Do Your Students Know How to Analyze a Case—Really?

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J ust as actors, athletes, and musicians spend thousands of hours practicing their craft, business students benefit from practicing their critical-thinking and decision-making skills. Students, however, often have limited exposure to real-world problem-solving scenarios; they need more opportunities to practice tackling tough business problems and deciding on—and executing—the best solutions.

To ensure students have ample opportunity to develop these critical-thinking and decision-making skills, we believe business faculty should shift from teaching mostly principles and ideas to mostly applications and practices. And in doing so, they should emphasize the case method, which simulates real-world management challenges and opportunities for students.

To help educators facilitate this shift and help students get the most out of case-based learning, we have developed a framework for analyzing cases. We call it PACADI (Problem, Alternatives, Criteria, Analysis, Decision, Implementation); it can improve learning outcomes by helping students better solve and analyze business problems, make decisions, and develop and implement strategy. Here, we’ll explain why we developed this framework, how it works, and what makes it an effective learning tool.

The Case for Cases: Helping Students Think Critically

Business students must develop critical-thinking and analytical skills, which are essential to their ability to make good decisions in functional areas such as marketing, finance, operations, and information technology, as well as to understand the relationships among these functions. For example, the decisions a marketing manager must make include strategic planning (segments, products, and channels); execution (digital messaging, media, branding, budgets, and pricing); and operations (integrated communications and technologies), as well as how to implement decisions across functional areas.

Faculty can use many types of cases to help students develop these skills. These include the prototypical “paper cases”; live cases , which feature guest lecturers such as entrepreneurs or corporate leaders and on-site visits; and multimedia cases , which immerse students into real situations. Most cases feature an explicit or implicit decision that a protagonist—whether it is an individual, a group, or an organization—must make.

For students new to learning by the case method—and even for those with case experience—some common issues can emerge; these issues can sometimes be a barrier for educators looking to ensure the best possible outcomes in their case classrooms. Unsure of how to dig into case analysis on their own, students may turn to the internet or rely on former students for “answers” to assigned cases. Or, when assigned to provide answers to assignment questions in teams, students might take a divide-and-conquer approach but not take the time to regroup and provide answers that are consistent with one other.

To help address these issues, which we commonly experienced in our classes, we wanted to provide our students with a more structured approach for how they analyze cases—and to really think about making decisions from the protagonists’ point of view. We developed the PACADI framework to address this need.

PACADI: A Six-Step Decision-Making Approach

The PACADI framework is a six-step decision-making approach that can be used in lieu of traditional end-of-case questions. It offers a structured, integrated, and iterative process that requires students to analyze case information, apply business concepts to derive valuable insights, and develop recommendations based on these insights.

Prior to beginning a PACADI assessment, which we’ll outline here, students should first prepare a two-paragraph summary—a situation analysis—that highlights the key case facts. Then, we task students with providing a five-page PACADI case analysis (excluding appendices) based on the following six steps.

Step 1: Problem definition. What is the major challenge, problem, opportunity, or decision that has to be made? If there is more than one problem, choose the most important one. Often when solving the key problem, other issues will surface and be addressed. The problem statement may be framed as a question; for example, How can brand X improve market share among millennials in Canada? Usually the problem statement has to be re-written several times during the analysis of a case as students peel back the layers of symptoms or causation.

Step 2: Alternatives. Identify in detail the strategic alternatives to address the problem; three to five options generally work best. Alternatives should be mutually exclusive, realistic, creative, and feasible given the constraints of the situation. Doing nothing or delaying the decision to a later date are not considered acceptable alternatives.

Step 3: Criteria. What are the key decision criteria that will guide decision-making? In a marketing course, for example, these may include relevant marketing criteria such as segmentation, positioning, advertising and sales, distribution, and pricing. Financial criteria useful in evaluating the alternatives should be included—for example, income statement variables, customer lifetime value, payback, etc. Students must discuss their rationale for selecting the decision criteria and the weights and importance for each factor.

Step 4: Analysis. Provide an in-depth analysis of each alternative based on the criteria chosen in step three. Decision tables using criteria as columns and alternatives as rows can be helpful. The pros and cons of the various choices as well as the short- and long-term implications of each may be evaluated. Best, worst, and most likely scenarios can also be insightful.

Step 5: Decision. Students propose their solution to the problem. This decision is justified based on an in-depth analysis. Explain why the recommendation made is the best fit for the criteria.

Step 6: Implementation plan. Sound business decisions may fail due to poor execution. To enhance the likeliness of a successful project outcome, students describe the key steps (activities) to implement the recommendation, timetable, projected costs, expected competitive reaction, success metrics, and risks in the plan.

“Students note that using the PACADI framework yields ‘aha moments’—they learned something surprising in the case that led them to think differently about the problem and their proposed solution.”

PACADI’s Benefits: Meaningfully and Thoughtfully Applying Business Concepts

The PACADI framework covers all of the major elements of business decision-making, including implementation, which is often overlooked. By stepping through the whole framework, students apply relevant business concepts and solve management problems via a systematic, comprehensive approach; they’re far less likely to surface piecemeal responses.

As students explore each part of the framework, they may realize that they need to make changes to a previous step. For instance, when working on implementation, students may realize that the alternative they selected cannot be executed or will not be profitable, and thus need to rethink their decision. Or, they may discover that the criteria need to be revised since the list of decision factors they identified is incomplete (for example, the factors may explain key marketing concerns but fail to address relevant financial considerations) or is unrealistic (for example, they suggest a 25 percent increase in revenues without proposing an increased promotional budget).

In addition, the PACADI framework can be used alongside quantitative assignments, in-class exercises, and business and management simulations. The structured, multi-step decision framework encourages careful and sequential analysis to solve business problems. Incorporating PACADI as an overarching decision-making method across different projects will ultimately help students achieve desired learning outcomes. As a practical “beyond-the-classroom” tool, the PACADI framework is not a contrived course assignment; it reflects the decision-making approach that managers, executives, and entrepreneurs exercise daily. Case analysis introduces students to the real-world process of making business decisions quickly and correctly, often with limited information. This framework supplies an organized and disciplined process that students can readily defend in writing and in class discussions.

PACADI in Action: An Example

Here’s an example of how students used the PACADI framework for a recent case analysis on CVS, a large North American drugstore chain.

The CVS Prescription for Customer Value*

PACADI Stage

Summary Response

How should CVS Health evolve from the “drugstore of your neighborhood” to the “drugstore of your future”?

Alternatives

A1. Kaizen (continuous improvement)

A2. Product development

A3. Market development

A4. Personalization (micro-targeting)

Criteria (include weights)

C1. Customer value: service, quality, image, and price (40%)

C2. Customer obsession (20%)

C3. Growth through related businesses (20%)

C4. Customer retention and customer lifetime value (20%)

Each alternative was analyzed by each criterion using a Customer Value Assessment Tool

Alternative 4 (A4): Personalization was selected. This is operationalized via: segmentation—move toward segment-of-1 marketing; geodemographics and lifestyle emphasis; predictive data analysis; relationship marketing; people, principles, and supply chain management; and exceptional customer service.

Implementation

Partner with leading medical school

Curbside pick-up

Pet pharmacy

E-newsletter for customers and employees

Employee incentive program

CVS beauty days

Expand to Latin America and Caribbean

Healthier/happier corner

Holiday toy drives/community outreach

*Source: A. Weinstein, Y. Rodriguez, K. Sims, R. Vergara, “The CVS Prescription for Superior Customer Value—A Case Study,” Back to the Future: Revisiting the Foundations of Marketing from Society for Marketing Advances, West Palm Beach, FL (November 2, 2018).

Results of Using the PACADI Framework

When faculty members at our respective institutions at Nova Southeastern University (NSU) and the University of North Carolina Wilmington have used the PACADI framework, our classes have been more structured and engaging. Students vigorously debate each element of their decision and note that this framework yields an “aha moment”—they learned something surprising in the case that led them to think differently about the problem and their proposed solution.

These lively discussions enhance individual and collective learning. As one external metric of this improvement, we have observed a 2.5 percent increase in student case grade performance at NSU since this framework was introduced.

Tips to Get Started

The PACADI approach works well in in-person, online, and hybrid courses. This is particularly important as more universities have moved to remote learning options. Because students have varied educational and cultural backgrounds, work experience, and familiarity with case analysis, we recommend that faculty members have students work on their first case using this new framework in small teams (two or three students). Additional analyses should then be solo efforts.

To use PACADI effectively in your classroom, we suggest the following:

Advise your students that your course will stress critical thinking and decision-making skills, not just course concepts and theory.

Use a varied mix of case studies. As marketing professors, we often address consumer and business markets; goods, services, and digital commerce; domestic and global business; and small and large companies in a single MBA course.

As a starting point, provide a short explanation (about 20 to 30 minutes) of the PACADI framework with a focus on the conceptual elements. You can deliver this face to face or through videoconferencing.

Give students an opportunity to practice the case analysis methodology via an ungraded sample case study. Designate groups of five to seven students to discuss the case and the six steps in breakout sessions (in class or via Zoom).

Ensure case analyses are weighted heavily as a grading component. We suggest 30–50 percent of the overall course grade.

Once cases are graded, debrief with the class on what they did right and areas needing improvement (30- to 40-minute in-person or Zoom session).

Encourage faculty teams that teach common courses to build appropriate instructional materials, grading rubrics, videos, sample cases, and teaching notes.

When selecting case studies, we have found that the best ones for PACADI analyses are about 15 pages long and revolve around a focal management decision. This length provides adequate depth yet is not protracted. Some of our tested and favorite marketing cases include Brand W , Hubspot , Kraft Foods Canada , TRSB(A) , and Whiskey & Cheddar .

Art Weinstein

Art Weinstein , Ph.D., is a professor of marketing at Nova Southeastern University, Fort Lauderdale, Florida. He has published more than 80 scholarly articles and papers and eight books on customer-focused marketing strategy. His latest book is Superior Customer Value—Finding and Keeping Customers in the Now Economy . Dr. Weinstein has consulted for many leading technology and service companies.

Herbert V. Brotspies

Herbert V. Brotspies , D.B.A., is an adjunct professor of marketing at Nova Southeastern University. He has over 30 years’ experience as a vice president in marketing, strategic planning, and acquisitions for Fortune 50 consumer products companies working in the United States and internationally. His research interests include return on marketing investment, consumer behavior, business-to-business strategy, and strategic planning.

John T. Gironda

John T. Gironda , Ph.D., is an assistant professor of marketing at the University of North Carolina Wilmington. His research has been published in Industrial Marketing Management, Psychology & Marketing , and Journal of Marketing Management . He has also presented at major marketing conferences including the American Marketing Association, Academy of Marketing Science, and Society for Marketing Advances.

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Case Study-Based Learning

Enhancing learning through immediate application.

By the Mind Tools Content Team

problem solving approach case study

If you've ever tried to learn a new concept, you probably appreciate that "knowing" is different from "doing." When you have an opportunity to apply your knowledge, the lesson typically becomes much more real.

Adults often learn differently from children, and we have different motivations for learning. Typically, we learn new skills because we want to. We recognize the need to learn and grow, and we usually need – or want – to apply our newfound knowledge soon after we've learned it.

A popular theory of adult learning is andragogy (the art and science of leading man, or adults), as opposed to the better-known pedagogy (the art and science of leading children). Malcolm Knowles , a professor of adult education, was considered the father of andragogy, which is based on four key observations of adult learners:

  • Adults learn best if they know why they're learning something.
  • Adults often learn best through experience.
  • Adults tend to view learning as an opportunity to solve problems.
  • Adults learn best when the topic is relevant to them and immediately applicable.

This means that you'll get the best results with adults when they're fully involved in the learning experience. Give an adult an opportunity to practice and work with a new skill, and you have a solid foundation for high-quality learning that the person will likely retain over time.

So, how can you best use these adult learning principles in your training and development efforts? Case studies provide an excellent way of practicing and applying new concepts. As such, they're very useful tools in adult learning, and it's important to understand how to get the maximum value from them.

What Is a Case Study?

Case studies are a form of problem-based learning, where you present a situation that needs a resolution. A typical business case study is a detailed account, or story, of what happened in a particular company, industry, or project over a set period of time.

The learner is given details about the situation, often in a historical context. The key players are introduced. Objectives and challenges are outlined. This is followed by specific examples and data, which the learner then uses to analyze the situation, determine what happened, and make recommendations.

The depth of a case depends on the lesson being taught. A case study can be two pages, 20 pages, or more. A good case study makes the reader think critically about the information presented, and then develop a thorough assessment of the situation, leading to a well-thought-out solution or recommendation.

Why Use a Case Study?

Case studies are a great way to improve a learning experience, because they get the learner involved, and encourage immediate use of newly acquired skills.

They differ from lectures or assigned readings because they require participation and deliberate application of a broad range of skills. For example, if you study financial analysis through straightforward learning methods, you may have to calculate and understand a long list of financial ratios (don't worry if you don't know what these are). Likewise, you may be given a set of financial statements to complete a ratio analysis. But until you put the exercise into context, you may not really know why you're doing the analysis.

With a case study, however, you might explore whether a bank should provide financing to a borrower, or whether a company is about to make a good acquisition. Suddenly, the act of calculating ratios becomes secondary – it's more important to understand what the ratios tell you. This is how case studies can make the difference between knowing what to do, and knowing how, when, and why to do it.

Then, what really separates case studies from other practical forms of learning – like scenarios and simulations – is the ability to compare the learner's recommendations with what actually happened. When you know what really happened, it's much easier to evaluate the "correctness" of the answers given.

When to Use a Case Study

As you can see, case studies are powerful and effective training tools. They also work best with practical, applied training, so make sure you use them appropriately.

Remember these tips:

  • Case studies tend to focus on why and how to apply a skill or concept, not on remembering facts and details. Use case studies when understanding the concept is more important than memorizing correct responses.
  • Case studies are great team-building opportunities. When a team gets together to solve a case, they'll have to work through different opinions, methods, and perspectives.
  • Use case studies to build problem-solving skills, particularly those that are valuable when applied, but are likely to be used infrequently. This helps people get practice with these skills that they might not otherwise get.
  • Case studies can be used to evaluate past problem solving. People can be asked what they'd do in that situation, and think about what could have been done differently.

Ensuring Maximum Value From Case Studies

The first thing to remember is that you already need to have enough theoretical knowledge to handle the questions and challenges in the case study. Otherwise, it can be like trying to solve a puzzle with some of the pieces missing.

Here are some additional tips for how to approach a case study. Depending on the exact nature of the case, some tips will be more relevant than others.

  • Read the case at least three times before you start any analysis. Case studies usually have lots of details, and it's easy to miss something in your first, or even second, reading.
  • Once you're thoroughly familiar with the case, note the facts. Identify which are relevant to the tasks you've been assigned. In a good case study, there are often many more facts than you need for your analysis.
  • If the case contains large amounts of data, analyze this data for relevant trends. For example, have sales dropped steadily, or was there an unexpected high or low point?
  • If the case involves a description of a company's history, find the key events, and consider how they may have impacted the current situation.
  • Consider using techniques like SWOT analysis and Porter's Five Forces Analysis to understand the organization's strategic position.
  • Stay with the facts when you draw conclusions. These include facts given in the case as well as established facts about the environmental context. Don't rely on personal opinions when you put together your answers.

