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What the Case Study Method Really Teaches

• Nitin Nohria

Seven meta-skills that stick even if the cases fade from memory.

It’s been 100 years since Harvard Business School began using the case study method. Beyond teaching specific subject matter, the case study method excels in instilling meta-skills in students. This article explains the importance of seven such skills: preparation, discernment, bias recognition, judgement, collaboration, curiosity, and self-confidence.

During my decade as dean of Harvard Business School, I spent hundreds of hours talking with our alumni. To enliven these conversations, I relied on a favorite question: “What was the most important thing you learned from your time in our MBA program?”

• Nitin Nohria is the George F. Baker Jr. Professor at Harvard Business School and the former dean of HBS.

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Case Study-Based Learning

Enhancing learning through immediate application.

By the Mind Tools Content Team

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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Understanding Multiple Environmental Stresses: Report of a Workshop (2007)

Chapter: 4 lessons learned from the case studies, 4 lessons learned from the case studies.

This workshop looked at two case examples, using presentations and discussion, to explore current understanding of multiple environmental stresses in the earth system and to discuss the types of research needed to improve integrated understanding of these kinds of complex, nonlinear problems. Understanding multiple stresses is challenging because it almost always requires consideration of multiple variables and larger, more complex spatial scales. Yet without a more sophisticated understanding of the impacts of a suite of environmental stresses, we cannot make the kind of progress necessary to improve our predictive capability and response strategies.

The overarching lesson of the workshop discussions is that a thorough understanding of the integrated effects of—and future vulnerability to—multiple stresses to natural and socioeconomic systems requires improved use of existing tools and strategies and, in addition, the development of improved tools and strategies—such as observational, modeling, and information systems infrastructure—to support environmental monitoring, vulnerability assessment, and response analysis and that the entire process needs significant involvement of stakeholders.

During the workshop, the National Ecological Observing Network 1 (NEON) was mentioned as an example of the type of nationally networked research, communication, and informatics infrastructure needed to provide more comprehensive and interdisciplinary measurements and experiments. References were also made to other possible infrastructure, such as

the National Phenology Network 2 (USA-NPN), designed to facilitate systematic collection and free dissemination of phenological data from across the United States to support research concerning interactions among plants, animals, and the lower atmosphere, especially the long-term impacts of climate change;

the Ocean Research Interactive Observatory Networks 3 (ORION), designed to provide high-frequency, continuous time-series measurements in broad-scale spatial arrays needed to define the links among physical, biological, chemical, and geological variables in the oceans and provide spatially coherent data to study processes and enable modeling efforts;

the Ameri-Flux Network, 4 designed to provide continuous observations of ecosystem-level exchanges of CO 2 , H 2 O, energy, and momentum spanning diurnal, synoptic, seasonal, and interannual timescales;

the proposed Integrated and Sustained Ocean Observing System 5 (IOOS);

the International Global Ocean Observing System 6 (GOOS); and

the Global Earth Observation System of Systems 7 (GEOSS).

Observing systems alone cannot solve the puzzle of understanding multi-stress environmental problems, but they are a necessary component because they provide the data needed to characterize the environment and determine trends. There is a real need for careful attention to the systematic creation and validation of long-term, consistent climate data records (NRC, 2004a). The following paragraphs describe some of the other tools and strategies highlighted during the workshop.

COMPREHENSIVE REGIONAL FRAMEWORKS

Many participants advocated development of comprehensive regional frameworks for environmental studies as outlined during the workshop’s keynote address by Dr. Eric Barron. The vision Dr. Barron proposed included

an integrated regional web of sensors that link existing observations into a coherent framework and enable new observations to be developed within an overall structure;

an integrated and comprehensive regional information system accessible to a wide variety of researchers, operational systems, and stakeholders;

directed process studies designed to examine specific phenomena through field study to address deficiencies in understanding;

a regional, high-resolution modeling foundation for constructing increasingly complex coupled system models at the spatial and temporal scales appropriate for the examination of specific and integrated biological, hydrological, and socioeconomic systems; and

a strong connection to significant regional issues and stakeholders.

Workshop participants returned repeatedly to the Regional Integrated Sciences and Assessments (RISA) 8 program as a possible model for such regional frameworks. (RISAs are discussed in greater detail later in this chapter.)

A WEB OF INTEGRATED SENSORS

Current U.S. observation strategy tends to focus on the measurement of discrete variables at a specific set of locations designed to serve the different needs of weather forecasting, pollution monitoring, hydrological forecasting, or other specific mission objectives. This mission focus results in a diverse set of networks supported by a number of different federal agencies, states, or regional governments. A host of environmental issues motivates additional new observations. However, these new observations are frequently viewed independently of an integrated observing strategy. In addition, it is difficult to identify sufficient financial support for regular and consistently repeated observations. These factors severely limit our ability to integrate physical, biological, chemical, and human systems.

Creating comprehensive regional observing networks would allow us to (a) link observing systems into a web of integrated sensors building upon existing weather and hydrological stations and remote sensing capability; (b) create the agreements across a set of more limited agencies and federal, state, and local governments needed to create a structure to the observing system; (c) provide a compelling framework that encourages or demands the integration of new observations into a broader strategy; and (d) create strong linkages between research and operational observations that result in mutual benefit. Clearly, these steps will be difficult to achieve given political dynamics and constrained budgets, but these sorts of comprehensive approaches are needed to improve our capability to respond and ensure flexibility over time. The importance of continued support for and maintenance of existing environmental networks should not be under-estimated as a foundation for what needs to happen in the future.

REGIONAL INFORMATION SYSTEMS

Efforts to create comprehensive information systems increasingly reflect federal and state mandates to make data more accessible and useful to the public

and to ensure that our investments in research yield maximum societal benefit. Development of a tractable regional digital database is feasible and enables participation of universities; federal, state, and local governments; and industry in an endeavor for which immediate benefit for a state or region can be evident. For this to happen efficiently these information systems will need to take advantage of existing facilities and infrastructure, augmenting selectively as needed and, overall, improving the connections that bind the pieces together. This will take careful and detailed planning and a strong commitment to implementation.

FRAMEWORK FOR PROCESS STUDIES

Process studies are a critical element of scientific advancement because they are designed to probe uncertainties in knowledge about how the earth system functions. The objective is to use field study to address deficiencies in our understanding. Targeted process studies improve our ability to quantify thresholds, understand nonlinear interactions of multiple environmental factors, and decipher long timescale responses to climate change. The benefit of these intensive studies is maximized when they can be coupled with a highly developed, integrated set of sensors, with readily accessible spatial and temporal data within a regional information system, and with a predictive model framework that readily enables the entrainment and testing of new information from process studies.

IMPROVING OUR PREDICTIVE CAPABILITY

Prediction is central to the translation of knowledge about the earth system into economic benefit and societal well-being. Although there is still substantial room for improvement, over the last several decades we have experienced enormous increases in our ability to forecast weather and to project climate and climate variability into the future. The demand for new forecasting products involving air quality, energy demand, water quality and quantity, ultraviolet radiation, and human health indexes is growing rapidly. Environmental issues will demand an even greater capability to integrate physical, biological, chemical, and human systems in order to examine the response of critical regions or cases to multiple stresses.

