RES 6033 Module 1 Qualitative Designs Comparison Example

Closing the Birthing Unit: Comparing Case Study, Phenomenology, Grounded Theory, Ethnography and Narrative Inquiry for a Study of How Rural Hospital Leaders Decide

Student Name

American College of Education

RES6033: Qualitative Research Designs

Module 1 Assignment

Instructor Name

October 12, 2026

Introduction

I am chief operating officer for a group of four critical access hospitals in western Kansas, and two years ago our board voted to stop delivering babies at one of them. The decision took 14 months, involved physicians, nurses, county commissioners and families and left the community angry. As a DBA student, I want to study how leaders of small rural hospitals reach decisions like this one. Hung et al. (2016), surveying rural hospitals in nine states, found obstetric services ending at 7.2% of those hospitals between 2010 and 2014, most often small hospitals in communities with few obstetricians and family physicians. That study shows which hospitals close units; it cannot show how their leaders decide. A qualitative design can, and this paper compares five of them.

What the Problem Needs From a Design

The decision unfolds over months, among many people, in an organization with its own finances, staffing and history. Any design must be able to follow a process over time, include several viewpoints and use more than interviews, since board minutes, financial reports and local news coverage record parts of the decision that participants may forget or reframe. The study should also produce something useful to other rural hospital leaders, which means findings that can be compared across hospitals rather than a portrait of one.

Case Study

A case study examines a bounded system in depth, drawing on multiple sources of evidence. Baxter and Jack (2008) explained that the case must be bounded by time, place or activity and that a multiple case study, examining several cases, allows the researcher to see what holds across settings and what differs. Here each case would be one hospital's obstetric decision, bounded from the first formal discussion to the final vote. Data would include interviews with executives, board members, physicians and nurses, along with minutes, financial analyses and news coverage. The product would be a description of each decision and a cross-case analysis of patterns, matching what the problem needs.

Phenomenology

Phenomenology seeks the essence of a lived experience shared by several people. Neubauer et al. (2019) described its aim as understanding a phenomenon as those who live it experience it, and distinguished descriptive approaches, which set aside the researcher's assumptions, from interpretive ones, which acknowledge them. A phenomenological study would ask what it is like to be a rural hospital executive who closes a birthing unit, interviewing perhaps 10 to 15 such leaders in depth. The product would capture the weight of the decision, including guilt, isolation and conflict with the community. It would not trace how the decision was made, and documents would play little part.

Grounded Theory

Grounded theory builds a theory of a process from data. Chun Tie et al. (2019) described its core features as concurrent data collection and analysis, constant comparison, theoretical sampling, where each new participant is picked to test ideas still forming, and memo writing that develops categories into a theory. A grounded theory study would ask how rural hospital leaders move from concern about an obstetric unit to a final decision, producing a model of stages and conditions. This is the strongest alternative, since the problem concerns a process. Its demand for theoretical sampling until categories are saturated, however, could require 25 or more interviews across many hospitals, a heavy load for a part-time doctoral student.

Ethnography

Ethnography studies the culture of a group through extended immersion, usually including observation over months. An ethnographic study would examine how the culture of a rural hospital and its town shapes decisions about local services, perhaps by spending a year observing board meetings, medical staff meetings and community forums at one hospital weighing a closure. The product would be a rich account of shared values and conflicts. The design is poorly matched to my situation: decisions already made cannot be observed, decisions in progress are rare and sensitive and as an executive in one system I could not observe a competitor's board.

Narrative Inquiry

Narrative inquiry studies the stories individuals tell about their experiences and how they make meaning through them. A narrative study might follow two or three leaders through extended interviews about their careers and the closure decision within them. The product would show how leaders understand themselves and their responsibility to a community. Like phenomenology, it centers on individuals rather than on the organizational process, and with so few participants it would offer other hospitals little basis for comparison.

Comparing the Designs

The five designs differ in their unit of study, their data and their product. Case study takes a bounded system as its unit, uses many kinds of data and produces descriptions and cross-case patterns. Phenomenology takes a shared experience, relies on in-depth interviews and produces a description of essence. Grounded theory takes a process, uses interviews with theoretical sampling and produces a theory. Ethnography takes a cultural group, uses observation and produces a cultural portrait. Narrative inquiry takes individual stories and produces a retelling of meaning. Only case study and grounded theory treat the decision itself as the thing to be explained, and only case study builds documents into its core design.

Where I Stand

My own position shapes the choice as well. I helped prepare the financial analysis that our board used, and some leaders I would interview know me as the executive who closed a unit. That history could make some participants guarded and others eager to justify similar decisions. Each design handles a researcher's position differently: interpretive phenomenology and narrative inquiry treat it as part of the analysis, grounded theory asks the researcher to record it in memos and case study asks for it to be disclosed and balanced through multiple sources. Because documents provide a check on what participants tell me, a case study offers some protection against my own assumptions, which I will also record in a reflexive journal from the first interview onward.

My Choice

I am choosing a multiple case study of four to six rural hospitals in Kansas and neighboring states that have decided, in the past five years, whether to keep or close an obstetric unit. Including hospitals that kept their units is deliberate: comparing decisions that went different ways will show what tipped the balance, which a sample of closures alone cannot. Three reasons support the choice. The decision is bounded in time and place, the definition of a case. Documents are essential, and case study is designed to combine them with interviews. And cross-case analysis will give other hospital leaders patterns they can compare with their own situation. The costs are real: case study can sprawl without firm boundaries, and access to board minutes depends on each hospital's willingness to share them, a problem Module 4 will address.

Conclusion

Each qualitative design would tell a different story about obstetric unit decisions: the experience of the leaders who make them, the stories they tell, the culture around them, a theory of the process or a set of compared cases. The multiple case study best fits a problem that is bounded, recorded in documents and meant to inform other hospitals. Module 2 turns to the interview protocol. The comparison also clarified what the study will not do: it will not judge whether any closure was right.

References

Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers. The Qualitative Report, 13(4), 544-559. https://doi.org/10.46743/2160-3715/2008.1573

Chun Tie, Y., Birks, M., & Francis, K. (2019). Grounded theory research: A design framework for novice researchers. SAGE Open Medicine, 7, 1-8. https://doi.org/10.1177/2050312118822927

Hung, P., Kozhimannil, K. B., Casey, M. M., & Moscovice, I. S. (2016). Why are obstetric units in rural hospitals closing their doors? Health Services Research, 51(4), 1546-1560. https://doi.org/10.1111/1475-6773.12441

Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019). How phenomenology can help us learn from the experiences of others. Perspectives on Medical Education, 8(2), 90-97. https://doi.org/10.1007/s40037-019-0509-2