Writing a Case Study

You may have to write a case study yourself. These are complex documents that take a while to research and compile. The quality of the case study influences the quality of the analysis. Here are some tips if you want to write your own:

  • Write your case study as a structured story. The goal is to capture an interesting situation or challenge and then bring it to life with words and information. You want the reader to feel a part of what's happening.
  • Present information so that a "right" answer isn't obvious. The goal is to develop the learner's ability to analyze and assess, not necessarily to make the same decision as the people in the actual case.
  • Do background research to fully understand what happened and why. You may need to talk to key stakeholders to get their perspectives as well.
  • Determine the key challenge. What needs to be resolved? The case study should focus on one main question or issue.
  • Define the context. Talk about significant events leading up to the situation. What organizational factors are important for understanding the problem and assessing what should be done? Include cultural factors where possible.
  • Identify key decision makers and stakeholders. Describe their roles and perspectives, as well as their motivations and interests.
  • Make sure that you provide the right data to allow people to reach appropriate conclusions.
  • Make sure that you have permission to use any information you include.

A typical case study structure includes these elements:

  • Executive summary. Define the objective, and state the key challenge.
  • Opening paragraph. Capture the reader's interest.
  • Scope. Describe the background, context, approach, and issues involved.
  • Presentation of facts. Develop an objective picture of what's happening.
  • Description of key issues. Present viewpoints, decisions, and interests of key parties.

Because case studies have proved to be such effective teaching tools, many are already written. Some excellent sources of free cases are The Times 100 , CasePlace.org , and Schroeder & Schroeder Inc . You can often search for cases by topic or industry. These cases are expertly prepared, based mostly on real situations, and used extensively in business schools to teach management concepts.

Case studies are a great way to improve learning and training. They provide learners with an opportunity to solve a problem by applying what they know.

There are no unpleasant consequences for getting it "wrong," and cases give learners a much better understanding of what they really know and what they need to practice.

Case studies can be used in many ways, as team-building tools, and for skill development. You can write your own case study, but a large number are already prepared. Given the enormous benefits of practical learning applications like this, case studies are definitely something to consider adding to your next training session.

Knowles, M. (1973). 'The Adult Learner: A Neglected Species [online].' Available here .

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Problem-Solving in Business: CASE STUDIES

  • ABOUT THIS LIBGUIDE
  • PROBLEM-SOLVING DEFINED AND WHY IT IS IMPORTANT
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  • Last Updated: Feb 8, 2024 1:33 PM
  • URL: https://libguides.nypl.org/problem_solving_in_business
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The HBS Case Method

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How the HBS Case Method Works

problem solving approach case study

How the Case Method Works

problem solving approach case study

  • Read and analyze the case. Each case is a 10-20 page document written from the viewpoint of a real person leading a real organization. In addition to background information on the situation, each case ends in a key decision to be made. Your job is to sift through the information, incomplete by design, and decide what you would do.
  • Discuss the case. Each morning, you’ll bring your ideas to a small team of classmates from diverse professional backgrounds, your discussion group, to share your findings and listen to theirs. Together, you begin to see the case from different perspectives, better preparing you for class.
  • Engage in class. Be prepared to change the way you think as you debate with classmates the best path forward for this organization. The highly engaged conversation is facilitated by the faculty member, but it’s driven by your classmates’ comments and experiences. HBS brings together amazingly talented people from diverse backgrounds and puts that experience front and center. Students do the majority of the talking (and lots of active listening), and your job is to better understand the decision at hand, what you would do in the case protagonist’s shoes, and why. You will not leave a class thinking about the case the same way you thought about it coming in! In addition to learning more about many businesses, in the case method you will develop communication, listening, analysis, and leadership skills. It is a truly dynamic and immersive learning environment.
  • Reflect. The case method prepares you to be in leadership positions where you will face time-sensitive decisions with limited information. Reflecting on each class discussion will prepare you to face these situations in your future roles.

Student Perspectives

problem solving approach case study

“I’ve been so touched by how dedicated other people have been to my learning and my success.”

Faculty Perspectives

problem solving approach case study

“The world desperately needs better leadership. It’s actually one of the great gifts of teaching here, you can do something about it.”

Alumni Perspectives

problem solving approach case study

“You walk into work every morning and it's like a fire hose of decisions that need to be made, often without enough information. Just like an HBS case.”

Celebrating the Inaugural HBS Case

problem solving approach case study

“How do you go into an ambiguous situation and get to the bottom of it? That skill – the skill of figuring out a course of inquiry, to choose a course of action – that skill is as relevant today as it was in 1921.”

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  • J Microbiol Biol Educ
  • v.19(3); 2018

A Systematic Approach to Teaching Case Studies and Solving Novel Problems †

Carolyn a. meyer.

1 Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80523

Heather Hall

Natascha heise, karen kaminski.

2 School of Education, Colorado State University, Fort Collins, CO 80523

Kenneth R. Ivie

Tod r. clapp, associated data.

Both research and practical experience in education support the use of case studies in the classroom to engage students and develop critical thinking skills. In particular, working through case studies in scientific disciplines encourages students to incorporate knowledge from a variety of backgrounds and apply a breadth of information. While it is recognized that critical thinking is important for student success in professional school and future careers, a specific strategy to tackle a novel problem is lacking in student training. We have developed a four-step systematic approach to solving case studies that improves student confidence and provides them with a definitive road map that is useful when solving any novel problem, both in and out of the classroom. This approach encourages students to define unfamiliar terms, create a timeline, describe the systems involved, and identify any unique features. This method allows students to solve complex problems by organizing and applying information in a logical progression. We have incorporated case studies in anatomy and neuroanatomy courses and are confident that this systematic approach will translate well to courses in various scientific disciplines.

INTRODUCTION

There is increasing emphasis in pedagogical research on encouraging critical thinking in the classroom. The specific mental processes and behaviors involved require the individual to engage in reflective and purposeful thinking. Critical thinking encompasses the ability to examine ideas, make decisions, and solve problems ( 1 , 2 ). The skills necessary to think critically are essential for learners to evaluate multiple perspectives and solve novel problems in the classroom and throughout life. Career success in the 21st century requires a complex set of workforce skills. Current labor market assessments indicate that by the year 2020, the majority of occupations will require workers to display cognitive skills such as active listening, critical thinking, and decision making ( 3 , 4 ). In particular, current studies show that the US economy is impacted by a deficit of skilled workers able to solve problems and transfer learning to any unique situation ( 3 ).

The critical thinking skills necessary to tackle novel problems can best be addressed in higher education institutions ( 5 , 6 ). Throughout education, and specifically in college courses, students tend to be required to regurgitate knowledge through a myriad of multiple-choice exams. Breaking this habit and incorporating critical thinking can be difficult for students. While the ability to recite information is helpful for establishing base knowledge, it does not prepare students to tackle novel problems. Ideally, the objective of any course is to encourage students to move beyond recognition of knowledge into its application ( 7 ). Considering this, the importance of critical thinking is widely accepted; however, there has been some debate in educational research regarding how to teach these skills ( 8 ). Research has demonstrated that students show significant improvements in critical thinking as a result of explicit methods of instruction in related skills ( 9 , 10 ). Explicit instruction provides a protocol on how to approach a problem. By establishing the necessary framework to work through unfamiliar details, we enable students to independently solve complex problems.

These skills, which are important in every facet of the workforce, are vital for students in the sciences ( 10 , 11 ). Here, we discuss a specific process that teaches students a systematic approach to solving case studies in the anatomical sciences. Case studies are a popular method to encourage critical thinking and engage students in the learning process ( 12 ). While the examples described here are specifically designed to be implemented in anatomy and neuroanatomy courses, this platform lends itself to teaching critical thinking skills across scientific disciplines. This four-step approach encourages students to work through four separate facets of a problem:

  • Define unfamiliar terms
  • Create a timeline associated with the problem
  • Describe the (anatomical) systems involved
  • Identify any unique features associated with the case

Often, students start by trying to plug in memorized facts to answer a complicated question quickly. With the four-step approach, students learn that before “solving” the case study, they must analyze the information presented in the case. The case studies implemented are anatomically-based case studies that emphasize important structural relationships. The case may include terminology with which the students are not familiar. They therefore begin by identifying and defining unfamiliar terms. They then specify the timeline in which the problem occurred. Establishing a timeline and narrowing the focus can be critical when considering the relevant pathology. Students must then describe the anatomical systems involved (e.g., musculoskeletal or circulatory), and finally list any additional unique features of the case (e.g., lateral leg was struck or patient could not abduct the right eye). By dissecting the details along the lines of these four categories, students create a clear roadmap to approach the problem. Case studies with a clinical focus are complex and can be overwhelming for unpracticed students. However, teaching students to follow this systematic approach gives them the tools to begin to carefully dismantle even the most convoluted problem.

Intended audience

This approach to solving case studies has been applied in undergraduate courses, specifically in the sciences. This curriculum is currently utilized in both human gross anatomy and functional neuroanatomy capstone courses. While it is ideal to implement this process in a course that runs in parallel with a lecture-heavy course, it can also be utilized with case studies in a typical lecture class.

Anatomy-based case studies lend themselves well to this problem-solving approach due to the complexities of clinical problems. However, we believe with an appropriately designed case study, this model of teaching critical thinking can easily be expanded to any discipline. This activity encourages critical thinking and engages students in the learning process, which we believe will better prepare them for professional school and careers in the sciences.

Prerequisite student knowledge

Required previous student knowledge only extends to that which students learn through the related course taken previously or concurrently. Application of this approach in different classroom settings only requires that students have a basic understanding of the material needed to solve the case study. As such, the case study problem and questions should be built around current topics being studied in the classroom.

Using unfamiliar words teaches students to identify important information. This encourages integration of information and terminology, which can be critical for understanding anatomy. Simple terms, like superficial or deep, guide discussions about anatomical relationships. While students may be able to recite the definitions of these concepts, applying that information to a case study requires integrating the basic definition with an understanding of the relevant anatomy. Specific prerequisite knowledge for the sample case study is detailed in Appendix 1 .

Learning time

This process needs to be learned and practiced over the course of a semester to ensure long-term retention. With structured and guided attempts, students will be able to implement this approach to solving case studies in one 50-minute class period ( Table 1 ). The course described in this study is a capstone course that meets once weekly. Each 50-minute class period centers around working through a case study. As some class sessions are reserved for other activities, students complete approximately 10 case studies during the semester. Students begin to show increased confidence with this method within a few weeks and ultimately are able to integrate this approach into their critical thinking skillset by the end of the semester. Presentation of the case study, individual or small group work, and class discussion are all achieved in one standard class session ( Table 1 ). The current model does not require student work prior to the class meeting. However, because this course is taken concurrently with a related, content-heavy lecture component, students are expected to be up to date on relevant material. Presenting the case study in class to their peers encourages students to work through the systematic approach we describe here. Each case study is designed to correlate with current topics from the lecture-based course. Following the class period, students are expected to complete a written summary of the discussed case study. The written summary should include a detailed explanation of the approach they utilized to solve the problem, as well as a definitive solution. Written summaries are to be completed two days after the original class period.

Anticipated in-class time to implement this model.

Learning objectives

This model for teaching a systematic approach to solving case studies provides a framework to teach students how to think critically and how to become engaged learners when given a novel problem. By mastering this technique, students will be able to:

  • Recognize words and concepts that need to be defined before solving a novel problem
  • Recall, interpret, and apply previous knowledge as it relates to larger anatomical concepts
  • Construct questions that guide them through which systems are affected, the timeline of the pathologies, and what is unique about the case
  • Formulate and justify a hypothesis both verbally and in writing

As a faculty member, it can be challenging to create appropriate case studies when developing this model for use in a specific classroom. There are resources that provide case studies and examples that can be tailored to specific classroom needs. The National Center for Case Study Teaching in Science (University at Buffalo) can be a useful tool. The ultimate goal of this model is to teach an approach to problem solving, and a properly designed case study is crucial to success. To build an effective case study, faculty must include sufficient information to provide students with enough base knowledge to begin to tackle the problem. This model is ideal in a course that pairs with a lecture-heavy component, utilized in either a supplementary course or during a recitation. The case study should be complex and not quickly solved. An example of a simplified case study utilized in Human Gross Anatomy is detailed in Appendix 1 .

This particular case study encourages students to think through the anatomy of the lateral knee, relevant structures in this area, and which muscle compartments may be affected based on movement disabilities within the case. While more complex case studies can certainly be developed for the Neuroanatomy course through Clinical Case Studies, this case study provides a good example of a problem to which students cannot immediately provide the answer. They must think critically through the four-step process to identify the “diagnosis” for this patient.

This approach to solving case studies can be integrated into the classroom with no special materials. However, we use a Power-Point presentation and personal whiteboards (2.5’ × 2’) to both improve delivery of the case study and facilitate small group discussion, respectively. The Power-Point presentation is utilized by faculty to assist in leading the classroom discussion, prompting student responses and projecting relevant images. As the faculty member is presenting the case study during the first five minutes of class ( Table 1 ), the wording of the case study can be displayed on the PowerPoint slide as a reference while students take notes.

Faculty instructions

It is helpful to first present an overview of the approach and to solve a case study together as a class. We recommend giving students a lecture describing the benefits of a systematic approach to case studies and emphasizing the four-step approach outlined in this paper. Following this lecture, it is imperative that faculty walk the students through the first case study. This helps to familiarize students with the approach and lays out expectations on how to break down the individual components of the case. During the initial case study, faculty must heavily moderate the discussion, leading students through each step of the approach using the provided Case Study Handout ( Appendix 2 ). In subsequent weeks, students can be expected to show increasing independence.

Following initial presentation of the case study in class, students begin work that is largely independent or done in small groups. This discussion has no grades assigned. However, following the in-class discussion and small group work, students are asked to detail their approach to solving the case study and their efforts are graded according to a set rubric ( Appendix 3 ). This written report should document each step of their thought process and detail the questions they asked to reach the final answer, providing students with a chance for continual self-evaluation on their mastery of the method.

Implementing this model in the classroom should focus not only on the individual student approach, but also on creating an encouraging classroom environment and promoting student participation. Student questions may prompt other student questions, leading to an engaging discussion-based presentation of the case study, which is crucial to increasing confidence among students, as has been seen with the data represented in this paper. When moderating the discussion, it is important that faculty emphasize to students that the most critical goal of the exercise is to learn how to ask the next most appropriate question. The questions should begin with broad concepts and evolve to discussing specific details. Efforts to quickly arrive at the answer should be discouraged.

Students should be randomly assigned to groups of two to three individuals as faculty members moderate small group discussion during class. Randomly assigning students to different groups each week encourages interaction between all students in the class and promotes a collaborative environment. Within their small groups, students should work through the systematic four-step process for solving a novel problem. Students are not assigned specific roles within the group. However, all group members are expected to contribute equally. During this process, it can be beneficial to provide students with a template to follow ( Appendix 2 ). This template guides their discussion and encourages them to use the four-step process. Additionally, each small group is given a white board that they can use to facilitate their small group discussions. Specifically, asking students to write down details of each of the four facets of the problem (definitions, timeline, systems involved, unique features) and how they arrived at these encourages them to commit to their answers. This also ensures they have concrete evidence to support their “diagnosis” and that they have confidence in presenting it to the class. Two or three small groups are chosen randomly each week to present their hypothesis to the class using their whiteboard.