Global weather and climate models provide the strongest physical foundation for more comprehensive predictive capability. The numerical models that underpin this type of forecast are increasingly becoming the framework for the addition of new numerical formulations designed to predict air quality, the water balance for river forecast models, and a host of other variables, including the migration of forests under climate change conditions. As we attempt to produce predictions at the scale of human endeavors, mesoscale models (capable of predicting synoptic weather systems) and downscaling of coarser resolution model output are increasingly becoming the focal point of weather and climate studies because of their

potential to make predictions on the scale of river systems, cities, agriculture, and forestry. Development of a mesoscale numerical prediction capability that meshes with regional sensor webs and information systems would facilitate development of tractable coupled models, initiate experimental forecasts of new variables, and enable assessment of the outcomes associated with multiple stresses.

RESEARCH NEEDS RELATED TO NONLINEARITIES AND THRESHOLDS

Workshop participants frequently highlighted lessons learned about non-linearities in the climate system and the difficulties associated with quantifying

the effects of multiple interacting stresses and technological change. Although current models are useful in identifying single-variable nonlinearities, few models are sufficiently comprehensive to provide quantitative predictions of the effects of multiple environmental stresses. While coupled modeling systems developed in the future are expected to be useful in the identification of nonlinearities, it was thought that nonlinearities are currently best identified by long-term observations.

The thresholds considered by participants to have the highest priority for study include climate/pest interactions resulting in changes in functional types of natural vegetation; megadrought (climate threshold, ecosystem thresholds, human thresholds, cascading effects); and interaction between ecosystems, climate change, and air pollution. Suggestions regarding how best to approach the study of thresholds included studies involving initial system observations followed by single-variable and multiple environmental stresses experiments and modeling; studies focused on ecotones, zones where marginality of nutrients, predators, climate, land use, economics, and policies create unstable land uses that are especially sensitive to small variations in drivers; and studies of extreme conditions (e.g., air pollution in megacities) where changes in state may be observed. Participants also encouraged development of threshold typology, identification of a core set of controlling (and dynamic) variables that determine system behavior, assessment of the interaction of fast and slow variables (as related to the threshold); assessment of the degree to which a system may be capable of self-organization; and assessment of the ability to build and increase the capacity for learning and adaptation. Threshold-focused research needs to study both direct and indirect effects, linking thresholds and impact occurrence to indicators/indices, study of the full probability space of observations and model outputs, and consideration of new opportunities that are likely to result from globalization.

RESEARCH NEEDS RELATED TO INCREASING RESILIENCE

Workshop participants encouraged the following approaches to increasing resilience to multiple environmental stresses:

use of models;

improvement of models for response planning;

identification of additional water storage;

consideration of new conservation strategies;

maintenance of biodiversity;

improved communication of environmental capacities and limitations to local officials;

improved understanding of adaptive or buffering capacity, which is determined by the types of capital available (natural, social, human, cultural, and produced);

full leveraging of adaptive capacity, technological capacity, and expertise;

in-parallel focus on combinations of social and environmental stresses and combinations of environmental stresses;

use of war games as a scenario-based tool for informing decision making, examination of historical analogs that share important similarities with contemporary (and anticipated future) stresses;

incorporation of “normal” (rather than fair to good) socioeconomic conditions and civil and regional wars in scenarios for sustainable development; and

linking results of models to resilience, improvement of public awareness of related issues, and elimination of nonsustaining financial incentives.

Moreover, a number of steps were suggested for the creation of vigorous and continuous links between researchers and decision makers, including

incorporation of the variety of time and space scales and the diversity of variables that are important to decision makers;

emphasis on the education of the user in the meaning and significance of climate and land use information in order to promote greater use and more robust applications;

ensuring mutual information exchange and feedback;

focus on communication and accessibility of information;

continuous evaluation and assessment of the use and effectiveness of the services;

employment of active mechanisms to enable the transition from research discovery to useful products; and

employment of a variety of methods of education and outreach.

RESEARCH NEEDS RELATED TO REGIONAL STUDIES

During the workshop the argument was made that the ability to anticipate the future is what makes knowledge powerful. The knowledge we seek concerns the role and effects of multiple stresses in the context of atmosphere-ecosystem interactions. These interactions include climate variability and change over a wide range of time/space scales, land use/land cover changes, human social systems, waste products and streams, and the combined effects of all the above on natural ecosystems. This knowledge must perforce be place based (i.e., site or region specific) because context is important. Integrated assessments of multiple stresses across a variety of time/space scales are required in which the impacts and decisions are place based but the drivers of impacts are drawn from a much larger scale. We can summarize by saying it is critical to link the large-scale drivers to place-based contexts with a focus on multiple stressors and put the knowledge to work—that is, connect in partnerships with real stakeholders and decision makers from the place where the work is done.

Obstacles to realizing the vision above include lack of the following:

integrated observing systems;

a common modeling framework;

a foundation of process studies geared toward prediction;

an integrated data and information system; and

systematic, vigorous connections to real users of the information and decision makers.

One program in existence comes close to meeting the challenge described above and that is the Regional Integrated Sciences and Assessments (RISA) program of NOAA’s Office of Global Programs. As described at the workshop, the RISA program was launched in 1995 with a pilot project at the University of Washington (the Climate Impacts Group). The program now consists of eight regional teams distributed across the United States, each with a focus on the role of climate variability and the projected impacts of climate change in defined sectors of human socioeconomic activity and on specified ecosystems. Each program is required to establish links and partnerships with stakeholders and decision makers so that research results can be translated into usable knowledge and decision-support tools that are specific to the subregion. Emphasis is placed not only on assessing the climate sensitivity of different activities and ecosystems but also on their vulnerabilities to climate variability and change and on policies and programs that would increase the resilience of these subregions to climate-related risks of varying magnitude.

So far RISA teams cover the Pacific Northwest, the Southwest, the Colorado River system, California, Hawaii, the Southeast (Florida and Georgia), the Carolinas, and New England. Although the basic template and objectives for each team are the same, there is considerable variation in the way the teams implement the vision because each team is grounded in a particular place in which the mix of concerns varies along with constituents, capabilities, and climate-related risks. These teams document what and how climate drivers function in specific places, what impacts they typically exert on various kinds of natural systems and socioeconomic activities that are sensitive to climate variability, and what levels of risk each subregion faces, inter alia. The crucial questions, not surprisingly, shift from place to place. So, for instance, “Will winter snowpack and spring streamflow be above or below normal this year?” might be a critical question in the Pacific Northwest, but it will have no meaning in Florida where “Will it freeze?” is definitely one of the critical questions. In the western United States water is the central issue and will be even more so under scenarios of climate change because the entire West consists largely of snowmelt-driven systems. No matter what their foci, all subregions are now faced with the necessity of trying to understand what their vulnerabilities to anthropogenic climate change are, what the magnitudes and rates of change might be, and how best to adapt to and cope with these changes over time.

