitative results have not yet been illuminated in social needs case management contexts, yet the prominence of trusting relationships in this study as well as other sources 26 27 33 34 suggests that measures of trust should be used to complement currently emphasised outcomes such as inpatient and outpatient utilisation. Future research and programme evaluation will need to develop new trust measurement or modify existing trust measures for the social needs case management context. 31 35

In summary, study themes provide waypoints of how to conceptualise programme design, new staff training and potential measurement development for complex case management programmes like CommunityConnect. Despite the broad swath of social needs addressed, case managers coalesced on establishing a trusting relationship as a necessary foundation to appropriately identify needs and facilitate connections. Second, fostering patients’ own ideas, including a change their mindset or initiative, was important to fully make use of programme resources. Third, supporting new-found independence or stability was a gratifying, but not universally achieved marker of success. Commonly, case managers highlighted moments of success with mindfulness toward small victories, illuminating that success is non-linear with no certain path nor single end point. Themes emphasise the importance of bringing compassion for the complexity in patients’ lives and developing collaborative relationships one interaction at a time.

Acknowledgments

The authors would like to thank the CommunityConnect evaluation team for their support conducting and transcribing interviews and applying preliminary coding, especially Gabriella Quintana, Alison Stribling, Julia Surges and Camella Taylor.

Contributors: MK coded and analysed qualitative data, identified key themes and related discussion areas, and drafted and critically revised the manuscript. EEE conducted interviews, coded and analysed qualitative data, and drafted and critically revised the manuscript. EH developed the study instrument, conducted interviews, supervised data collection, contributed to the data interpretation and critically revised the manuscript. MDF contributed to the interpretation and critically revised the manuscript. NS contributed to the interpretation and critically revised the manuscript. ALB contributed to the design and interpretation and critically revised the manuscript. All authors approve of the final version to be published.

Funding: MK was supported by the Agency for Healthcare Research and Quality (AHRQ) under the Ruth L. Kirschstein National Research Service Award T32 (T32HS022241). MDF was supported by the Agency for Healthcare Research and Quality, grant # K01HS027648.

Disclaimer: Its contents are solely the responsibility of the authors and do not necessarily represent the official views of AHRQ. Funding had no role in the study’s design, conduct or reporting.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement

Ethics statements, patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by Contra Costa Regional Medical Center and Health Centers Institutional Review Committee (Protocol 12-17-2018). Participants gave informed consent to participate in the study before taking part.

• 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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Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK

Trisha Greenhalgh, Julie L. Darbyshire & Emma Ladds

Imperial College Healthcare NHS Trust, London, UK

LOCOMOTION Patient Advisory Group and Lived Experience Representative, London, UK

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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 .

Ethics declarations

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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Received : 04 December 2023

Accepted : 26 March 2024

Published : 15 April 2024

DOI : https://doi.org/10.1186/s12916-024-03371-6

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• Post-covid-19 syndrome
• Quality improvement
• Breakthrough collaboratives
• Warranted variation
• Unwarranted variation
• Improvement science
• Ethnography
• Idiographic reasoning
• Nomothetic reasoning

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