Suggestions for determining student learning

The cadence of the in-class discussion can provide an informal gauge of how students are progressing with their ability to apply the systematic approach. The discussion for the initial case studies should be largely faculty led. Then, as the semester progresses, faculty should step back into a facilitator role, allowing the dialogue to be carried by the students.

Additionally, requiring students to write a detailed summary of their approach to the problem provides a strong measure of student learning. While it is important for students to document their final “diagnosis” or solution to the problem, the focus of this assignment is primarily on the process and the series of relevant questions the student used to arrive at the answer. These assignments are graded according to a set rubric ( Appendix 3 ).

Sample data

The following excerpt is from a student who showed marked improvement over the course of the semester in implementing this approach to solving case studies. The initial submission for the case study write-up was rudimentary, did not document the thought process through appropriate questions, and lacked an in-depth explanation to demonstrate any critical thinking. By the end of the semester, this student documented a logical thought progression through this four-step approach to solving the case study. This student, additionally, detailed the questions that led each stage of critical thinking until a “diagnosis” was reached (complete sample data are available in Appendix 4 ).

Initial sample

“Given loss of sensory and motor input to left lower limb, right anterior cerebral artery ischemia caused the sensory and motor cortices of the contralateral (left) lower limb to be without blood flow for a short amount of time (last night). The lack of flow led to a fast onset of motor and sensory paresis to limb.”

Final sample

“…the left vestibular nuclei which explains the nystagmus, and the left cerebellar peduncles which carry information that aids in coordinating intention movements. My next question was where in the brainstem are all of these components located together? I narrowed this to the left caudal pons. Finally, I asked which artery supplies the area that was damaged by the lesion? This would be the left anterior inferior cerebellar artery.”

Safety issues

There are no known safety issues associated with implementing this approach to solving case studies.

The primary goal of the model discussed here is to give students a method that uses critical reasoning and helps them incorporate facts into a complete story to solve case studies. We believe that this model addresses the need for teaching the specific skill set necessary to develop critical thinking and engage students in the learning process. By encouraging critical thinking, we begin to redirect the tendency to simply recite a memorized answer. This four-step approach to solving case studies is ideal for the college classroom, as it is easily implemented, requires minimal resources, and is simple enough that students demonstrate mastery within one semester. While it was designed to be used in anatomy and neuroanatomy courses, this platform can be used across scientific disciplines. Outside of the classroom, in professional school and future careers, this approach can help students to break down the details, ask appropriate questions, and ultimately solve any complex, novel problem.

Field testing

This model has been implemented in several courses in both undergraduate and graduate settings. The data and approach detailed here are specific to an undergraduate senior capstone course with approximately 25 students. The lecture-based course, which is required to be taken concurrently or as a prerequisite, provides a strong base of information from which faculty can develop complex case studies.

Evidence of student learning

Student performance on written case study summaries improved over approximately ten weeks of practicing the systematic four-step approach ( Fig. 1 ). As indicated by the data, scores improve and begin to plateau around five weeks, indicating a mastery of the approach. In the spring 2016 semester, a marked drop in scores was observed at week 8. We believe that this reflects a particularly difficult case study that was assigned that week. After observing the overall trend in scores, instructional format was adjusted to provide students with more guidance as they worked through this particular case study.

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Grade performance in case study written summaries as measured with the grading rubric throughout the semester. A) Mean (with SD) grade performance in case study write-ups in the spring semester of 2016. B) Mean (with SD) grade performance in case study write-ups in the spring semester of 2017. Overall grade performance in case study written summaries improved throughout the 10 weeks in which this method was implemented in the classroom. Written summaries are graded based on a set rubric ( Appendix 3 ) that assigned a score between 0 and 1 for five different categories. Data represent the mean of students’ scores and the associated standard deviation. Improved student performance throughout the semester indicates progress in successful incorporation of this method to solve a complex novel problem.

After the class session, students were asked to provide a written summary of their findings. A set rubric ( Appendix 3 ) was used to assess students on their ability to apply basic anatomical knowledge as it relates to the timeline, systems involved, and what is unique in each case study. Students were also asked to describe the questions that they had asked in order to reach a diagnosis for the case study. The questions formulated by students indicate their ability to bring together previous knowledge to larger anatomical concepts. In this written summary, students were also required to justify the answer they arrived at in each step of the process. In addition to these four steps, students were assessed on the organization of their paper and whether their diagnosis is well supported.

Although class participation was not formally assessed, the improvements demonstrated in the written assignments were mirrored in student discussions in the classroom. While it is difficult to accurately assess how well students think critically, students demonstrated success in learning this module, which provides the necessary framework for approaching and solving a novel problem.

Student perceptions

Students were asked to answer the open response question, “Describe the process you use to figure out a novel problem or case study.” Responses were anonymized, then coded based on frequency of responses. Responses were collected at the start of the semester, prior to any instruction in the described systematic approach, and again at the end of the semester ( Figs. 2 and ​ and3). 3 ). Overall, student comments indicated that mastering this four-step approach greatly increased their confidence in tackling a novel problem. Below are some sample student responses.

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Student responses to a survey regarding their approach to solving a novel problem. Data were collected prior to and following the completion of the spring semester of 2016. A) Student approach to solving a novel problem at the beginning of the semester. B) Student approach to solving a novel problem at the end of the semester. Student responses indicate that following a semester of training in using this method, students prefer to use this four-step systematic approach to solve a novel problem.

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Student responses to a survey regarding their approach to solving a novel problem. Data were collected prior to and following the completion of spring semester of 2017. A) Student approach to solving a novel problem at the beginning of the semester. B) Student approach to solving a novel problem at the end of the semester. Student responses indicate that students overwhelmingly utilize this systematic approach when solving a novel problem.

“Rather than being intimidated with a set of symptoms I can’t explain, I’m now able to break them down into simpler questions that will lead me down a path of understanding and accurate explanation.” “I now know how to address an exam question or life problem by considering what is needed to solve it. This knowledge will help me to address each problem efficiently and calmly. As a future nurse, I will benefit from developing a logical and stereotypical approach to solving problems. I have learned to assess my thinking and questioning and modify my approach to problem-solving. While the problems may be different in the future, I am confident that I will be able to efficiently learn from my successes and setbacks and continually improve.” “I’m sure I’ll use this approach when I’m faced with any other novel problem, whether it’s scientific or not. Stepping back and establishing what I know and what I need to find out makes difficult problems a lot more approachable.” “Before, I would look at all the information presented and try to find things that I recognized. Then I would simply ask myself if I knew the answer. Even if I did actually know the answer, I had no formula to make the information understandable, cohesive, or approachable. I now feel far more confident when dealing with novel problems and do not become immediately overwhelmed.”

This approach encourages students to quickly sort through a large amount of information and think critically. Although students can find the novel nature of this method cumbersome in the initial implementation in the classroom, once they become familiar with the approach, it provides a valuable platform for attacking any novel problem in the future. The ability to apply this approach to critical thinking in any discipline was also demonstrated, as is evidenced by the two following student responses.

“When I first thought about this question and when solving case studies I tried to find the answer immediately. I’m good at memorizing information and spitting it back out but not working through an issue and having a method. I definitely have a more successful way to think through complex problems and being patient and coming up with an answer.” “I already use it in many of my other classes and life cases. When I take an exam that is asking a complicated question or is in a long format, I work to break it down like I did in this class and try to find the base question and what the answer may be. It has actually helped significantly.”

Possible modifications

Currently, students are randomly assigned to groups each week. In future semesters, we could improve small group work by utilizing software that helps to identify individual student strengths and assign groups accordingly. Additionally, while students are given flexibility within their small groups, if groups struggle with equality of workload we could assign specific roles and tasks.

We are also using this model in a large class (100 students) and assessing understanding of the case study through instant student response questions (ICLICKER). While this model does not allow for the valuable in-depth classroom discussions, it still presents the approach to students and allows them to begin to implement it in solving complex problems. Preliminary data from these large classes indicate that students initially find the method difficult and cumbersome. Further development and testing of this model in a large classroom will improve its use for future semesters.

SUPPLEMENTAL MATERIALS

Appendix 1: sample case study, appendix 2: case study handout, appendix 3: case study grading rubric, appendix 4: student writing sample, acknowledgments.

Use of anonymized student data and student responses to surveys was approved by the Institutional Review Board at Colorado State University. The authors declare that there are no conflicts of interest.

† Supplemental materials available at http://asmscience.org/jmbe

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Approaching a Case

How to solve a case study – a structured approach.

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Key takeaways:

  • Follow the 4 Commandments
  • Get a feeling and true  understanding  of the problem and the objective
  • Lay out an exhaustive, well-thought-through  structure
  • Build an initial  hypothesis  and  prioritize  the different areas
  • Gather data  based on your hypothesis and priorities
  • Evaluate  the data keeping in mind your problem and goal
  • Track down  the root cause and the area which would have the biggest impact
  • Develop possible solutions,  weigh them, and choose the best one. Make sure your solution is based on the data irrespective of whether it is positive or negative. Keep in mind that the  best feasible solution  is truly the best solution!

Do you need more insightful tips on how to approach your case interview in management consulting? Read our comprehensive case interview guide that gives you tips for your case interview preparation, step-by-step explanations to solve the case, and lastly 13 valuable tips for your actual interview day.

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How to Approach a Case Study in a Problem Solving Workshop

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How to Approach a Case Study - A Structured 4-Step Approach

  • Last Updated February, 2023

The Internet is filled with frameworks on how to approach a case study. But which one will help you ace your case and land an offer at a top consulting firm?

At My Consulting Offer, former Bain, BCG, and McKinsey consultants have developed a proven 4-step approach that will help you tackle any type of case study. We’v helped over 600 recruits land the consulting jobs of their dream.

Want to know the secret? Keep reading!

In this article, we’ll walk you through our 4-step approach and talk about what the interviewer expects at each step, including:

  • How to approach a case study.
  • Clarifying the client’s objectives.
  • Framing a logical structure.
  • Making sense of the provided information.
  • Giving a strong recommendation.

Let’s get started!

Approaching a Case Study

Analyzing the right case information, case interview opening: getting to know the key objective, concluding your case with a strong recommendation, framing a customized problem-solving structure.

A case interview always starts with a prompt. A prompt is the initial information about the case provided by the interviewer. It gives you a brief background of the client’s problem and the key objective.

Here’s an example:

“Your client today is an NYC-based violinist. She’s been saving up for her wedding, but she broke her leg and can’t leave her apartment. She’s got to find a new plan for coming up with her wedding savings now and needs help.”

In the above example, we get to know the background and the objective.

Background: Our client Maria is an NYC-based violinist and has been saving for her wedding.

Objective: Find ways for the client to increase her savings for her wedding without leaving her apartment. 

After the prompt is given, you’re expected to drive the case forward. Our 4-step approach will help you do just that.

  • Opening – Understand and reconfirm the objective and ask clarifying questions.
  • Structure – Develop a problem-solving structure to answer the key questions.
  • Analysis – Dive deeper into analyzing relevant issues and use data provided by your interviewer to make conclusions.
  • Recommendation – Give a strong actionable recommendation by tying together the insights.

Let’s dive into each step of the 4-step guide so you can solve cases like a pro!

The first step to solving any problem is to know the key objective a.k.a. the “north star” which will help you guide the case in the right direction.

This seemingly simple, but it’s where many interviewees fail. They think the prompt has given them all the relevant information, so they rush to start solving the problem.

But, as you saw in the prompt, the objective is touched upon but isn’t clear or measurable . You got to know that the client is looking for ways to increase her wedding savings while staying in her apartment with a broken leg.

We still don’t know what the target is and how much of it is already saved. Additionally, as there were no clarifying questions asked, no other details were shared by the interviewer.

Nail the case & fit interview with strategies from former MBB Interviewers that have helped 89.6% of our clients pass the case interview.

What should the Case Opening Look Like?

It’s important to ask questions like:

  • What does success look like for the client? Does she have a target in mind for her wedding?
  • How was she making money before she broke her leg?
  • What are her income streams?
  • Is she willing to cut her expenses to increase savings or is she looking only for ways to increase her income?

These questions help us understand the following:

Tangible or Measurable Objective – What is the target in the client’s mind?

Additional Information – prior income sources, income source while stuck in her apartment, her focus on increasing income rather than reducing costs.

What does the interviewer expect from you in the case opening?

  • Restate the prompt in your own words
  • Confirm the key objective 
  • Ask a few key clarifying questions (3-5) to know more about the overarching context of the case – making sure you understand the client’s product, business model, or geographic focus 

Now let’s learn how to create a comprehensive and customized problem-solving structure.

The internet is filled with problem-solving approaches and frameworks, like:

  • The BCG 2 x 2 Matrix
  • The Profitability Formula
  • McKinsey’s 7S Framework
  • Porter’s 5 Forces

These frameworks help break business problems into smaller parts that can be analyzed to figure out a solution. But as these frameworks are generic, it might feel like they are being force-fitted to the problem in your case. No standard framework will ever fit all situations. 

Creating a case-specific problem-solving structure isn’t difficult and with the right approach, you can create it with ease.

How to Create a Customized Structure

Start with the key objective, increasing Maria’s savings for her wedding. How can we break this problem down into sub-parts? If you were using a generic framework, you might use the 3C + P framework and break the problem into:

  • Competitors

You could then think of questions in each bucket that would help Maria understand potential opportunities to expand her income. 

But, with this approach, you wouldn’t be likely to stand out! Lots of candidates will approach this case with the same 4 buckets. This is why a customized approach is important.

While creating your structure, there are a few things that you should do to ensure that your structure touches on all relevant points and helps you to drive the case forward. Your structure should be:

  • Logical – Each bucket in the structure should logically align with the key objective.
  • Personalized – As you are creating the buckets, personalize them to the case at hand.
  • MECE – MECE stands for “ Mutually exclusive, Collectively exhaustive .” This helps you ensure that there are no overlapping buckets and you cover all the key aspects of the problem.
  • Depth – As you dig deeper into each bucket, ask yourself if you have covered all possible questions in the bucket. Create sub-buckets of the main buckets wherever necessary.

You can read more about structuring your analysis of business problems in our article on issue trees .

What does a Good vs. Great Structure Look Like?

Comparing the two structures above, we can see that Candidate B has created a better structure than Candidate A. Although Candidate A covered all important aspects, Candidate B has personalized their structure to Maria’s problem.

Communicating the structure in an easy-to-understand manner is as important as creating a robust structure. When communicating the structure:

  • Ensure that the interviewer can follow your structure.
  • Communicate one level at a time.
  • Use a numbered list to walk through the structure.

After walking the interviewer through the structure, you should choose the bucket that should be explored first to answer the key question. You could say something like –

“Now that we have walked through the opportunities for increasing her revenue, I’d like to dive into the skills Maria has that she could leverage.”

The interviewer could either agree or disagree with the first bucket that you want to dig deeper into. Some companies, like McKinsey, use interviewer-led case interviews and will lead you through the case following a specified path. Others, like Bain and BCG, will let you lead the case and just nudge you if you seem to be veering off-path. In either case, you’ll need to start by brainstorming and providing ideas on the first bucket or you’ll need to analyze data and derive conclusions.