The RISA teams clearly demonstrate how useful such an approach can be. But to date this is still a small program and a long way from fulfilling the vision of cohesive observations, data management, data access, carefully designed process studies across regions and subregions nested in a framework for developing regional predictive models of the effects of multiple stresses and translating the research outputs in a series of vigorous and continuing connections with stakeholders.

NEAR-TERM OPPORTUNITIES

Looking overall at the workshop presentations and discussions, a great range of issues and opportunities were explored. As a final step, the steering committee reviewed the information generated and identified seven near-term opportunities for advancing our understanding of multiple stresses and making this understanding useful to decision makers.

1. A Ground-Based Measurements Network . There is a real need for comprehensive ground-based measurements of important ecological indicators such as biodiversity, species composition, ecosystem functioning, ecological aspects of biogeochemical cycles, and other elements. This information over time will allow improved understanding of the ecological implications of climate change, the evolution of infectious diseases, invasive species, and land use change over time and across large spatial scales (NRC, 2003). The National Ecological Observatory Network (NEON) that has been under development is an example of the kind of system that could contribute the types of information needed.

2. Global Information Systems and Satellite Observations . In 2005 members of the Group on Earth Observations (GEO), which includes 60 countries and the European Commission, agreed to a 10-year implementation plan for a Global Earth Observation System of Systems (GEOSS). Anticipated foci and socioeconomic benefits include

sustainable agriculture and reduced desertification;

disaster reduction and improved ecosystem management and protection;

biodiversity conservation;

improved weather information, forecasting, and warning;

adaptation to climate variability and change;

improved water resource management;

understanding of environmental factors affecting human health and well-being; and

improved management of energy resources (NRC, 2005b).

GEOSS could be configured to assist with detecting and understanding multiple stresses and extreme events. For example, one of the key components of the

International Earth Observing System (IEOS), 9 the primary contribution by the United States to GEOSS, would be a National Integrated Drought Information System (NIDIS). The goal of NIDIS is to develop an integrated drought information system that would enhance the ability of users to assess on a timely basis the risks and potential impacts associated with drought through the availability of appropriate decision-support tools. Other aspects of NIDIS focus on the development of a comprehensive drought early warning and delivery system, an enhanced research environment that emphasizes impact mitigation and improved predictive capabilities, and a framework for interacting with and educating stakeholders and the public on causes of drought, preparedness strategies, and how drought impacts human and natural systems. NIDIS is considered to be an invaluable resource in helping water managers and policy makers at all levels deal with the increasing impacts of drought and water resources management in a climate change environment.

IEOS/GEOSS could also provide longer-term forecasting, especially for severe weather events, such as Hurricane Katrina, and an all-hazards, all-media alerting system. (In the case of wildfires, hikers, for example, would get immediate messages on their cell phones to evacuate areas . ) Furthermore, as improved forecasting will help with the distribution of resources in warm or cold years and in extreme wet or dry seasons, IEOS/GEOSS could be very important to the water and energy sectors.

3. Synthesis of Data . The Heinz Center’s 10 State of the Nation’s Ecosystems project—done in concert with federal, corporate, and academic partners—is characterizing data gaps and data integration needs by sector (urban, forests, coasts, etc.) in order to produce indicators on the improvement or degradation of U.S. resources. This multiyear effort could include a section on the composite effect of multiple stresses on ecological and urban sectors and identify missing data most needed to characterize the status of trends of ecosystem health.

4. Nonlinearities and Thresholds . There is a rich historical record of responses to extremes of record (droughts, floods, hurricanes). Overlaying those conditions on the socioeconomic and ecological conditions of today—conducting “what if” scenarios to see if today’s communities and natural resources could cope with, for example, the drought of the 1930s or a direct hit of hurricane Andrew on Miami—would be extremely valuable. Similarly, scenarios reconstructing extreme events of the past could study if an increase in temperature and a change in water availability would lead to breakpoints or thresholds in the ecological or economic realms (e.g., as observed by Breshears et al., 2005).

5. Resilience . Within the assessment processes, institutional, technological, and economic options that offer insurance or appear the most robust to a suite of environmental changes could be identified. These could include such measures as changed cropping patterns, water conservation, germplasm preservation, park design, and habitat connectivity, within the context of long-term resiliency to a changing climate. In addition, early warning systems for various environmental indicators (droughts, floods, tropical cyclones, wildfires) could be established in pertinent regions. Finally, development of a compendium of best practices for coping with extreme events and deployment of appropriate preparedness programs would enhance resilience.

6. Regional Foci . Understanding the impacts of climate change in a particular place in concert with the other environmental stressors operating in that region is key to developing wise coping options. The Regional Integrated Sciences and Assessments program and the regional studies begun under the U.S. National Assessment process are models of this nascent type of analysis, and an increase in this kind of activity is greatly needed.

7. Stakeholder Involvement . Connecting stakeholders to an ongoing research effort directly aimed at producing usable knowledge of value to stakeholders requires long-term partnerships, trust that researchers will actually stay the course, thorough familiarity on both sides about what each is doing, considerable effort expended by the research teams to gain knowledge about the decision context and the needs of the different types of stakeholders, and appreciation by the stakeholders of the added value the results of the research can offer to their concerns. All of this takes time and resources. The RISA teams, for example, have used periodic systematic surveys, annual workshops custom-tailored to the specific interests of different combinations of stakeholders (e.g., water resource managers, forest fire managers, fisheries managers, farmers, coastal managers), and the co-production of specific decision-support tools as ways to build in true stakeholder involvement.

Research and experience to date show that overemphasizing climate forecasts per se is counterproductive. Users have a decided preference for deterministic forecasts and lack of understanding of probabilistic forecasts to an extent that only the technically advanced early adopters find probabilistic climate forecasts to be useful. For others a softer approach is more useful and more readily understood. This approach is grounded on the fact that all stakeholders really want to understand to what extent climate is responsible for the underlying variation in the resources they use or manage or the economic activities in which they are engaged. Once researchers recognize this fact, it is possible to have fruitful, long-term relationships that evolve. However, each party to the relationship has to be committed to learning from the other, and the researchers need to strive to produce information and decision tools that are useful and timely to the stakeholders. However, it should be understood that stakeholders cannot define the totality of the research agenda for the simple reason that often the stakeholders do not and

cannot be expected to know what they need to know about the dynamics of the climate system. So the research agenda must be balanced; it cannot be the product of curiosity alone but rather it must be defined to meet certain ends that can be transferred to the decision maker.

The research of the last decade has demonstrated that ecosystems and human systems are influenced by multiple factors, including climate, land use, and the by-products of resource use. Understanding the net impact of a suite of simultaneously occurring environmental changes is essential for developing effective response strategies. Using case studies on drought and a wide range of atmosphere-ecosystem interactions, a workshop was held in September 2005 to gather different perspectives on multiple stress scenarios. The overarching lesson of the workshop is that society will require new and improved strategies for coping with multiple stresses and their impacts on natural socioeconomic systems. Improved communication among stakeholders; increased observations (especially at regional scales); improved model and information systems; and increased infrastructure to provide better environmental monitoring, vulnerability assessment, and response analysis are all important parts of moving toward better understanding of and response to situations involving multiple stresses. During the workshop, seven near-term opportunities for research and infrastructure that could help advance understanding of multiple stresses were also identified.