There are 3 main types of analysis you may need to do to answer the key question:

Brainstorming

Market sizing, exhibit reading.

Let’s see how each of these would help us drive the case forward and derive conclusions.

In a brainstorming exercise, a strong candidate will generate 8-10 ideas bucketed into categories. In the current case example, you could be asked for ideas on how Maria could make more money.

One set of categories you could use to generate ideas follows what we call the “X-not X” approach. Essentially, you start with a bucket like “playing music” and generate ideas in that bucket. Then switch to “not playing” and generate ideas for this bucket. This will help you in generating at least 2x ideas you otherwise would and will look more impressive to your interviewer because it is MECE and structured.

Let’s see how brainstorming plays out in our case example.

“Maria likes your approach and wants to start right away. Because she is currently not making any money, she would like some ideas. What are some ideas you have on how she could make money? She only wants to focus on leveraging her violin talents.”

The above example shows how you could use the “X-not X” approach to generate a lot of ideas – and how you could even further structure the ideas into “online” and “offline” categories to make it an exceptional brainstorming example.

You may also be expected to calculate the size of a market for your client’s product or service – after all, one of the most important things to know before pursuing an opportunity is the size of that opportunity. In the current example, you could be asked to calculate the income that Maria could earn by offering online violin classes.

There are 2 approaches to market sizing:

  • Top-down: This is used when there are no constraints. In this approach, you start with the overall population that may be interested in the product or service and slice it down based on the segments of the market most likely to purchase. The top-down approach is best for national and global markets.
  • Bottom-up: This approach is used when there are some constraints, like supply constraints, a limited number of hours, etc. In this approach, you start with the limiting factor and try to estimate the maximum that can be achieved based on the constraints.

Let’s see how we can use market sizing to help our client.

“Maria likes the ideas you came up with. She thought about being a violin teacher at one point since she had a great one when she started as a kid and is curious, how much could she make if she were to teach one-on-one Zoom classes for the next month? She wants to start small before she goes to group classes and, in the beginning, it will be just her teaching.”

Here’s an example of how you could work through this question:

The above shows how you could estimate the income which our client can expect to make in the first month. 

Follow up your analysis by giving your answer the “sniff test.” Does it seem right at a high level? Here we see that $4,000 is the estimated first month’s income, but as this would be the first time Maria will be taking online classes, she won’t be working at full capacity from the start. Her earnings will probably be lower than $4,000.

But, in the long run, it’s a good idea to start offering lessons because at full capacity, Maria will be able to earn $8,000 per month.

In case interviews, you’ll be expected to derive conclusions based on tables or charts provided by your interviewer. In the current example, you could be asked to help the client prioritize which type of client should she target for her violin classes.

Let’s see what data is available and how we can conclude which segment to go after.

“Maria is happy to know that you think providing 1:1 violin lessons over Zoom is a viable idea. 

She knows that a lot of people are interested in violin lessons, but to make sure she can tailor her marketing and lessons, she is interested in only going after one or two segments.

Which one should she go after?”

The first step to deriving insights from an exhibit is to read it thoroughly and ideally interpret it aloud as you go for your interviewer. This chart has data about willingness to pay and competitiveness across various segments. It gives an idea about the level of competition from other violin instructors. The market size of each segment is portrayed using the size of the circle. At first glance, it might seem that the client should go ahead with the segment which has the lowest competition and highest willingness to pay, which is the “Adult-Advanced” segment. But, that segment has a really small market size and Maria would need extensive teaching experience to cater to advanced students.

This is the first time Maria is getting into this market, but she also wants to have a high earning potential. The optimum segment would be one with a good market size and a reasonable trade-off between willingness to pay and competitiveness. 

Based on this, Maria should go with the “college-intermediate” and “adult-intermediate” segments. She would be able to cater to both these segments with ease. Additionally, the combined market size is considerable and the relative trade-off of competitiveness and willingness to pay is suitable as well.

What does the interviewer expect when you are doing analysis and deriving insights?

  • Pause to think about the structure for marking sizing or ideas for brainstorming. If you’re asked to read an exhibit, take a moment to understand it and lay out what it says to your interviewer before interpreting the data it provides.
  • Offer insights into your client’s problem as the data presents them and draw conclusions.
  • Drive the case forward based on the insights. What does this data mean for solving your client’s problem?

Maria came to you with a problem in hand and won’t be thrilled to just get the insights in bits or pieces. Pull your problem-solving together for her with a persuasive recommendation.

Think of the case interview as baking an amazing cake. While the structure and derived insights form the main ingredients for baking the cake, the recommendation is like the cherry on top. It helps in creating a lasting positive impression.

Similar to the opening of the case, the recommendation can seem relatively straightforward, but it is definitely nuanced. MCO’s 5R framework could help you deliver great recommendations for every case.

How should you present your recommendations?

MCO’s 5R Framework:

  • Recap: As consultants, you deal with CXO (e.g., CEO, CFO) level clients who are busy with many projects, so recapping the problem you’re solving is essential to set the tone of the meeting.
  • Recommendation: State your recommendations clearly without any additional detail to showcase clarity.
  • Reasons: Follow this with logical reasons for your recommendations to provide context and show the credibility of the recommendations.
  • Risks: Every decision has risks associated with it. Just lay them out so the client knows what to watch out for during implementation.
  • Retain: End the recommendations with key next steps to pursue the opportunity, ensuring continuous engagement with the client.

Let’s see how to give a strong recommendation for our case example.

“Your client calls you and wants to know what you recommend.”

What does the interviewer expect when closing the case?

  • Keep the recommendation clear and succinct keeping the audience in mind.
  • Explain everything with a reason and point out risks associated with the recommendation.
  • Be presentable and communicate the recommendations with confidence.
  • Ensure that the next steps are clearly laid out.

A final note: Not all cases have a “Right” and “Wrong” answer. In some, the math is very cut and dry but in others, there is a mix of evidence and it is a judgment call on what to recommend. Remember that a well-defended recommendation is more important than the “exact right answer.”

– – – – –

In this article, we’ve provided frameworks and tips to ace the different sections of a case interview. You are now equipped with the knowledge to:

  • Approach a case study.
  • Clarify client objectives.
  • Frame a structure for effective problem-solving.
  • Analyze the right information.
  • Give a recommendation.

Apply these tips by practicing sample cases with case partners as much as possible so you’ll be ready to ace your next consulting case interview.

Happy casing!

Still have questions?

If you have more questions about how to approach a case interview, leave them in the comments below. One of My Consulting Offer’s case coaches will answer them.

Other people preparing for consulting case interviews the following pages helpful:

  • Our Ultimate Guide to Case Interview Prep
  • Case Interview Frameworks
  • Issue Trees
  • MECE Case Structures
  • Case Interview Examples
  • Case Interview Formulas

Help with Case Study Interview Prep

Thanks for turning to My Consulting Offer for advice on case study interview prep. My Consulting Offer has helped almost 89.6% of the people we’ve worked with get a job in management consulting. We want you to be successful in your consulting interviews too. For example, here is how Sharmeen was able to get her offer at BCG.

We want you to be successful in your consulting interviews too.

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

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

No thanks, I don't want free strategies to get into consulting.

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problem solving approach case study

MBA Boost

A Model for Case Analysis and Problem Solving

problem solving approach case study

ABOUT THIS CONTENT

Table of Contents

Why the Case Approach

The most effective way for learning to take place is to actually be in real situations, make decisions, deal with the consequences of those decisions, and learn from our real mistakes. Nothing will ever replace learning from experience. Cases (which involve real situations although names may be changed) allow us to "simulate" real life situations when we don’t have the luxury of having years of experience. Cases allow us (to some degree) to live with real situations, make decisions, and feel the consequences. Like scientists in a laboratory, students of management use case problems and experiential exercises as "laboratory" opportunities to experiment with real organizations in the classroom setting.

Cases attempt to reflect the various pressures and considerations managers confront in everyday organizational life. By using complex real world problems as a focus, cases are designed to challenge you to develop and practice skills that will be appropriate to the practical problems you will face in your career.

The case method is based on the learning principle that learning occurs most when people teach themselves, through their own struggles. You will gain greater understanding and improved skills in judgment when you work through a problem than if you listened passively to a lecture. Similarly, there will be greater learning if you "use" a theory than if you just heard about it. Therefore cases have two basic uses:

  • Helping us learn how to apply theories to real situations
  • Helping us learn how to solve real problems

Like real situations cases center around an array of partially-ordered, ambiguous, seemingly contradictory and reasonably unstructured facts, opinions, inferences and bits of information, data, and incidents out of which you must provide order by selectively choosing which bits to use and which to ignore. In real life others won’t do this for us. As in real life situations, it is unlikely that any two people would assemble the data or make inferences identically. You will have to work within the limitations inherent in evidence and arrive at internally consistent interpretations. Experiencing the process of learning this way may be frustrating and confusing, but it is also practical and realistic.

Cases, as in real management situations, require you to work with the "as is" of reality, not the "should be" of theory. Like managers you will have to exercise judgment which can be improved by discussion and consultation with others. However, note that like the manager, you will seldom be sure before your decision is made and often after it is made, that you have made the right or "best" decision. Like any manager, you will approach cases under time pressure, on the basis of limited facts, and in the face of many unknowns. You will approach cases along with other people who like you have idiosyncrasies and limitations, and different opinions.

In summary, cases have a number of benefits:

  • They allow us to develop skill in thinking clearly about ambiguous, unstructured situations using incomplete information;
  • They help us to develop skills at recognizing what information is important and what is missing
  • They help us to develop concise, reasonable, and consistent action plans;
  • Help you to identify implicit models and assumptions, values and goals you use every day
  • They provide an opportunity to develop skills in presenting (written and oral) our ideas to people and to groups; to influence and persuade others
  • Improve your ability to predict behavioral outcomes-yours and others

Your Responsibilities

Little can be learned from a case without preparing it carefully and discussing it with others. Cases are not designed to present you with a right answer which you can memorize in the hopes that you will remember it if you ever encounter a similar situation. Similarly you won’t gain much from listening to what others think is the right answer. The learning comes from actively participating in the search for solutions. Cases are the raw materials that permit simulation in the classroom of actual discussions carried on informally among managers.

Preparation : Cases require more preparation and active participation than most class activities. How much you get out of a case discussion depends heavily on how much effort you put into preparing it before class. Many students confronting cases for the first time are overwhelmed; they see so many factors that come into play. Facts are confusing and ambiguous and often incomplete. This guide is intended to help you walk through the critical steps.

Informal Discussion Groups: After preparing a case by yourself, it can really help to meet with a group of other students to talk about a case before class. This will give you a chance to test your ideas on others and learn about other perspectives about the case.

Participating in Class Discussions: The purpose of the class discussion is to test others ideas so that together students can reach a richer and deeper understanding of the case. The role of the discussion is to moderate and create an environment in which contributions of individual students build on one another to understand the problem more fully. The instructor’s role is not to answer. The instructor may highlight, synthesize the issues and help shape the discussion.

The quality of the class discussion depends on the quality of the students’ preparation and participation in class. The class should be considered a team of colleagues that has been asked to work together to solve a challenging problem. This requires good team members to push ideas and support them. Good class also requires an emphasis on listening; others will raise ideas you hadn’t thought of and you should be prepared to change your mind and incorporate new ideas when you find them persuasive.

Try to have your ideas build on the comments of others. Don’t be afraid to be challenged or to be wrong. Sometimes students leave a class discussion discouraged because many issues and arguments that were raised that they had not considered before class. Remember that no case would be worth discussing if it were simple and straightforward enough for you to have figured it out on your own.

The classroom should be a place where you can test ideas and learn from each other. Finally enjoy yourself. There should be a lot of satisfaction in struggling with a complex problem and through your efforts, coming to a better understanding of it.

Preparing a Case: Six Steps for Problem Analysis

The checklist is presented as a framework for diagnosis, problem-solving, and managerial action taking. Note that few if any situations that you will experience will require that you consider every element listed here. Management is a dynamic, ongoing process that never takes place as sequentially or rationally as this list would imply. In most real-world situations, as opposed to case discussions in class, you already know a great deal about the people and prior experiences that are relevant. In addition, events never turn out exactly as you anticipate them.

Step 1: Comprehend the Case Situation: Data Collection, Identify Relevant Facts

Most cases require at least two readings, sometimes more; the first time through should involve familiarizing yourself with the basic situation; you may be given some guide questions to help you and you also might think about why the case was assigned now. There are some standard questions that you might keep in mind as you read the case:

  • What are the key issues in the case; who is the decision maker in the case; is there a critical decision?
  • What is the environment in which the key people operate; what are the constraints on their actions; what demands are imposed by the situation?
  • Are solutions called for?
  • If you had the chance to talk to critical people in the company, what would you want to know?
  • What are the actual outcomes of the current situation-productivity, satisfaction, etc; how stable are present conditions?
  • What are the "ideal" outcomes; what is an ideal "future" condition?
  • What information is lacking; what are the sources of the available information?

Managers and students rarely have complete information and must rely on inferences. Be prepared to make creative assumptions; good analysis goes beyond identifying the relevant facts in the case. If some facts aren’t given, figure out what you can assume they are.

Rereading: After the first reading, try to formulate several plausible courses of action and explanation for the data in the case. Imagine yourself as various key people in the case and figure out why you (as the person in the case) might have acted as he/she did, or what you would do. Think about the consequences if you are wrong.

Using evidence and numbers: One of the most difficult problems in preparing a case is sorting through the mass of information and evidence. Often cases involve considerable background information of varying relevance to the decision at hand. Often cases involve conflict with different actors providing selective information and courses of action to support their claims. As in real life, you must decide what information is important and what isn’t and evaluate apparently conflicting evidence.

As in real life, you will be faced with a lot of information but perhaps not exactly the information you need. It is not uncommon to feel paralyzed by all the available information; it is difficult to identify the key information after the first reading. You should be slightly skeptical about the information presented or the interpretation placed on it by various actors in the case. You won’t have time to question all evidence in the case but if the evidence is critical, you might ask yourself what it really implies and whether it is as compelling as it seems.

As you read the case keep in mind:

  • remember that all behavior is caused, motivated, and goal-directed; behavior may see strange, or "irrational" but you can assume it makes sense to the actor
  • separate fact from opinion; distinguish between what people say vs. do
  • it might be possible to get more information about the case (eg. the industry) but for the most part you will be asked to do your best with the information available
  • separate symptoms from underlying causes
  • avoid judgments; avoid premature solutions

Step 2: Defining the Problem

What is the critical issue or problems to be solved? This is probably the most crucial part of the analysis and sometimes the hardest thing to do in the whole analysis. Perhaps the most common problem in case analysis (and in real life management) is that we fail to identify the real problem and hence solve the wrong problem. What we at first think is the real problem often isn’t the real problem .

To help in this stage here are some questions to ask in trying to identify the real problem:

  • where is the problem (individual, group, situation) why is it a problem; is there a "gap" between actual performance and desired performance; for whom is it a problem and why
  • explicitly state the problem; are you sure it is a problem; is it important; what would happen if the "problem" were left alone"; could doing something about the "problem" have unintended consequences?
  • what standard is violated; where is the deviation from standard
  • what are the actual outcomes in terms of productivity and job satisfaction; what are the ideal outcomes
  • how do key people feel about the problem and current outcomes
  • what type of problem is it ?(individual, relationships, group, intergroup, leadership/motivation/power, total system)
  • how urgent is the problem? How important is the problem relative to other problems?
  • assess the present conditions:
  • What are the consequences; how high are the stakes; what factors must and can change?
  • for the organization (costs and profits; meeting obligations; productivity)
  • for the people (personal and financial rewards; careers; satisfaction and growth)
  • How stable are present conditions?
  • What information is lacking?
  • What are the sources of the available information?

Traps in this stage :

  • suggesting a solution prematurely-stating a problem while implying a solution
  • stating problems in behavioral (personal) terms, not situational terms
  • not explicitly stating the problem-assuming "your" problem is "the" problem
  • blindly applying stereotypes to problems; accepting all information at face value; making premature judgments; multiple causality
  • most crucial at this step is to avoid suggesting a solution
  • confusing symptoms with causes; differentiating fact from opinion; prematurely judging people and actions
  • stating the problem as a disguised solution (eg. Hardesty’s failure is due to his not visiting purchasing agents)

Step 3: Causes

Once you have identified the key problem(s), try to find the causes here. Most critical here is avoiding solutions, and avoiding blaming or judging people. Also

  • don’t quit at the most obvious answer-try playing devil’s advocate; put yourself in the other person’s shoes
  • accept the multiple causality of events
  • there may be a number of viable ways to fit the data together; explore as many as you can; go past the obvious
  • there is a great tendency to evaluate behavior as good or bad; I care about why it occurred; judgments leads to a poor analysis focusing on justification for the evaluation
  • the concern is not whether behavior is good or bad but why it occurred and its consequences
  • be careful about hindsight; actors in the case usually don’t have access to outcomes when they act so avoid "Monday Morning Quarterbacking"-consider what actors in the case are reasonably likely to know or do
  • as before, avoid premature solutions and premature judgments

Step 4: Generating Alternative Solutions (not all assignments will call for this)

In thinking about a context for generating alternatives, think about:

  • what are the decision-maker’s sources of power in the situation? (legitimate, reward, punishment, expert, referent)
  • what are possible leverage points (changing technology such as machines, processes, product designs; changing organizational structure; changing reward systems, job descriptions education, changing personnel, changing culture)
  • can individual behavior be changed (education, training, reward systems, job description, etc.)
  • what are the constraints on the solution? (time, money, organizational traditions, prior commitments, external realities, legal etc)
  • what are the available resources (time, money, people, existing relationships, power)
  • should others be involved (in problem definition, data collection, generating alternatives, implementing solutions, monitoring and assessing realities)
  • In this stage it is important to avoid reaching for a solution too quickly; be creative here and put yourself in the case. Try living with various alternatives that you are thinking about; what would be the impact on you and on others. Be sure to think about the costs and benefits of each alternative.

Step 5: Decision (note that not all assignments will call for a solution)

In considering the alternatives generated above you need to be clear on the criteria you will use to evaluate them. Some possible criteria include:

  • does the alternative address the critical aspect of the problem? What are your objective? Be specific.
  • what are the intended consequences; what are some unintended possible consequences; how will your decision improve the situation
  • what is the probability of success; what are the risks; what happens if the plan fails
  • what does the plan depend on? What are the costs? What power and control is needed?
  • who would be the "change agent" Does he/she have the power, skills, knowledge to be successful
  • is the "solution" consistent with organizational realities

Remember that there is no one "elegant" solution; all solutions have costs and benefits ; identify pros and cons of each alternative; evaluate relative to goals; look at main and side effects you may have to make inferences and judgments; do this as long as you have good reasons for your inferences Choose alternative which best meets the criteria. The decision might not be accepted by those involved so you may have to choose a more acceptable one. You might want to rank order your alternatives according to how well they meet the criteria used. as you think about action, put yourself into the case; try to project living with the consequences

Step 6: Taking Action and Following Up

In thinking about implementation you want to think about these areas:

  • what are leverage points for change-technology, reward systems, work relationships, reporting relationships, personnel changes
  • what are the decision maker’s sources of power: legitimate, reward, expert, referent, etc?
  • what are the constraints on a solution: time, money, organizational policies, traditions, prior commitments, external realities
  • does culture have to change; what historical relationships must be respected
  • implementation-will people resist change; is change being reinforced; is a new stability developing
  • monitoring changes-are further changes necessary; are costs and benefits of changes as expected
  • make sure you have thought about the ramifications of implementing the plan; how will you address them

Action Plans : provide options for meeting specific objectives should include: a brief description of the plan, costs, benefits, drawbacks

Some simple models are helpful in thinking about implementation. One involves thinking about implementation as involving three stages:

  • Unfreezing: Making sure those affected feel the need for change
  • Change: introducing the change
  • Refreezing: Reinforcing the new behaviors

General Reminders/Check List

  • remember you will never have enough information!
  • the most critical aspect of case analysis may be "identifying the problem"
  • you will never be sure you have identified the real problem
  • there is rarely one "right" answer-different answers may be somewhat right

Accept that cases and managerial situations involve:

  • ambiguous situations multiple causality inadequate information
  • no elegant solution
  • acknowledge that personal values play a role in case analysis
  • no one (including the instructors) can "solve" the case
  • try to imagine "living" with the problem and your recommendations

Try to avoid:

  • blindly applying stereotypes to problems accepting information at face value
  • confusing symptoms with problems making premature evaluations
  • judging behavior-we assume no one is "good" or "bad"; labelling people as such is an easy way to dispense with problems of trying to figure out why someone does what he does
  • don’t assume you are so much smarter or better informed than managers you observe or read about that you can readily solve problems they have been dealing with for years
  • managers involved may understand their problems better than you do and act the way they do for reasons that are sound to themselves

Writing Tips

  • while it is critical to follow the above advice on case analysis, much of this analysis may not appear in your paper. The analysis is required to generate material for your memo but may not necessarily appear in it
  • think carefully in your writing who your audience is
  • assume your reader is a little dense; write in a form that is easy to digest-good introduction, subheadings, manageable paragraphs, clear topic sentences, clear transitions
  • provide a strong introduction; give your reader a reason to read the analysis; give the reader the "benefits"
  • in a memo, you can only convey one or two main points; make sure the reader knows what they are; make sure your introduction provides a clear "road map" for where you are going; reinforce this in the conclusion
  • use models/theories in your analysis, but you may not necessarily "leave" these "tools" in your document.

Final Comments

Case teaching is a lab experience. It is low risk and participative. It does not provide "how to" or surefire techniques. Students sometimes express dissatisfaction with cases. "Information is ambiguous, redundant, irrelevant; the issue isn’t stated clearly; the instructor isn’t directive enough; we never know the "right" answer; the instructor should lecture more."

These comments are legitimate. But for the most part the difficulties associated with case teaching stem from real situations themselves. These are the same dilemmas you will face as managers.

More Related Posts

  • Case Hints – Marketing Management Case Analysis
  • Case Hints – Suggested Technique for Case Analysis
  • Case Hints – Case Analysis Evaluation
  • Case Hints – Why We Use the Case Method
  • Case Hints – The Case Method

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How To Solve Case Study? (A Strategy By IIM L Student That Works Every Time!)

Muskan Atar - IIM Lucknow

Table of content: 

  • Step 1: Identify the problem statement

Step 2: Propose solutions with a pinch of creativity

Step 3: establish the scale and impact of the solution.

“Case study competitions” - Something that is arguably one of the most valuable parts of your MBA life. But this may be daunting for many. Maybe you’re not sure which case competitions to participate in, so you pile too much on your plate. Maybe you’re not sure about the right way to solve a case study. In this article, we’ll break down everything you need to know about acing a case study competition, from scratch! 

A case study competition can be an academic or corporate competition in which participants come together to solve either a real-world case or a framed case that is presented. We present to you Muskan Atar, who will walk you through her tested strategy to solve case study competitions and win them in style!

Hero Campus Challenge S8 Winners Take Us Through Their Road To Victory

Framework to solve case studies

After participating in 7-8 case competitions, I realized I had been unconsciously solving it using the same framework. It is very similar to the framework used for product management cases. Hence, it didn't disappoint me. 

Step 1: Identify the problem statement 

Case competitions like Accenture Strategy Case Connect and Colgate Transcend provide an exact problem statement with the expected outcome. But, in most cases, we must dive deep to break down the problem statement and identify the potential causes. 

Like, for Colgate Transcend, the problem statement was (summary) -

Should Colgate diversify into Electric Tooth Brush (ETB) Segment? If yes, then how?

Here, we identified the problems through secondary research (reports from consultancy firms) and primary research (customer surveys). The problem statement identified were:

  • Low awareness of ETB 
  • Low willingness to pay
  • High competition from existing players

How to solve case study

After identifying the problems, we need to establish whether solving them is actually worth it or not. We did this by:

  • Expected Sales, Market Size, and Expected Growth Rate of identified customer segment
  • Increasing willingness to upgrade life (Market Trend)
  • High adaptability to technological changes (Market Trend)

How to solve case studies

Other methods of identifying problem statements are Focus Groups, Customer Interviews, Journey Analyzers, BCG matrix, Value Chain Analysis, PESTEL, SWOT(W part), Porter's Five Forces, Annual Reports, etc.

How to solve a case study

Given the short time for case competitions, I think the most efficient method is first-hand experience. Rather than starting from scratch, it is better to identify the problems as a customer and collect more data on the same.

Further, this data can be represented in the form of - Customer Personas, Key Insights, Trends, Customer Decision Making Journey, etc. 

If you have identified the right problems, your half work is done!

Before even thinking of solutions, set the KPIs based on the problem statement.

Like, in Accenture Strategy Case Connect, the problem statement was (summary) -

Should a large-scale oil refinery firm diversify into EV charging stations? If yes, suggest an execution strategy 

After establishing that the firm needs to diversify, we set the KPI for the solution as - Increment in business generated due to portfolio diversification.

Accenture Strategy Case Connect Case Study

Then, we did a VRIO analysis to identify the competitive advantage (CA), available resources, and capabilities of the firm. SWOT analysis can also be done to get a bird's eye view. 

MBA Case Study

Key insights were:

  • The firm has an established infrastructure across the nation (CA)
  • The firm is cash-positive (resource)
  • Lack of EV charger manufacturing capabilities

Based on the above insights, we decided mode of entry as a strategic alliance with EV charger manufacturers to minimize the entry risk and cost of development. 

MBA case study

We represented the solution in the form of a business plan that covered the roles of stakeholders, partners, customer value proposition, and a phase-wise rollout plan for the future.

MBA Case study solutions

After setting the KPIs and VRIO analysis, in case you struggle to create solutions, you can do:

  • Competitor benchmarking to get a reference
  • Research strategies implemented by outside-India players
  • Study recent technological trends and their application
  • Understand the current focus of the firm through annual reports, recent acquisitions, and news headlines

How to solve the case study

Other ways of representing the strategies are Ansoff Matrix, Portfolio Strategy, Market Mapping, 4Ps, Marketing Funnel, GTM, Mock-ups, etc.

How to solve the case study

Above all, you should always suggest solutions that reduce customer efforts. If you try changing consumer behavior by increasing efforts, they will exCHANGE you with your competitors.

Competitions like the HCCB Case Challenge provide an exact budget. For others, you must look at financial reports and funding rounds to estimate the budget. Then, you can utilize the data to calculate ROI using guesstimates as accurately as possible (use published data).

You can also do a cost-benefit, NPV- IRR, break-even point, cash-flow analysis, etc. I prefer showing profitable unit economics to envision scale and impact.

In PM/Marketing cases, you can also show whether customers accept the solution or not. If 90% of customers are facing a problem, doesn't mean that 90% will accept your solution.

Like in Myntra Stylbiz, we had to suggest solutions for the 18-25 customer segment such that Myntra becomes the most engaging and preferred destination. We showed results of UAT (using Figma) that indicated the likelihood of customers using the solution. This data also helped to estimate the increase in sales, purchase frequency, and new customers. 

Myntra Stylbiz case study

I have also seen participants running marketing campaigns on social media on a small scale. 

Myntra stylbiz MBA Case study

More than thinking big, focus on thinking real. 

For more, check out her post. 

If you'd like to submit your story, click here .

Whatever your concern, we have broken down everything you need to know about case study competitions , from scratch:

  • Challenge Yourself With These B-school Competitions
  • Case Study Competitions- Details, Winning Strategies, And More!
  • Cheat Sheet To Crack Hiring Challenges And Case Competitions
  • How To Win Business Case Competitions: The Secret Revealed
  • Why MBA case competitions are worth the hype!

Muskan Atar - IIM Lucknow

In pursuit of being a good product manager, she started participating in Case Competitions during her MBA. It gave her a mention in Forbes D2C Top 100 Competitive Leaders, but more than that it helped her build problem-solving and team-building skills. It also helped her become insensitive to results, and make a rational sense of them. Apart from PMing, she likes to write, watch movies, crack lame jokes and eat really good food.

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Find the AI Approach That Fits the Problem You’re Trying to Solve

  • George Westerman,
  • Sam Ransbotham,
  • Chiara Farronato

problem solving approach case study

Five questions to help leaders discover the right analytics tool for the job.

AI moves quickly, but organizations change much more slowly. What works in a lab may be wrong for your company right now. If you know the right questions to ask, you can make better decisions, regardless of how fast technology changes. You can work with your technical experts to use the right tool for the right job. Then each solution today becomes a foundation to build further innovations tomorrow. But without the right questions, you’ll be starting your journey in the wrong place.

Leaders everywhere are rightly asking about how Generative AI can benefit their businesses. However, as impressive as generative AI is, it’s only one of many advanced data science and analytics techniques. While the world is focusing on generative AI, a better approach is to understand how to use the range of available analytics tools to address your company’s needs. Which analytics tool fits the problem you’re trying to solve? And how do you avoid choosing the wrong one? You don’t need to know deep details about each analytics tool at your disposal, but you do need to know enough to envision what’s possible and to ask technical experts the right questions.

  • George Westerman is a Senior Lecturer in MIT Sloan School of Management and founder of the Global Opportunity Forum  in MIT’s Office of Open Learning.
  • SR Sam Ransbotham is a Professor of Business Analytics at the Boston College Carroll School of Management. He co-hosts the “Me, Myself, and AI” podcast.
  • Chiara Farronato is the Glenn and Mary Jane Creamer Associate Professor of Business Administration at Harvard Business School and co-principal investigator at the Platform Lab at Harvard’s Digital Design Institute (D^3). She is also a fellow at the National Bureau of Economic Research (NBER) and the Center for Economic Policy Research (CEPR).

Partner Center

  • Open access
  • Published: 14 February 2024

Implementing a tobacco-free workplace program at a substance use treatment center: a case study

  • Anastasia Rogova 1 , 2 ,
  • Isabel Martinez Leal 1 , 2 ,
  • Maggie Britton 1 , 2 ,
  • Tzuan A. Chen 2 ,
  • Lisa M. Lowenstein 1 ,
  • Bryce Kyburz 3 ,
  • Kathleen Casey 3 ,
  • Kim Skeene 3 ,
  • Teresa Williams 3 &
  • Lorraine R. Reitzel 1 , 2  

BMC Health Services Research volume  24 , Article number:  201 ( 2024 ) Cite this article

Metrics details

People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center.