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• What is Blue Ocean Strategy and How Can it Transform Your Business?
• How to Conduct a PEST Analysis: Uncovering Key Factors for Strategic Planning
• Improving Performance: Identifying Areas for Success
• Benefits and Limitations of the Model
• SWOT analysis
• What is SWOT analysis?
• Using SWOT analysis to inform strategy
• How to conduct a SWOT analysis
• Porter's Five Forces
• What is Porter's Five Forces?
• How to apply Porter's Five Forces model
• Using Porter's Five Forces in strategic planning
• PEST analysis
• How to conduct a PEST analysis
• What is PEST analysis?
• Using PEST analysis to identify external factors
• Implementing and monitoring the plan
• Assigning responsibilities
• Creating an action plan
• Measuring progress and making adjustments
• Introduction to strategic planning
• Key components of a strategic plan
• Benefits of strategic planning
• What is strategic planning?
• Steps in the strategic planning process
• Developing strategies and tactics
• Assessing the current state
• Setting goals and objectives
• Market research and analysis
• Using data to inform strategy
• Conducting market research
• Analyzing market trends
• Scenario planning
• What is scenario planning?
• Creating and evaluating scenarios
• Incorporating scenarios into strategic planning
• Financial analysis
• Using financial data in strategic planning
• Forecasting financials
• Assessing financial performance
• Strategy development and implementation
• Expert guidance in strategy implementation
• Ensuring alignment with business goals
• Customized strategic planning services
• Change management consulting
• Managing organizational change
• Implementing new strategies and processes
• Maximizing employee buy-in and adoption
• Performance improvement consulting
• Developing strategies for performance enhancement
• Measuring and monitoring progress
• Identifying areas for improvement
• Success stories
• Real-world examples of successful strategic planning
• Key takeaways and lessons learned
• Applying principles to your own strategy
• Challenges and failures
• Identifying common pitfalls and how to avoid them
• Applying insights to your own strategy
• Learning from failed strategic planning efforts
• Industry-specific case studies
• Examples of strategic planning in specific industries
• Best practices and lessons learned for your industry
• Applying strategies to your own business
• OKR (Objectives and Key Results)
• Understanding the OKR framework
• Integrating OKRs into strategic planning
• Setting and tracking objectives and key results
• Blue Ocean Strategy
• What is Blue Ocean Strategy?
• Case studies and success stories
• Applying Blue Ocean Strategy to your business
• Balanced Scorecard
• What is the Balanced Scorecard?
• Benefits and limitations of the model
• Using the Balanced Scorecard in strategic planning
• Case studies
• How to Craft a Successful Case Study: Key Takeaways and Lessons Learned

Discover the Essential Elements of a Winning Case Study and Improve Your Success Rate

Are you looking to improve your business strategies and learn from successful examples? Look no further than case studies and success stories. These powerful tools allow us to dive deep into the experiences of others and extract key takeaways and lessons learned. Whether you are a marketer, entrepreneur, or student, case studies provide valuable insights and practical knowledge that can help you excel in your field. In this article, we will explore the art of crafting a successful case study. From identifying the right subject to highlighting the most important lessons, we will guide you through the process of creating a compelling and informative case study.

So, if you're ready to take your skills to the next level, read on to discover how to create a powerful case study that will leave a lasting impact. In today's digital age, case studies have become an integral part of marketing and business success. Through real-life examples and success stories, they showcase the effectiveness and benefits of a product or service. However, creating a successful case study goes beyond just highlighting numbers and statistics. It requires a deep understanding of the main purpose of a case study - to provide value to potential customers. The focus of a case study should not be solely on promoting your product or service, but rather on solving a problem or addressing a need that your target audience may have.

This means that your case study should be relatable and engaging for readers, rather than just listing features and promoting your brand. For example, if you are promoting a project management software, your case study should highlight how it helped a company streamline their processes and increase productivity. This not only showcases the benefits of your product, but also provides valuable information for potential customers who may be facing similar challenges. When crafting a case study, it is important to focus on the key takeaways and lessons learned from the real-life example being presented. These takeaways should be actionable and applicable to potential customers, showing them how they can achieve similar results by using your product or service. By including these key takeaways and lessons learned in your case study, you are providing value to potential customers and positioning yourself as an expert in your industry. This can greatly increase the effectiveness of your marketing efforts and contribute to the success of your business. In conclusion, when creating a successful case study, remember to focus on providing value to potential customers through relatable and actionable examples.

Identifying Your Target Audience

Crafting a compelling story.

It should tell a story that resonates with the reader and evokes emotions. Make sure to include quotes and testimonials from your client, as well as before and after scenarios to showcase the transformation that your product or service brought about. This will make your case study more relatable and credible. Crafting a compelling story is crucial in capturing the attention of potential customers and convincing them of the effectiveness of your product or service.

Choosing the Right Format

In this article, we will discuss the key takeaways and lessons learned from crafting a winning case study. In conclusion, crafting a successful case study requires a thorough understanding of your target audience, choosing the right format, and telling a compelling story. By following these key takeaways and lessons learned, you can create a winning case study that not only promotes your product or service but also provides value to potential customers.

• if you're ready

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• Expert Guidance in Strategy Implementation: A Comprehensive Overview
• Understanding Porter's Five Forces: A Comprehensive Overview
• Creating an Action Plan: A Comprehensive Guide to Strategic Planning
• A Comprehensive Guide to Implementing New Strategies and Processes
• How to Master Scenario Planning: A Comprehensive Guide
• Integrating OKRs into Strategic Planning: A Comprehensive Overview

A Complete Guide to Strategic Planning

• Using Financial Data in Strategic Planning: A Comprehensive Guide
• Understanding SWOT Analysis: A Comprehensive Overview
• Assessing the Current State: A Comprehensive Look at the Strategic Planning Process
• Key Components of a Strategic Plan: A Comprehensive Overview
• Developing Strategies and Tactics: A Comprehensive Guide to the Strategic Planning Process
• Using Data to Inform Strategy: How to Use Market Research and Analysis for Strategic Planning
• Applying Blue Ocean Strategy to Your Business
• Conducting Market Research: A Comprehensive Guide
• Incorporating Scenarios into Strategic Planning: A Comprehensive Guide
• How Case Studies and Success Stories Can Revolutionize Your Strategic Planning Models
• Setting goals and objectives: A Strategic Planning Process
• Applying Strategies to Boost Your Business
• An Overview of Porter's Five Forces Model
• Real-World Examples of Successful Strategic Planning
• Creating and Evaluating Scenarios for Strategic Planning
• How to Ensure Alignment with Business Goals for Successful Strategy Implementation
• The Importance of Assigning Responsibilities in the Strategic Planning Process
• The Power of Strategic Planning
• Understanding the Balanced Scorecard: A Strategic Planning Model
• How Customized Strategic Planning Services Can Boost Your Business
• Measuring Progress and Making Adjustments: A Guide to Strategic Planning
• Strategies for Enhancing Performance: Unlocking Your Potential
• Understanding PEST Analysis: Identifying External Factors for Strategic Planning