This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff ( n  = 6) and clients ( n  = 16) at the substance use treatment center and site visits ( n  = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice.

Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center.

Conclusions

Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.

Peer Review reports

According to data from the Centers for Disease Control and Prevention, 12.5% of the US adults aged ≥ 18 years reported current use of cigarettes in 2020 [ 1 ]. While this figure represents a substantial decrease from over 40% of the adult population smoking in the 1960s, tobacco use is still the leading preventable cause of death in the US [ 2 ] with annual deaths directly attributable to tobacco use estimated to be at least 480,000 [ 3 ]. However, these devastating effects of tobacco use do not equally impact all population groups. The proportion of people who use tobacco products is dramatically elevated among the often intersecting groups of people experiencing socioeconomic disadvantage, who are medically underserved, and/or people living with comorbid mental health and non-nicotine substance use disorders [ 4 ]. These health disparity populations have disproportionately high smoking rates; for example, over 65% of adults with substance use disorders (and up to 90% according to some sources) are active smokers [ 5 , 6 , 7 ]. As a result, adults with substance use disorders are disproportionately affected by tobacco-related disease compared to the general population [ 7 , 8 ].

There is an overwhelming body of evidence that adults with substance use disorders are interested in and capable of quitting with appropriate support [ 9 , 10 ]. Current clinical guidelines recommend that all clients be provided with evidence-based cessation care, which includes behavioral interventions such as tobacco use assessment, brief cessation advice, individual or group counseling, and pharmacotherapy such as nicotine replacement therapy or non-nicotine medication (bupropion and varenicline) [ 11 , 12 ]. Moreover, the adoption of system-level policies, including comprehensive tobacco-free workplace policies, which prohibit the use of any form of tobacco inside buildings and on the grounds of behavioral health treatment centers, are also shown to be effective in improving quit rates [ 13 ]. Despite their proven effectiveness, however, evidence-based practices and policies remain underutilized, and tobacco use treatment is given a low priority in substance use treatment centers. For example, according to a 2016 nationwide study, only 64.0% of substance use treatment centers reported screening clients for tobacco use, 47.4% offered tobacco cessation counseling, 26.2% offered nicotine replacement therapy, and 34.5% had tobacco-free policies [ 4 ]. Furthermore, although not reported, it is possible that some proportion of these centers had tobacco-free workplace policies that may have been non-comprehensive in product coverage (e.g., not extending to e-cigarettes/vaping) or workplace area coverage (e.g., allowing smoking areas), which are known to be less effective than their comprehensive policy counterparts [ 14 , 15 , 16 ]. Consequently, there is a missed opportunity for substance use treatment centers to comply with clinical care guidelines [ 11 , 12 ] and to intervene to reduce tobacco use and related health disparities among their clients.

There are several previously identified barriers to providing tobacco cessation treatment at substance use treatment centers, including limited training, limited resources, time restraints, and cultural norms [ 9 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Additionally, available treatment opportunities that take little time or training, such as referral to a state tobacco cessation quitline, are often unknown by staff at substance use treatment centers [ 23 ]. Our use of “staff” here refers to both clinical employees, those providing direct services to clients, and nonclinical employees. Moreover, despite evidence to the contrary, staff may believe that treating tobacco use and substance use disorders simultaneously will jeopardize substance use treatment and recovery [ 25 ]. Together, these barriers and others may contribute to the known translational lag whereby any type of evidence-based practice takes a long time (e.g., up to 17 years) to be implemented into practice to reach the intended population and ensure the improvement of clients’ health [ 26 , 27 ]. While this translational lag is detrimental for all clients and communities, the negative consequences of these delays are even worse for populations who experience health disparities, such as individuals living with substance use disorders.

Together, the previously described evidence-based tobacco cessation practices and policies, such as tobacco use assessment, brief cessation advice, individual or group counseling, pharmacotherapy, tobacco-free policies, form the core components of a comprehensive tobacco-free workplace program [ 28 , 29 ]. Academic-community partnerships can assist substance use treatment centers in implementing comprehensive tobacco-free programs and reducing the translational gap that affects health disparities among their clients [ 29 , 30 , 31 , 32 ]. This study describes the implementation of a tobacco-free workplace program at a substance use treatment center in Houston, Texas, which included a comprehensive tobacco-free workplace policy implementation, education and specialized training support, and the provision of resources to support tobacco cessation care. The goal of the study was to identify barriers and facilitators to successful integration of tobacco-free workplace policy and cessation practices into a substance use treatment center. The current study was based on an ethnographic approach and uses a case study design, which is considered an efficient way to present qualitative ethnographic findings [ 33 , 34 ]. Case study design has been found to be particularly useful in implementation research, as it allows for an in-depth analysis of complex interventions in combination with a participatory approach in a real-life context [ 35 , 36 , 37 , 38 ]. Prior research has shown the importance of studying interventions in close connection with the context of dynamic environments that can have an extensive influence on the implementation process [ 37 ]. In the case of complex interventions, such as comprehensive tobacco-free programs, this is particularly relevant, given their dependence on contextual elements for their effectiveness [ 39 ]. Intervention and context cannot be easily separated in this situation, and there is an urgent need to better understand the relationship between these two core elements of implementation to ensure that research evidence can meaningfully impact policy and healthcare organizational culture [ 38 ]. By applying a case study design, this work contributes to the existing research on implementing tobacco-free workplace programs at substance use treatment centers [ 32 ] by providing an in-depth qualitative description of program implementation in the setting of a nonprofit outpatient substance use treatment center serving diverse clients, most of whom belong to socioeconomically disadvantaged and medically underserved groups. Additionally, this study represents both staff, clinical and nonclinical alike, including leadership, and clients’ perspectives on this program, the latter of which were not included in prior work [ 32 ]. The findings presented in this study can be used by other substance use treatment centers that serve similar populations and seek to implement a comprehensive tobacco-free program in the most sustainable way.

Case description

This initiative was undertaken as a part of the Taking Texas Tobacco Free (TTTF) program, which is a multicomponent, evidence-based comprehensive tobacco-free workplace program that was designed to address tobacco dependence within healthcare treatment settings, including substance use treatment settings [ 30 , 32 ]. TTTF includes (1) tobacco-free policy development and implementation and/or refreshment for comprehensiveness or quality assurance; (2) education and specialized training for staff on tobacco use and cessation, screening practices, and treatment provision; and (3) resource provision, including free nicotine replacement therapy, signage, and passive dissemination materials. Throughout the implementation process, TTTF team members, comprising an academic-community collaboration, provide ongoing technical assistance and support (for more information on the TTTF program, see previously published studies [ 28 , 30 , 31 , 32 , 40 , 41 , 42 , 43 , 44 ]).

To ensure the privacy of the research participants, we refer to the field research location as the “Center” herein. The Center is located in a Houston, Texas, zip code that is among the Centers for Medicare and Medicaid Services-designated low-income and health professional shortage areas. It is a small Center that employs 7 staff (including clinical and nonclinical staff) and serves approximately 1,000 unique clients each year. One of these staff members was designated the TTTF program champion to serve as the main point of contact for all aspects of the tobacco-free workplace program implementation process. This staff member was not financially compensated for accepting this role, but they received additional week-long full-time training to become a Tobacco Treatment Specialist. The financial compensation for this role was not a part of the current program, and the expectation was that the Center’s leadership incorporates this role in the regular scope of work for their staff to ensure the sustainability of the program.

The Center serves a diverse group of clients, with 90% of their clients having histories of incarceration or another form of engagement in the criminal justice system, many of whom come from low socioeconomic backgrounds and/or have been diagnosed with comorbid behavioral health (i.e., mental health or substance use disorders) and physical health conditions. The Center estimated that approximately 80% of their clients smoked conventional cigarettes and 30% used other tobacco products, including e-cigarettes (there is an overlap, as some clients might be dual or multiple product users). Most clients participate in the Center’s substance use treatment program for 90 days. The Center introduced a tobacco-free policy in 2000, which prohibited the use of tobacco products of any type both indoors and outdoors; however, they had not provided any tobacco cessation services to their clients beyond the requirement not to use tobacco on their property prior to their enrollment in the TTTF program. The tobacco-free workplace program implementation components and the Center’s timeline are presented in Table  1 .

This project was approved by the Internal Review Board of the University of Houston and the Quality Improvement Assessment Board at the University of Texas MD Anderson Cancer Center. Oral informed consent was received from all participants prior to participation in qualitative study procedures. The aims of the project and interviews were discussed with participants who were given an opportunity to ask any questions about the interview process and the nature of the study. Additionally, all participants gave oral permission to audio-record the interview; they were given the option to remain anonymous and not use their names or other identifying information in any written summary of the collected data. Participants were informed that their participation was voluntary, that they could decline to answer any questions and stop participating in the interview at any time.

Data collection instruments

Data for this qualitative case study were collected via group and individual interviews with staff and clients at the Center, as well as site visits and participant observations. Data include interview transcripts and fieldnotes. We conducted one pre- and one post-implementation focus group with clients ( n  = 16), two pre-implementation semi-structured interviews with staff ( n  = 2), two individual interviews with staff during the implementation process ( n  = 2), and one post-implementation group interview with staff ( n  = 2). Interview guides were used for interviews and focus groups, which lasted 60–90 min (see Additional file 1 : Interview Guides). Pre-implementation interview questions for staff focused on any Center-specific needs for the program rollout, populations they served, their personal experience with tobacco use, their knowledge of and attitudes toward tobacco use and cessation among their clients, and implementation barriers and facilitators they anticipated. Staff post-implementation interview questions addressed experiences with implementing the program, interventions that were successful and less successful, changes in their practices addressing tobacco dependence, and any challenges they experienced. Focus groups with clients addressed their experiences with tobacco use and cessation, their knowledge of the tobacco-free program at the Center, their attitudes toward and interest in this program, and their experiences with and results of receiving any tobacco cessation support at the Center. In addition, we undertook several site visits ( n  = 8), when A.R. (the 1st author) and I.M.L. (the 2nd author), both cultural anthropologists who worked as qualitative research specialists on the project, conducted observations and made fieldnotes using a free-form approach. The site visits (1 to 2 h long) incorporated both direct and indirect observations. The collected observational data were not subjected to standalone analysis but served to inform the interview questions, gain a more nuanced understanding of how the Center was implementing various parts of the program, and provide further details about the study’s context and setting.

Two authors (A.R. and I.M.L.) moderated the focus groups and completed the interviews. Audio-recordings of focus groups and interviews were transcribed verbatim by a professional transcription service and analyzed using thematic analysis to initially inductively code and identify themes within the dataset. Data analysis was conducted iteratively using constant comparison, and themes were drawn directly from the data. The process of constant comparison provided analytic rigor and ensured accurate accounting of all the data, identifying appropriate selection of categories and themes [ 45 ]. At the next stage of the analysis, the concepts of the extended Normalization Process Theory (discussed in detail below) were applied to these themes to more effectively analyze and evaluate the implementation process.

Approach: extended normalization process theory

When exploring the implementation process, the application of a theoretical framework enhances understanding of the process and highlights barriers to and facilitators of the implementation. Implementation scientists have developed several major frameworks and theories to describe and evaluate the implementation process [ 26 , 46 , 47 , 48 , 49 ]. For this analysis, we followed the extended Normalization Process Theory (eNPT) [ 46 , 47 ], which is a sociological theory that informs the implementation of innovations in healthcare practice, focusing on bridging the translational gap between evidence-based practices and their implementation [ 50 ]. This theory approaches the implementation process as a series of interactions between people’s actions (their ‘agency’) and the context within which the intervention is implemented [ 46 , 50 ].

The eNPT identifies and explains key elements that contribute to or impede normalization of complex interventions within a social system, including four core constructs, two of which are focused on context (potential and capacity) and two of which address agency (capability and contribution, see Fig.  1 for details) [ 46 ]. The identification of these major constructs helps researchers guide and understand the implementation process and provide a systematic description [ 46 ]. The eNPT has been effectively utilized at all stages of research projects, both during the planning stages and the post-implementation analysis, as in this case, where this theory helps to frame emergent themes and consider their implications for further research and implementation practice [ 51 ]. The application of the eNPT as a theoretical framework enhances stakeholders’ ability to improve design for more successful implementation in the future and to enhance the application and normalization of interventions within organizations by community adopters and researchers [ 50 ].

figure 1

Concepts and Constructs of the Extended Normalization Process Theory (eNPT, adapted from May 2013 [ 46 ])

The two constructs of the eNPT that characterize the context of implementation are potential and capacity . Participants’ potential is expressed through individual intentions and collective commitment to participate in the intervention [ 52 ]. Capacity, which is another crucial element of context, is defined as the availability of material and cognitive resources, as well as existing social norms and social roles. Attention to these contextual elements ensures a better understanding of the implementation process and its outcomes, as they shape agents’ ability to effectively cooperate with each other to bring about change [ 46 ]. Capability and contribution are two constructs that characterize the agency of the participants involved in the implementation process. Capability refers to how workable the complex intervention is, as well as to the possibility of integrating it in everyday practice. Contribution refers to the actions of the agents who are involved in the implementation process [ 46 ]. This construct focuses on how the agents, including individuals and groups, enact potential and capacity by undertaking actions to make things happen and ensure that new processes and practices become “the way we do things here.” [ 46 ] Each of these constructs is further divided into categories used to understand and evaluate the implementation process (see Table  2 ).

After conducting the initial coding, the emerged themes were systematized and organized in relation to the major concepts and constructs of the eNPT theory. Table  2 shows the identified themes from the case study data and how they are related to the eNPT constructs and dimensions. In the section below, we present our results in relation to these theoretical constructs.

Context: potential

The Center’s CEO initiated the Center’s participation in the tobacco-free workplace program and continuously expressed their personal support and commitment to implement and maintain the program. The Center’s staff were also enthusiastic about the tobacco-free program and expressed commitment to its implementation. Most participants welcomed this forthcoming change and expansion of tobacco cessation services and agreed that it was necessary and beneficial for the Center’s working environment and for their clients’ needs and well-being. This collective commitment was supported and reinforced during the preparation phase of the implementation process, when all staff received training provided by the TTTF program:

I think one of the biggest things in preparation for implementing the program was when we had our staff retreat. Bryce [B.K.] actually flew in, and he participated in the retreat and helped train our staff prior to us actually implementing the program. So, he did a workshop with us, and that gave us an opportunity to ask him questions […] So, everybody was ready. Everybody was pumped and ready because we knew what to do. We knew what the problem was about . (Staff post-implementation interview)

The number of staff who used tobacco products themselves was very low at the Center. The only staff member who said that she smoked cigarettes participated in the program herself and, at the time of the interview, reported a successful quit attempt and being tobacco-free. In the pre- and post-implementation interviews, staff members shared their negative attitudes towards smoking related to health concerns and their readiness to facilitate tobacco cessation efforts at their center:

I grew up as an athlete, and so smoking is something that was not encouraged in my field. I didn’t partake when I was around people that did such as my mom who later on in life actually stopped smoking. (Staff pre-implementation interview)

Context: capacity

One of the major barriers to the implementation of the tobacco-free workplace program at the Center was associated with the widespread practice of tobacco use among the Center’s clients and within their immediate environment. There are two closely interrelated aspects of this problem: clients’ lived experiences with tobacco being an innate part of their everyday life and staff attitudes and expectations of their clients’ interest in and ability to quit tobacco, both of which are discussed below.