A Comprehensive Look at Managing Organizational Change

• Understanding Porter's Five Forces for Strategic Planning

The Importance of Analyzing Market Trends

• Applying Principles to Your Own Strategy: A Case Study in Success
• Understanding the OKR Framework for Strategic Planning
• Forecasting Financials: A Comprehensive Overview for Strategic Planning
• Examples of Strategic Planning in Specific Industries
• The Importance of Measuring and Monitoring Progress in Performance Improvement Consulting
• Best Practices and Lessons Learned for Your Industry: Capturing Readers' Attention
• Applying Insights to Your Own Strategy: How to Succeed in the Face of Challenges and Failures
• Understanding PEST Analysis: A Comprehensive Guide
• Assessing Financial Performance: A Comprehensive Guide
• Learning from Failed Strategic Planning Efforts: Understanding the Importance of Reflection and Adaptation
• A Beginner's Guide to Conducting a SWOT Analysis
• Setting and Tracking Objectives and Key Results: A Comprehensive Guide

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Methodology

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

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

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

A case study is a detailed study of a specific subject, such as a person, group, place, event, organization, or phenomenon. Case studies are commonly used in social, educational, clinical, and business research.

A case study research design usually involves qualitative methods , but quantitative methods are sometimes also used. Case studies are good for describing , comparing, evaluating and understanding different aspects of a research problem .

Table of contents

When to do a case study, step 1: select a case, step 2: build a theoretical framework, step 3: collect your data, step 4: describe and analyze the case, other interesting articles.

A case study is an appropriate research design when you want to gain concrete, contextual, in-depth knowledge about a specific real-world subject. It allows you to explore the key characteristics, meanings, and implications of the case.

Case studies are often a good choice in a thesis or dissertation . They keep your project focused and manageable when you don’t have the time or resources to do large-scale research.

You might use just one complex case study where you explore a single subject in depth, or conduct multiple case studies to compare and illuminate different aspects of your research problem.

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Once you have developed your problem statement and research questions , you should be ready to choose the specific case that you want to focus on. A good case study should have the potential to:

• Provide new or unexpected insights into the subject
• Challenge or complicate existing assumptions and theories
• Propose practical courses of action to resolve a problem
• Open up new directions for future research

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

Unlike quantitative or experimental research , a strong case study does not require a random or representative sample. In fact, case studies often deliberately focus on unusual, neglected, or outlying cases which may shed new light on the research problem.

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

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

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

While case studies focus more on concrete details than general theories, they should usually have some connection with theory in the field. This way the case study is not just an isolated description, but is integrated into existing knowledge about the topic. It might aim to:

• Exemplify a theory by showing how it explains the case under investigation
• Expand on a theory by uncovering new concepts and ideas that need to be incorporated
• Challenge a theory by exploring an outlier case that doesn’t fit with established assumptions

To ensure that your analysis of the case has a solid academic grounding, you should conduct a literature review of sources related to the topic and develop a theoretical framework . This means identifying key concepts and theories to guide your analysis and interpretation.

There are many different research methods you can use to collect data on your subject. Case studies tend to focus on qualitative data using methods such as interviews , observations , and analysis of primary and secondary sources (e.g., newspaper articles, photographs, official records). Sometimes a case study will also collect quantitative data.

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

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

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In writing up the case study, you need to bring together all the relevant aspects to give as complete a picture as possible of the subject.

How you report your findings depends on the type of research you are doing. Some case studies are structured like a standard scientific paper or thesis , with separate sections or chapters for the methods , results and discussion .

Others are written in a more narrative style, aiming to explore the case from various angles and analyze its meanings and implications (for example, by using textual analysis or discourse analysis ).

In all cases, though, make sure to give contextual details about the case, connect it back to the literature and theory, and discuss how it fits into wider patterns or debates.

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

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

Research bias

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

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“Case Studies in Healthcare: Success Stories and Lessons Learned”

Table of Contents

The healthcare industry is an ever-evolving field with innovations and improvements happening daily. As healthcare providers strive to deliver the best care possible, case studies have become a valuable resource for learning and growth. In this article, we will explore various case studies in healthcare, highlighting both success stories and the lessons learned along the way. By analyzing what works and why, we can gain insight into the practices that lead to triumphs in healthcare and potentially replicate these successes in our own organizations.

Case Studies in Healthcare: A Closer Look at Triumphs and Takeaways

Healthcare case studies provide a unique opportunity to dissect real-world scenarios, understand the decisions made, and measure the outcomes of those choices. One notable success story is the implementation of telemedicine in rural areas. By leveraging technology, healthcare providers have successfully expanded access to care for patients who would otherwise have to travel long distances for treatment. Lessons learned include the importance of investing in reliable technology and training staff to effectively use telemedicine platforms.

Another critical case study involves the management of electronic health records (EHRs). When a large hospital system transitioned to a new EHR system, they faced significant resistance from physicians who were accustomed to the old way of doing things. However, by involving physicians in the planning and implementation process, the hospital successfully integrated the new system, leading to improved efficiency and patient care. This case study highlights the value of stakeholder engagement and effective change management.

In the fight against infectious diseases, case studies have shown the significance of swift and coordinated responses. An example of this is the containment of Ebola in West Africa. Through international collaboration and the rapid deployment of healthcare resources, the spread of the virus was effectively limited. This case study underscores the importance of preparedness, communication, and teamwork in tackling healthcare crises.

Success Stories in Healthcare: Analyzing What Works and Why

Understanding why certain strategies succeed is crucial for replicating positive results in the healthcare industry. For instance, one hospital’s initiative to reduce patient readmissions focused on comprehensive discharge planning and follow-up care. By ensuring patients had clear instructions and support after leaving the hospital, readmission rates dropped significantly. This case study emphasizes the role of thorough patient education and post-discharge care in improving outcomes.

In the realm of preventive care, a primary care clinic introduced a program to increase vaccination rates among its patient population. By actively reaching out to patients due for immunizations and offering flexible scheduling options, the clinic saw a dramatic increase in vaccination rates. The takeaway from this case study is the impact of proactive patient engagement and removing barriers to care.

Lastly, a healthcare organization’s embrace of continuous quality improvement (CQI) led to enhanced patient safety and satisfaction. By fostering a culture of open communication and ongoing learning, the organization identified areas for improvement and systematically implemented changes. This case study demonstrates the power of a commitment to CQI as a driver for excellence in healthcare.

The healthcare industry is rich with case studies that provide valuable insights and lessons learned. By analyzing and understanding these success stories, healthcare providers can apply similar strategies to achieve positive outcomes in their own organizations. Whether it’s through technology, stakeholder engagement, or quality improvement initiatives, these case studies offer a blueprint for triumph and provide a roadmap for future success in the ever-changing landscape of healthcare.

Why are case studies valuable in the healthcare industry, and how do they provide insights into successful decision-making and problem-solving within healthcare organizations?

Case studies are valuable as they offer real-world examples of challenges and solutions in healthcare. They provide insights into successful decision-making, problem-solving, and strategies that can be applied by healthcare professionals and organizations facing similar scenarios.

How does the article select and present case studies, and what criteria are considered to ensure the relevance and applicability of the showcased success stories to a diverse audience?

The article discusses the criteria for selecting case studies, such as their impact on healthcare outcomes, innovation, or overcoming significant challenges. It highlights the diversity of cases to ensure relevance to a broad audience, considering different healthcare settings, specialties, and contexts.

Can you provide examples of healthcare case studies featured in the article, and how do these stories illustrate successful decision-making or lessons learned that can benefit readers in the healthcare field?

Certainly! Examples may include cases where innovative technologies improved patient outcomes, or instances where strategic decisions enhanced operational efficiency. The article presents these stories to illustrate valuable lessons learned and best practices that readers can apply in their own healthcare settings.

In what ways do case studies contribute to professional development and learning opportunities for healthcare professionals, and how can organizations leverage these stories for continuous improvement and staff training?

The article explores how case studies offer learning opportunities, allowing healthcare professionals to gain insights from others’ experiences. Organizations can leverage these stories for staff training, fostering a culture of continuous improvement and encouraging employees to apply lessons learned to their daily practices.

For healthcare leaders seeking to implement successful strategies within their organizations, what recommendations and actionable insights does the article provide based on the analysis of the showcased case studies?

The article offers recommendations based on the case studies, such as the importance of collaboration, data-driven decision-making, and embracing innovation. It provides actionable insights that healthcare leaders can use to inform their decision-making processes and drive positive outcomes within their organizations.

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Application of case study research and ethnography methods: Lessons learned

Affiliations.

• 1 East Carolina University, College of Nursing, Health Sciences Building, Greenville, NC 27858, United States of America. Electronic address: [email protected].
• 2 East Carolina University, College of Nursing, Health Sciences Building, Greenville, NC 27858, United States of America.
• PMID: 37722800
• DOI: 10.1016/j.apnr.2023.151713

While case studies can offer an in-depth investigation of a particular issue in healthcare, cultural context may be overlooked. Researchers may want to consider adding a cultural component to the design aimed at identifying and/or explaining values, beliefs, or traditions influencing the case. The addition of focused ethnography as a supplemental component to the research design is one strategy to examine cultural content. In this article, we provide insights gained from using case study research and focused ethnography in a qualitatively-driven mixed method design. Despite a detailed research plan, there were challenges that hindered the implementation of the design. To help prevent others from experiencing similar methodological challenges, we provide the following lessons learned and recommended strategies: discussion of structured procedures for intentional observations, reflexivity to guide decision-making, and refinement of processes using a pilot study.

Keywords: Case study research; Cultural context; Culture; Focused ethnography; Lessons learned; Mixed-method; Qualitatively-driven.

Copyright © 2023 Elsevier Inc. All rights reserved.

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• Research Support, Non-U.S. Gov't
• Anthropology, Cultural*
• Pilot Projects
• Research Design*
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Case Study: Lessons Learned From A Tough SAP S/4HANA Implementation

Three years ago, in advance of commencing a large-scale SAP S/4HANA transformation project, I talked to thirty CIOs to get their best practice advice.

The exercise was invaluable, and full of critical insight and tips often presented by SAP and other expert partners. But the incredible experience of leading a project from inception through go-live has taught me so much more about end-to-end process improvement, organizational change management, operating models, competitive advantage, and real enterprise transformation. The opportunity for a company to digitally transform finance, HR, and operations with the SAP S/4HANA suite is a fundamental value-shift that can easily be squandered if not managed well. And so, there is much to learn from others who have undertaken this journey… and arguably more from the tougher projects.

This post is a quick survey of the more interesting (and often controversial things) I learned along the way; lessons that I know can make SAP S/4HANA projects more successful. All are based on real-life, hard-knock moments, mistakes, surprises, and successes. May these be a great conversation starter for those about to commence their SAP S/4HANA transformation.

Future State Vision and Benefits

First and foremost, the project founders must define and broadly communicate a simple and compelling statement: How will this SAP transformation enable capabilities vital to the enterprise's future survival ? This visioning effort is an important test if the executive suite is aligned. The tighter the vision is tied to strategic survival, the better. Will key leaders trade their current jobs for one in the future state? Will they put their bonuses on the line? This vision will be a north star that will be referred to often in times of trouble and change. Write it down and proudly put it on the wall, on t-shirts, and compensation plans.

Ritualize Reconfirming Cross-Functional Teams on the Vision

Everyone must be aligned and incentivized, including controller, FP&A, revenue, billing, commercial, product, operations, HR, and the C-suite. The goal should be zero detractors from day one. Extra points if all agree on how to mutually manage the inevitable cutover challenges ahead. Alignment means no finger pointing. No one should assume this is going to be easy, or someone else’s problem. Any lingering doubts or reservations will continue to resurface unless leadership demonstrates that alignment is mandatory. Do surveys regularly and confirm all stakeholder commitment often, both in public and private settings.

Build an Enterprise-Shared Vision and a Crisp and Bottoms-Up Business Case

Focus on avoiding benchmarks and top-down index estimates, which will not stand the test of time. All executives must be aligned on the numbers, and signed up personally to deliver. A PE exec once challenged me that a true ERP business case must have a list of employee numbers with exit dates, or it will likely never happen. That’s the detail rigor most organizations will need, as most will find that eventually, they will not have a choice.

Be Resilient Over Time

It is so easy for these epic projects to be waylaid by questions and challenges along the way. It is important to build resilience into your vision, budget, and governance to steer you through tough waters. What if key leaders or executive sponsors go? Can/should it live through organizational and strategy changes? Ownership changes? PE vs. public? Your transformation will undoubtedly need to remain relevant and supported through multiple years of operating plan cycles. It needs to be important and big enough in vision to last five years or more. The strength of your future state vision and the rigor of your business case are the key drivers of the project’s resilience.

Build a Senior Project Management Office

This office should be multi-disciplinary, focused on verifiably changed processes/data, customizations proposed/confirmed/rejected, unanimous approval gates, testing gates, training confirmed, capacity effectiveness, budget and business-case progress. Signal that attendance is mandatory. Document all decisions and votes, especially for customizations. Any software customizations must be publicly PMO-approved with a finance-approved business case, ideally unanimously. Make sure to have measurable KPIs.

The PMO Should Report up to a Steering Committee

Optimally, this committee should be made of those in the C-suite (and ideally, include the CEO, CFO, and COO), a top SAP leader (a key designate from the SAP product; I recommend the President of SAP North America, Lloyd Adams), and a top five systems integrator (SI) executive (ideally a chair/division lead superior to the project team). Compel monthly attendance for these steering committee leaders.