Most of the Center’s clients grew up in an environment where smoking had been normalized for years. They shared their experiences of having parents, older siblings, grandparents, neighbors, and friends who had smoked on a regular basis for most of their lives:

Kind of like I think started smoking from– because I would light cigarettes for my daddy or whatever, so he was smoking. (Client focus group, pre-implementation) Me growing up around my grandfather and stuff, he smokes. […] Mine started just with social. Got out of high school, my own place. All my friends, they bring over rum […] and cigarettes and everything. (Client focus group, pre-implementation)

Some of the clients reported a lack of interest in quitting or their perceived inability to quit:

So officially, once I turned 18 or the age to buy a pack of cigarettes, I bought a pack of cigarettes and since then it’s been– I never had the urge to quit, never tried to quit. Just always adapted to it. (Client focus group, pre-implementation) They [clients] point-blank told me that they feel that if they stop smoking, that they’ll latch back onto something else that is not as legal. (Staff post-implementation interview)

However, these experiences do not mean that none of the clients problematized tobacco use practices and were interested in quitting tobacco. Some clients reported varied attitudes toward quitting. For example, one of the clients who participated in a focus group shared her motivation to quit smoking:

I didn’t want him [her son] to - when he’s picking up pieces of paper towel and putting it to his mouth like a cigarette, it bothers me. I don’t want him to […] also, my baby’s father wasn’t a smoker. It’s a shame thing. I was ashamed. (Client focus group, post-implementation)

In the interviews with the Center’s staff members, they generally revealed that tobacco cessation treatment was a low-priority problem, related partly to a perceived lack of interest in quitting among their clients. Staff shared expectations that clients must be proactive in expressing their interest in quitting and seeking support. Staff at the Center repeatedly expressed the idea that if their clients were interested in quitting tobacco use, they had to ask for help to proactively demonstrate that they were interested in and committed to quitting. As the Center’s program champion said during a conversation with one of the researchers:

I see some of the guys who signed up for the program, but they go out and smoke with other guys outside. I walk by, I see him, but I am not going to say anything to him. It must be his decision, he is an adult, and he must take responsibility. I cannot do it for them. (fieldnotes, conversation with program champion, May 2022)

In a similar way, one of the clinicians at the Center shared during the interview:

I guess if they ask me, if they would like the patches, if they want to participate, I guess that’s when I’ll bring it up […] I think it’s ultimately really up to the client if they really want to make that change. That’s what I love. Some of the clients really want to commit strongly about making the change to stop smoking. (Staff post-implementation interview)

Tobacco education trainings were offered to all Center staff at the beginning of implementation, which were designed to mitigate these barriers (e.g., by providing information about how to proactively address tobacco use with clients) and enhance the implementation capacity by ensuring that they had the knowledge and skills required to implement the program. One of the staff evaluated this training as being very important to help them to be able to deliver tobacco cessation services:

Teaching us about pharmacology, motivational interviewing […]. That thing that was really helpful for us to learn and to be able to explain it to the clients if questions were to come up. (Staff post-implementation interview)

The capacity to implement the program also depends on the availability of material resources. One of most important and expensive resources, nicotine replacement therapy products, were provided to the Center free of charge as a part of the active implementation process. The availability of the nicotine replacement products was widely discussed by the Center’s staff and evaluated as one of the central elements of the program implementation at the Center:

We actually not only have “No Smoking” sign posted up, but we’re able to say, “Here, we have products, nicotine replacement products, that we could give you to help you stop smoking.” (Staff post-implementation interview).

Agency: capability

The Center’s capability to implement the program was evaluated by assessing the implementation’s workability and integration with the everyday workflow and preexisting work processes, following the eNPT framework concepts.

The Center already had a standard tobacco-free policy in place prior to the involvement in the project, and while the TTTF presented them with a much more comprehensive program, the initial buy-in was facilitated by the level of familiarity with the intervention by both staff and clients:

We weren’t really implementing anything. It [tobacco-free policy] was there. It was understood, but this gave us a fuller picture of a way to implement, how to introduce it, a guideline to follow . (Staff post-implementation interview)

One element of the program that contributed to the increased workability was the introduction of the program champion role into the program:

I think the best thing is to have a point person. Because we have a point person, that point person stays on top of all the policy procedures, regulation, inventory, whatever we have going on. (Staff pre-implementation interview)

The Center’s CEO and staff also emphasized that the support they received from the TTTF program increased the workability of the intervention. In addition to regular practical and informational support, they were able to contact program staff with any ongoing questions and requests for assistance. They shared that the focus groups that were conducted with clients also contributed to the program implementation success by increasing clients’ interest in the program:

You guys come in here and working with those guys, because you legitimize the process as a third-party source, and the guys come in to see and you do the surveys [focus group] with them. I think that’s very helpful. (Staff post-implementation interview)

New aspects of the program were reported to be well integrated into the everyday workflow, and while their implementation needed certain changes in practices and attitudes among staff and clients, these changes were not particularly disruptive or time consuming, according to staff who participated in post-implementation interviews:

It’s good to have it embedded into the program that you already have, immerse into what you have going and make it a part of the process, not as something separate, but just this is our program. This is included in the program. I think it’s welcomed a little bit more. (Staff post-implementation interview)

Agency: contribution

Most staff members shared a clear understanding of the purpose of the intervention and its potential benefits. They evaluated the program as important, saw the value of this program for their clients, and shared positive experiences of being involved in its implementation:

I love the program because it gives the clients an opportunity to work on solving that problem of addiction in a positive manner. (Staff post-implementation interview) I felt like it was a great idea to come into play here at the facility. (Staff post-implementation interview)

All staff were well aware of the program being implemented and what new practices and routines were introduced at the Center. They reported very little disagreement about a shared understanding of the need to implement this program:

Everybody was clear on what the mission was, how we would present it, and the way it would be implemented . (Staff post-implementation interview)

One example of effective engagement with the program was one of the staff members quitting smoking herself:

When I came in, he was doing a class and I sat in on it and I’m like, “Hey, I want to do this.” […] we talked about it and I signed up to do it. It’s worked very good for me. (Staff post-implementation interview)

In the interviews, staff at the Center discussed how their engagement in the program and enacting it in their everyday practices contributed to their deeper sense of belonging:

I have the feeling like you can’t disrespect the facility [ by smoking ]. This is our facility and we need to respect her. (Staff post-implementation interview)

Staff members shared a commitment to serving their clients and supporting each other, which was further reinforced by their increased capacity to provide tobacco cessation support to their clients:

That sign right there says we are community, and that’s what we promote, that we are a community center, and this community center has many different programs in it that can provide assistance and this is one of the additional programs that we have that can provide assistance. (Staff post-implementation interview)

Various program components were implemented with different degrees of commitment. The tobacco-free policy was the component that staff reported to be implemented most consistently. The tobacco-free policy has been routinely maintained and reinforced by both the Center’s staff and clients themselves:

They are not allowed to smoke within the facility area. So, that’s worked pretty good. (Staff post-implementation interview) We were always like, “You can’t smoke in here. You got to walk outside.” I think that they just pretty much are just like, “Okay, we got to do the right thing.” […] So yes, they respect it, I think . (Staff post-implementation interview)

However, as A.R. and I.M.L. observed when they visited the Center, clients were often smoking outside. While they were not violating the policy as they were technically outside the property and were smoking while on a public road, they remained physically close to the building, and whoever was leaving or entering the property had to go past a group of clients smoking to enter through the only door to the Center. The Center’s leadership has not found a solution to this problem, as they said they did not have control over the territory and could not prohibit tobacco use beyond their property. This location-specific issue led to a situation in which the tobacco-free policy was technically enforced; however, clients were still able to smoke in the vicinity of the Center, visitors were exposed to secondhand smoke, and this practice was not challenged by leadership or staff, either pre-implementation or after.

Tobacco screenings were reported to be implemented on a regular basis, although there were some discrepancies in the participants’ accounts of screening practices and their regularity. All clients were reportedly screened for all forms of tobacco use during intake, but the follow-up screenings of those clients who reported using tobacco were less consistent. There seemed to be a lack of clear understanding and agreement among staff who was responsible for these screenings, which resulted in a lack of consistency and depended on a specific staff member’s practice rather than established and clearly understood guidelines:

Each time we do an intake on a form, there is an assessment that asks the client if they do smoke, and if they do smoke, do they smoke cigarettes, or do they smoke e-cigarettes? We do offer the NRT [nicotine replacement therapy, and if they want to participate, they would need to say yes or no. Let the counsellor know. […] The individual counsellors, after 30 days in their sessions, ask them again. (Staff post-implementation interview)

However, in individual interviews with staff, at least one of them said that they did not conduct any follow-up screenings unless their clients brought this up and asked about the tobacco cessation program themselves.

As one of the central elements of the program implementation, the program champion provided regular information sessions to inform their clients on the Center’s participation in the program and available support and resources for clients who were interested in quitting tobacco. All clients were expected to attend at least one of these sessions, as these presentations were performed during their mandatory group counseling sessions. Clients were made aware of the resources and support available to them at the Center if they decided to make a quit attempt, as well as given a brief educational presentation on the harms of smoking and the benefits of quitting. These presentations were seen as an effective tool to get clients interested in the program, provide them an opportunity to ask for more information, and engage in conversations about quitting:

People have changed their minds, actually. They initially said no, but then once they heard [the program champion] and people talk about it, they come back and say, well, yes, they would like to. There’s been a couple of guys that have done it, that I know personally, that have done that. (Staff post-implementation interview)

The actual engagement of clients and motivating them to make a quit attempt was the most challenging part of the implementation process for the Center. The overall number of participants who made a quit attempt was 17 clients and two staff members by the end of the implementation period. While the reach of the program is larger than immediate client participation in cessation treatment, there were also some clients’ accounts of inconsistency in support they received during their time at the Center regarding their tobacco use:

Nobody has ever asked me anything [about tobacco use], except you. (Client focus group, post-implementation)

While staff supported the implementation of the program from the beginning, there were some concerns about how well this program might be accepted by their clients. In the post-implementation interview, a counselor shared an observation that their clients were more interested in quitting than they anticipated:

I guess I’m just surprised that I feel like I’m getting some yes’s now instead of a whole bunch of no’s. So, I think that’s actually a good thing because I feel like now that the program has been implemented here, that we’re getting quite a few yes’s. So, that’s definitely something to feel good about, that makes me feel good. (Staff post-implementation interview)

While we observed a variation in the degree to which tobacco cessation intervention services were provided in practice, there was a shared understanding that some of the services needed to be improved:

To be honest, it’s a question [tobacco use and interest in quitting] I feel like I need to ask them more. I haven’t been asking them about it, but I feel like I do need to ask them . […]So, that’s something I could work on. (Staff post-implementation interview)

In the quote above, the counsellor acknowledges that they should ask their clients about their smoking habits and interest in quitting more proactively, which is a positive example of reflexive monitoring of their own actions and practices and could ultimately lead to better outcomes of the intervention.

Staff also demonstrated their involvement by critically evaluating the program delivery and expressing suggestions for improvement:

[We say] “We’re going to have smoking cessation group today and this is going to be the only one for the month.” Well, why can’t we bring it up every meeting? Look, we have three meetings a week, let’s bring it up every time. […] I think there should be a smoking class […] for the whole group at least once a month. (Staff post-implementation interview)

Staff reflected on how this program changed their Center, and they reported a positive change, creating an opportunity to provide more meaningful and involved support and services to their clients:

It’s positively changed or impacted our facility because it gives us some legitimacy behind not only just having a no smoking sign just posted like every public place you see, but actually giving some type of support, nicotine replacement therapy. […] (Staff post-implementation interview).

This case study discusses the implementation of a tobacco-free workplace program at a substance use treatment center serving a diverse group of clients, including many from low socioeconomic backgrounds. This analysis and consideration of the interplay between context and emergent agency, facilitated by the application of the eNPT framework, contribute to the existing knowledge on implementing similar programs in substance use treatment settings that serve marginalized and medically underserved populations facing socioeconomic and health challenges. The findings from this study offer insights that can guide other substance use treatment centers with similar populations in implementing sustainable tobacco-free programs effectively.

A key barrier associated with the context of the implementation, as defined by the eNPT framework, was the widespread tobacco use among clients and within their immediate environment. Prior research has indicated that individuals with substance use disorders are often interested in quitting smoking [ 16 ], but they tend to have lower success rates [ 53 , 54 ]. These contextual barriers to achieving success in tobacco cessation efforts among this population require an exceptionally high level of commitment from the staff working at substance use treatment centers to provide continuous, robust support to their clients [ 55 , 56 ]. As our findings suggest, it is essential to acknowledge and consider the difficulties faced by these individuals when they are trying to quit smoking. While these challenges should not deter clinicians from motivating their clients to quit smoking, it is crucial that they are prepared to approach the situation with sensitivity and awareness of the contextual factors and lived experiences of the clients, which is also emphasized in the principles of trauma-informed care.

Other contextual categories, defined by the eNPT, which we addressed in our study to evaluate the Center’s potential to implement the program, include individual intentions and collective commitment shared by staff and leadership. Most of the staff expressed a strong commitment to participate in the program and provide cessation services to the clients. However, we also encountered attitudes indicating that staff, including clinicians, were doubtful about their clients’ interest in quitting and ability to do so. Given their expertise and supportive roles as addiction treatment specialists, clinicians’ attitudes can greatly affect those of their clients; moreover, clinicians’ beliefs and attitudes are often cited as one of the major barriers to effectively implementing tobacco-free programs within substance use treatment settings [ 4 , 22 , 25 , 57 ]. Training given as a part of the program implementation provided staff with information on evidence-based tobacco cessation practices and addressed some of these attitudes to better prepare staff to provide cessation care to their clients. Such training programs are particularly important for successful implementation and can be further enhanced by placing a stronger emphasis on motivational interviewing techniques, providing practitioners with a better understanding of the nature of ambivalence toward behavior change and the diverse factors influencing clients’ readiness to quit tobacco use.

The capacity to successfully implement and maintain the tobacco-free workplace program is also dependent on access to material resources and, specifically, nicotine replacement therapy products. While two shipments of nicotine replacement products were provided free of charge by the TTTF program, ensuring a continuous supply of these products is anticipated to be challenging for the Center. While individual clients can access free nicotine replacement products through services such as the Texas Tobacco Quitline [ 58 ], the availability of these products on-site and the ability to distribute them immediately and at no cost has been emphasized by the Center’s staff as a crucial component of the program. To address this challenge, the TTTF staff provided informational resources to the Center’s leadership and program champion, highlighting the support available in the community to secure additional funding for the ongoing purchase of nicotine replacement products. However, it remains uncertain at this stage whether the Center will be able to secure the necessary funding to sustain the provision of free nicotine replacement products to their clients and how the availability of these products will impact the long-term sustainability of the tobacco-free program. This is a limitation of this study, as it was conducted during the active phase of implementation and shortly after its completion, lacking data on the program’s long-term maintenance and outcomes. Therefore, further investigation specifically focusing on the long-term sustainability of tobacco-free programs at substance-use treatment centers would be valuable to address this gap and provide insights into ensuring ongoing access to nicotine replacement therapy products for patients. We suggest, however, that it is important to maintain communication with centers after the program implementation is completed, highlighting specific local funding opportunities, as well as sharing examples of successful programs maintained by other centers as a mechanism to support collaboration and pursue additional resources.