Press for Co-Located IT/Finance/System Integrator Teamwork

It’s important to have everyone work together in person when possible, especially during the design phase. It is too easy for folks to be cheerleaders for transformation that may be quarters and years away… and even more when working remotely and in less-engaged video calls. Insist on in-person, dedicated sessions where participants clearly and publicly articulate how processes and roles will change in the future state.

Document the End-to-End Lead-to-Cash Process

Include sales force automation tool processes, pricing proposals, contracting, and all the relevant boundary systems for provisioning/fulfillment/delivery. Where are there manual processes today? Can they be automated/eliminated in the future? Create a manual work heat map where “human middleware” connects disparate systems and build automation into your transformation business case.

Focus on Finance

Arguably, the most important battleground of a finance transformation is an exhaustive line-by-line revenue/contract operating model review, considering all customers, contracts, products, proposals, and pricing processes. What are the revenue models that will exist in your future state? Don’t lift and shift bad processes here. Do this before you start your project as this may be the hardest and most controversial part. Can you consolidate products and revenue models? Can you reduce variation in contracting, pricing, milestone, and revenue recognition scenarios? Are your largest client revenue models different than longtail smaller clients? Identify your long-term strategic vision for revenue, and design SAP S/4HANA accordingly.

Next, consider whether your revenue recognition accounting is ready to be automated in SAP S/4HANA. You may have overly flexible or manual practices that have been accommodated in your legacy systems that are best not enabled/customized in new technology. Are your teams and executives ready for this discipline? SAP S/4HANA is designed to automate revenue in a lights-out process. It will be controversial to remove ad hoc human intervention in these processes. Engage your auditor/internal audit teams to help identify these scenarios.

It is also important to consider how your new SAP S/4HANA Finance cost planning and reporting ties to your Human Relations Information System (HRIS) or headcount control processes. Are you planning to optimize your current methods? Are finance and HR aligned on how systems should be integrated and normalized? This is not to be taken for granted, in particular, if HRIS and ERP transformations are not happening at the same time.

Experts will recommend that you should “stay standard” and “keep the core clean” by avoiding the customizations of SAP functionality out of the box. Your teams may agree to this in principle , but then be conflicted when it becomes time to actually change current legacy processes. Incentivize and applaud public commitments to legacy processes change during early project stages. Encourage your teams and partners to not just give in to the status quo in what I’ve come to call the “quiet lift and shift.” Insist that your SI push you to best practice, and not customization. It will be much harder to undo later.

Change Management > Technology

If stakeholders do not buy into new system processes, even if the software is perfectly implemented, your project will be challenged with defects and quality problems at cutover. Incentivize key user leaders and train teams early; make sure they are convinced and looking forward to the change. Create detailed bottoms-up procedures for how all finance jobs change. Consider ancillary functions like HR and commercial functions. What must change in commercial contracting? Client expectations? What jobs go away and when? What expertise must be imported? Specific job change management documentation cannot be detailed enough.

Tie SI Compensation to Real Outcome Success Measures

These post-cutover measures are things such as monthly close financial timeliness, billing accuracy and speed, well-trained associates, and defect/manual work elimination targets in the first six months after go-live. This will change the dynamic about readiness to go live and hypercare. Talk to your integrator about other cutovers they have managed, and what their expectations are for yours. Insist that they call your team out if they have concerns about readiness. Experienced SIs have seen it all before, so listen to their stories and insist they bring veterans to your project.

SAP Must Have Skin in the Project

Budget accordingly to afford additional cost here. Even the biggest system integrator firms rarely have all the expertise needed, and multiple perspectives are often useful for complex problems. A best practice is to have your integrator and SAP Services create a mutual RACI for the project, with all designs approved by SAP. Things will go wrong, and you will not want to hear that the design is not standard SAP practice.

Understand the Monthly/Quarterly Close Processes

This is where your stakeholders will first feel the impact of your transformation, and in most cases the first impression will raise questions and concerns. It is vital that key financial report stakeholders understand how information flow may be disrupted and delayed for some time after cutover as defects are ironed out. It is also important that controllership and FP&A teams are fully ready for the new close process. Do all actors in the close process know exactly how their jobs must change on day one? Are they really well trained and comfortable from hands-on testing? Do they all believe and want a successful transformation? Steve Jobs once said this about love, “The one who loves you will never leave you for another because even if there are 100 reasons to give up, he or she will find one reason to hold on.” You need a preponderance of transformation lovers and a few reason-finders for the first few months and quarters.

Highlight Reporting

The SAP Analytics Cloud concept of XPA ( distributed planning and analysis) versus traditional FP&A is compelling. Are executives across your company, and especially your finance colleagues, ready for automated real-time dashboards instead of pivot tables and PowerPoints? How will your finance team operating model change with a well-implemented SAP S/4HANA, SAP Analytics Cloud, and group reporting system? Effective and accurate reporting is a key scorecard item for SAP S/4HANA project success. Like your initial financial close efforts, reporting effectiveness is a key first impression opportunity on your project’s success.

Identify a Data Quality Owner Executive

This executive should be on the steering committee or PMO, with compensation tied to system data quality and availability. Measure data quality success with regular KPIs/validations for transforming the value of your data. Do not accept bad data or the technology (and more importantly, the user experience and change management) does not have a chance. It will be tempting to “fix data later.” Start with where data problems are in your current state legacy system. What workarounds must your teams endure today to fix data? Do folks download extracts and create “the real financials” in pivot tables outside the system? Your vision should correct data in the system automatically and make it available “on the glass.” Your future state vision should highlight how much better you could run the company if you had accurate, real-time, highly available data.

Plan for the Worst-Case Scenario

Be transparent with key leaders to set their expectations. Reporting could be hampered, revenue reconciliation discrepancies could need significant incremental manual work. Monthly close could be awkward and manual for a while, typically months. Communicate clearly and well in advance, and remind everyone about future state benefits. Again, understand your integrator’s experience and best practices for cutover effectiveness, and how they will bring their best efforts to assure your success. Again, engage your auditor, board, and entire C-suite in cutover scenario planning.

Plan for Continuous Improvement

Support, plan, and budget for continuous improvement post cutover, as enhancements and automation opportunities will always be available to make the solution better, faster, and less manual. Invariably, a minimum viable product (MVP) process will limit the full capabilities of the system at launch and require rapid releases in the first few months. Ideally, your team will have developed a depth of new SAP S/4HANA suite architecture skills and the capacity to run and build on your new environment (and enable you to migrate to business as usual and away from your SI sooner). Note that in a competitive environment for SAP expertise, this may take quarters, if not years. Planning well ahead of cutover is important here.

These are but a few of the more interesting lessons that I learned on my SAP S/4HANA journey—and many of these were learned by not getting it right at first, or believing we got it right, only to learn we had more work to do. Growth mindset, metrics-driven leadership, and feedback loops are essential along the path. Leadership’s future state visioning work early on is critical across all of these change management considerations. An SAP S/4HANA migration should be a foundationally transformational opportunity for any company, providing a clean digital core for decades to come. Executive leadership dedication to truly change is essential for this enterprise generational investment to pay dividends.