Analysis of the themes reflecting the expressions of agency, another major eNPT concept, showed a gradual positive change in tobacco treatment practices at the Center following the implementation of the program, including the enforcement of policies and staff quitting smoking. However, the findings also show that these changes did not immediately affect the provision of smoking cessation care to clients at the Center. Tobacco cessation treatment remained a problem of a lower priority, even for staff who had negative experiences with smoking associated with health concerns, did not use tobacco themselves and were overall very supportive of the program and excited about helping their clients to quit. Rather, this seemed closely related to a persistent perception that their clients were not genuinely interested in or capable of quitting, which was also revealed in the expectations shared by staff that clients had to be proactive in expressing their interest in quitting and seeking support.

We suggest that the expectation of clients proactively seeking support shared by the Center’s staff is associated, at least partially, with their understanding of the existing standards of client-clinician communication, which emphasizes the importance of “sharing power” equally with clients and involving them in the decision-making process [ 59 ]. The concept of patient-centered care, designed to improve healthcare provision and outcomes, is often regarded as a matter of ethical and moral healthcare practice, and it assumes patients’ involvement in their care [ 60 , 61 ]. It is important to consider, however, that these expectations might not work as planned with vulnerable populations, including clients who experience socioeconomic disadvantage, limited access to healthcare services, lower literacy levels and/or limited English proficiency [ 62 ]. These individuals’ ability to take a proactive stance and advocate for their health and well-being may be further hindered by systemic inequalities and structural racism disproportionately experienced by minoritized and underserved groups, and these factors have to be considered to improve the delivery of patient-centered care to these clients and ensure that the care they receive is tailored to their specific needs. Taking Texas Tobacco Free program has developed multiple training videos on smoking cessation support to special population groups [ 63 ], which can be used to provide continuing education on working with diverse groups to ensure that healthcare professionals are equipped with knowledge and skills needed to provide such care.

It is important to acknowledge that concerns about promoting smoking cessation are not entirely unfounded, as clinicians’ advice can have various consequences beyond the client simply following or not following it [ 64 ], and prior research has shown that avoidance of hearing specific recommendations to change behavior, including smoking, is reported as one of the reasons why people avoid seeking medical care [ 65 ]. However, these findings should not discourage health care providers from asking their clients about tobacco use, as this practice is associated with increased quit attempts and is recommended by The US Public Health Service Clinical Practice Guideline [ 66 ]. The potential risk of inadvertently stigmatizing clients who may already feel shame and guilt regarding their tobacco use and inability to quit might be avoided if clinicians use non-stigmatizing approaches identified in prior research [ 67 , 68 , 69 , 70 , 71 ]. It is particularly important to address these concerns in tobacco cessation trainings and educate staff on non-stigmatizing approaches. It is important to incorporate motivational interviewing in these trainings as this approach highlights the importance of displaying unconditional positive regard toward clients, which may increase client resilience in the face of behavioral change advice offered and minimize perceived stigma. It is crucial to find a balance between being sensitive to clients’ choices and priorities and providing the healthcare necessary to alleviate the consequences of systemic health inequities among minoritized and medically underserved groups.

One of the limitation of the study is the limited data on clients’ quit attempts and their outcomes. While the Center attempted to collect these data, they had difficulties following up with their clients after they left the program (most of the clients attended a 90-day program), which created difficulties in evaluating outcomes of those clients who initiated a quit attempt while being treated at the Center. While a more detailed analysis of client outcomes would enhance the evaluation of the intervention, the focus of this study has been on the implementation outcomes, including changes in provider behavior regarding assessing and treating tobacco dependence rather than assessing its direct impact on clients’ tobacco use and cessation [ 72 ]. Future research is needed to delve into evaluating the effects of the intervention on clients’ outcomes, which would provide valuable insights for further refining and optimizing the program.

While the Center’s staff exhibited strong potential and capacity to implement the program, our findings indicate that the actual change in practice has been less successful than anticipated based on the overall support of the program, high potential, and capability. Tobacco cessation treatment had not yet become a routine practice for all staff members by the end of the implementation process. However, despite encountering significant barriers, there is evidence that the program has led to a change in attitudes, including a better understanding of the need and improved ability to provide evidence-based tobacco cessation treatment to their patients. The staff at the Center have started to integrate tobacco treatment into their routine practices, informing clients about the available support, including nicotine replacement therapy products, providing personalized assistance, and assessing patients who may not be ready to quit. Although there are areas for improvement, the program has effectively initiated change in practices, normalizing tobacco cessation treatment and incorporating it as a routine practice at the Center.

The results of this study suggest that substance use treatment centers can maintain tobacco-free workplace policies and integrate evidence-based tobacco cessation practices in their daily operations, but they face extreme challenges due to the complex behavioral health needs and socioeconomic needs of their clients. Understanding the complex interplay between social norms, social roles, and limited resources within such settings is paramount for the success of tobacco cessation efforts. These organizations need extensive support, including a longer implementation period, as well as additional material resources, informational and educational support, and assistance in preparing and maintaining local policies. Regular training of staff, including implementing a train-the-trainer program, would allow to promote and sustain local expertise on evidence-based tobacco cessation interventions for minoritized and medically underserved populations. With proper support, substance use treatment settings have the potential to play a crucial role in addressing tobacco use and provide much needed cessation services to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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This project was supported by funding from the Cancer Prevention & Research Institute of Texas (grant #PP210003 to L.R.R.). A.R.’s time and effort for manuscript drafting was supported in part by MD Anderson’s Tobacco Settlement Funds and by Halliburton Employees Fellowship in Cancer Prevention Fund from The University of Texas MD Anderson Cancer Center. Publication was supported by start-up funds provided by MD Anderson to L.R.R. The funders had no role in the design of the study, the collection, analyses or interpretation of the data, the writing of the manuscript or the decision to publish the results.

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AR, LRR, IML conceptualized the research question and design of the case study; AR and IML completed the collection, analysis, and interpretation of qualitative data; TC completed the analysis of survey data; AR drafted the manuscript text; IML, LRR, MB, LML substantively revised it; MB, BK, KS, KC, TW administered the project and contributed to data collection. All authors reviewed and approved the manuscript.

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This project was approved by the Internal Review Board of the University of Houston (STUDY00002885, initial approval 4/20/2021) and the Quality Improvement Assessment Board at the University of Texas MD Anderson Cancer Center (initial approval 11/21/2022). All parts of the study were performed in accordance with the relevant guidelines and regulations as outlined in the approved research protocol. Oral informed consent was received from all participants prior to participation in qualitative study procedures. The aims of the project and interviews were discussed with participants who were given an opportunity to ask any questions about the interview process and the nature of the study. Additionally, all participants gave oral permission to audio-record the interview. Participants were informed that their participation was voluntary and that they could decline to answer any questions and stop participating in the interview at any time. Clients who participated in the interviews each received a $25.00 Amazon e-gift card as compensation for their time. Staff members did not receive remuneration.

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Rogova, A., Leal, I.M., Britton, M. et al. Implementing a tobacco-free workplace program at a substance use treatment center: a case study. BMC Health Serv Res 24 , 201 (2024). https://doi.org/10.1186/s12913-024-10629-5

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    By following steps, we can more clearly understand what problem it is we're solving, what are the components of the problem that we're solving, which components are the most important ones for us to pay attention to, which analytic techniques we should apply to those, and how we can synthesize what we've learned back into a compelling story.

  3. The process of implementing problem-based learning in a teacher

    For example, studies on topics related to problem solving (Helmi et al., Citation 2016), ... thought that the exploratory case study is a research approach used to initially explore a contemporary phenomenon that is inseparable from the context in which it exists. Therefore, this paper reports on an exploratory study that considered the ...

  4. Case Study-Based Learning

    What Is a Case Study? Case studies are a form of problem-based learning, where you present a situation that needs a resolution. A typical business case study is a detailed account, or story, of what happened in a particular company, industry, or project over a set period of time.

  5. The McKinsey guide to problem solving

    The McKinsey guide to problem solving Become a better problem solver with insights and advice from leaders around the world on topics including developing a problem-solving mindset, solving problems in uncertain times, problem solving with AI, and much more.

  6. Problem-Solving in Business: CASE STUDIES

    This guide is designed to help you approach your business problem-solving process in a systematic way through information sources that can help you understand your situation more clearly and provide a distinct direction towards the appropriate solution. ... ANATOMY OF A CASE STUDY -- PROBLEM-ORIENTED METHOD: 1. Case studies allow a company to ...

  7. The HBS Case Method

    That skill - the skill of figuring out a course of inquiry, to choose a course of action - that skill is as relevant today as it was in 1921.". Pioneered by HBS faculty, the case method presents the greatest challenges confronting organizations and places the student in the role of the decision maker.

  8. A Systematic Approach to Teaching Case Studies and Solving Novel

    We have developed a four-step systematic approach to solving case studies that improves student confidence and provides them with a definitive road map that is useful when solving any novel problem, both in and out of the classroom.

  9. Approaching a Consulting Case

    Allow YouTube videos Key takeaways: Follow the 4 Commandments Get a feeling and true understanding of the problem and the objective Lay out an exhaustive, well-thought-through structure Build an initial hypothesis and prioritize the different areas Gather data based on your hypothesis and priorities

  10. Full article: Problem Based Learning (PBL)

    A case study involves problem solving within a real life or work-related context. Other features of a case study include an interactive style, the development of personal skills and the opportunity to use reflection as part of learning (Citation Pontin et al, 1993). The two case studies that have been developed at Plymouth are both based on ...

  11. Problem Solving as Data Scientist: a Case Study

    So I decomposed the problem further into two steps: Step 1. calculate the purchase likelihood for a customer given the vehicle P (C|V) Step 2. based on the likelihood, attribute a car to the most likely customer in the batch. Now we can further identify the solution for each.

  12. PDF Problem-Solving Skills: Case Studies

    Problem-Solving Skills: Case Studies PROBLEM-SOLVING SKILLS are important in any career. They allow you to deal with a wide variety of situations in your professional life. For example, you may encounter problems such as arranging transportation to work, dealing with difficult coworkers, prioritizing daily tasks, and treating uncommon conditions.

  13. PDF Learning Systematic Problem Solving: Case Studies

    The systematic problem solving approach is based on The Eight-Dimensional Methodology for Innovative Thinking that stimulates innovation by effectively using both sides of the brain. It builds on comprehensive problem solving knowledge from industry, business, marketing, math, science, engineering, technology, and daily life.

  14. Creative Problem Solving (CPS) in Practice: A Case Study

    CREATIVE PROBLEM SOLVING IN PRACTICE 3 since this bridging has impacted the choices I have made in adopting certain perspectives. Organizational creativity (OC) has been explored both by scholars of Organizational and Management Studies (OMS) studies (Zhou & Shalley, 2009) and within the discipline of Adult

  15. How to Approach a Case Study in a Problem Solving Workshop

    Abstract This note, designed for students in the Problem Solving Workshop, gives helpful tips for approaching problem solving case studies. Learning Objectives Help students effectively read problem solving case studies and prepare for problem solving class discussions and exercises. Subjects Covered Problem Solving, Case Studies Accessibility

  16. How to Approach a Case Study

    01 Approaching a Case Study 04 Analyzing the Right Case Information 02 Case Interview Opening: Getting to Know the Key Objective 05 Concluding Your Case with a Strong Recommendation 03 Framing a Customized Problem-solving Structure Approaching a Case Study A case interview always starts with a prompt.

  17. What is Problem Solving? Steps, Process & Techniques

    Problem solving, and the techniques used to gain clarity, are most effective if the solution remains in place and is updated to respond to future changes. Problem Solving Resources. You can also search articles, case studies, and publications for problem solving resources. Books. Innovative Business Management Using TRIZ

  18. PDF Problem Solving: Nine Case Studies and Lessons Learned

    5When possible, do not shift the entire burden of addressing a particular problem to others; officers must agree to be part of the solution to increase acceptance of problem solving efforts. With the Lox Stock Billiards and Sports Bar, officers agreed to increase their patrol presence in the area at the time of closing.

  19. (PDF) Problem Solving Approach

    Problem Solving Approach . Arkeya Pal 1, Er. Faruk Bin Poyen 2. 1 Army Institute of Management, ... This case study included 15 participants who were purposefully selected regarding their grade ...

  20. A Model for Case Analysis and Problem Solving

    1. Comprehend the Case Situation: Data Collection, identify relevant facts 2. Defining the Problem 3. Identify the causes of the problem 4. Generate Alternative Solutions 5. Decision 6. Taking Action - General Reminders / Check List - Writing Tips - Final Comments Subject: Case Work

  21. 12 Approaches To Problem-Solving for Every Situation

    1. Rational One of the most common problem-solving approaches, the rational approach is a multi-step process that works well for a wide range of problems. Many other problem-solving techniques mirror or build off of its seven steps, so it may be helpful to begin with the rational approach before moving on to other techniques.

  22. PDF A Case Study on Students' Critical Thinking in Online Learning

    This study aims to identify epistemological obstacles in critical thinking related to proof, generalization, alternative answers, and problem-solving. This online learning involved 30 prospective mathematics teachers through video conferences. An exploratory case study was

  23. How To Solve Case Study? (With Strategy and Solution) // Unstop

    Step 1: Identify the problem statement Step 2: Propose solutions with a pinch of creativity Step 3: Establish the scale and impact of the solution "Case study competitions" - Something that is arguably one of the most valuable parts of your MBA life. But this may be daunting for many.

  24. Case Interview 101: What Is A Hypothesis Driven Approach?

    Being efficient at problem solving boils down to designing a good analytical approach. Photo by Volodymyr Hryshchenko on Unsplash. This is where "hypothesis-driven approach" comes in. Being hypothesis-driven in problem solving means working on trying to debunk (or prove) each component of the problem at a time, starting with components that ...

  25. Find the AI Approach That Fits the Problem You're Trying to Solve

    Summary. AI moves quickly, but organizations change much more slowly. What works in a lab may be wrong for your company right now. If you know the right questions to ask, you can make better ...

  26. Implementing a tobacco-free workplace program at a substance use

    The current study was based on an ethnographic approach and uses a case study design, which is considered an efficient way to present qualitative ethnographic findings [33, 34]. Case study design has been found to be particularly useful in implementation research, as it allows for an in-depth analysis of complex interventions in combination ...

  27. Electronics

    The monitoring and early avoidance of collisions in a workspace shared by collaborative robots (cobots) and human operators is crucial for assessing the quality of operations and tasks completed within manufacturing. A gap in the research has been observed regarding effective methods to automatically assess the safety of such collaboration, so that employees can work alongside robots, with ...

  28. Preaching beyond Binary Categories: An Approach from Process ...

    The article begins with a statement of the problem, summarizes key elements of process thought that come into play, sketches how a preacher might seek the creative transformation of binary impasses, and brings forward three case studies of binaries that illustrate this approach in action.