Recommendation

It’s time to start your migration to SAP S/4HANA, using this all-in-one resource! Get to know the migration paths, processes, and tools. First, explore on-premise, cloud, and hybrid deployment scenarios. Then, understand the steps involved in new implementations and system conversions. Finally, get step-by-step instructions for all the relevant migration tools. From basic concepts to implementation processes, you’ll find everything you need to plan, prepare, and kickstart your SAP S/4HANA migration!

Patrick Dineen is the Corporate CIO and Transformation Office Leader at the Nielsen Company. Patrick's extensive experience in sales management, products, M&A, and corporate finance transformation prepared him perfectly to lead Nielsen’s recent SAP S/4HANA journey. Before Nielsen, Pat held senior sales and marketing leadership roles at Quaero, CSG, USADATA, Claritas, and Equifax. A NYC native, Pat holds a Masters in Business Administration degree in Finance from NYU Stern School of Business and a Bachelor of Science degree in Industrial Engineering from Columbia University.

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Open Access

Peer-reviewed

Research Article

Implementing supportive supervision in acute humanitarian emergencies: Lessons learned from Afghanistan and Ukraine

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Validation, Visualization, Writing – original draft, Writing – review & editing

Roles Conceptualization, Project administration, Writing – review & editing

Affiliation Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent Societies, Copenhagen, Denmark

Roles Project administration, Writing – review & editing

Roles Project administration, Resources, Visualization, Writing – review & editing

Affiliation Rehabilitation and Support Department, Red Cross Society, Kyiv, Ukraine

Affiliation Mental Health and Psychosocial Services Department, Save the Children, Kyiv, Ukraine

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

• Nadeen Abujaber, 
• Meg Ryan, 
• Kelly A. McBride, 
• Pia Tingsted Blum, 
• Michelle Engels, 
• Anna Didenko, 
• Hannah Green, 
• Catia Sofia Peres de Matos, 
• Shona Whitton, 
• Frédérique Vallières

• Published: April 17, 2024
• https://doi.org/10.1371/journal.pgph.0002416
• Peer Review
• Reader Comments

Mental Health and Psychosocial Support (MHPSS) practitioners working in humanitarian contexts are at significant risk of mental health conditions, ultimately hindering the quality and sustainability of their work. Supportive supervision has shown to be effective in improving the wellbeing of MHPSS staff and volunteers and enhancing the effectiveness of MHPSS service delivery. Despite these proven benefits, there is a lack of standardised guidelines to inform supportive supervision within humanitarian contexts. To address this gap, the Trinity Centre for Global Health and the International Federation of the Red Cross Red Crescent Societies’ Reference Centre for Psychocosial Support co-developed the ‘Integrated Model for Supervision’ (IMS) Handbook and supporting tools and led IMS trainings with four humanitarian organisations in Ukraine, Afghanistan, Jordan, and Nigeria from June-August 2021. The subsequent acute humanitarian emergencies that occurred in Afghanistan and Ukraine provided the opportunity to (i) examine the implementation of the IMS in the acute stages of two humanitarian crises and (ii) identify the challenges and lessons learned from this process. This study employed a case study design using semi-structured qualitative interviews with five MHPSS personnel (female: 4; male: 1) who had received training in the IMS and were directly involved in the implementation of supportive supervision using IMS guidelines in either Ukraine or Afghanistan. Results showed that participants identified the key steps needed for the implementation of supportive supervision and reported two significant barriers to implementation including the stress of a humanitarian crisis leading to competing responsibilities and priorities, staff shortages and time constraints as well as the challenge of creating a new supervision structure when none had existed previously. Overall, participants felt that the IMS resulted in improved knowledge, confidence, perceived support, team cohesion, staff wellbeing and was a helpful blueprint to guide the implementation of supportive supervision in humanitarian contexts.

Citation: Abujaber N, Ryan M, McBride KA, Tingsted Blum P, Engels M, Didenko A, et al. (2024) Implementing supportive supervision in acute humanitarian emergencies: Lessons learned from Afghanistan and Ukraine. PLOS Glob Public Health 4(4): e0002416. https://doi.org/10.1371/journal.pgph.0002416

Editor: Saloni Dev, Tufts University School of Medicine, UNITED STATES

Received: June 30, 2023; Accepted: March 14, 2024; Published: April 17, 2024

Copyright: © 2024 Abujaber et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data contains potentially identifying or sensitive participant information. It has been recommended by the Research Ethics Committee to not make data publicly available. Data can be made available upon reasonable request by contacting the data protection office at Trinity College Dublin at the following email: [email protected] .

Funding: This study is made possible by the support of the American People through the United States Agency for International Development (USAID; Grant #: 720FDA19IO00106 to FV). The contents of this study are the sole responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Mental health and psychosocial problems are commonly reported within conflict affected populations [ 1 ]. Specifically, a greater prevalence of post-traumatic stress disorder (PTSD), depression, and psychosis, among other severe forms of psychological distress, have been observed within humanitarian settings [ 2 ]. In a concerted effort to mitigate this observed risk, the integration of mental health and psychosocial support (MHPSS) programming is increasingly recommended within humanitarian responses [ 3 ].

Like other humanitarian responders, those tasked with the delivery of MHPSS are exposed to several stressors including harsh and sometimes dangerous working conditions, long working hours, and large caseloads. MHPSS practitioners are also at increased risk of vicarious trauma, and, in cases where MHPSS practitioners are also members of affected communities, vicarious trauma can be further compounded by personal trauma [ 4 – 6 ]. Consequently, MHPSS staff and volunteers are also at heightened risk of anxiety, depression and PTSD, which can negatively impact the quality and sustainability of their work [ 7 ]. Reasonable workloads, with adequate resourcing, appropriate training, and regular supportive supervision are recommended to ensure the effectiveness of MHPSS service delivery, while also safeguarding the safety and wellbeing of MHPSS staff and volunteers [ 8 , 9 ].

Supportive supervision, defined by McBride and Travers [ 10 ] as a ‘safe, supportive, confidential and collaborative relationship between a supervisor and supervisee, where supervisees can voice their difficulties, discuss challenges and be recognised for their successes, receive constructive feedback and emotional support, and build their technical skills and capacity’, is associated with greater staff motivation, enhanced wellbeing, increased knowledge, competency, and confidence, decreased burnout and turnover rates and improved quality of health services [ 11 – 13 ]. The primary factors encompassed within supportive supervision are professional development, intervention monitoring fidelity, and emotional support [ 14 , 15 ]. Despite the proven benefits of supportive supervision, supervision for health programming is often inconsistent, poorly resourced, and of low quality [ 16 ]. Furthermore, there is a lack of standardised guidelines to inform supportive supervision within humanitarian contexts. To address this gap, the ‘Integrated Model for Supervision’ (IMS) Handbook and accompanying materials were developed in 2021.

The IMS was created by a collaboration between the Trinity Centre for Global Health (TCGH) and the International Federation of the Red Cross, Red Crescent Societies’ Reference Centre for Psychocosial Support (PS-Centre). It features standardised guidelines for incorporating and employing evidence-based supportive supervision practices for MHPSS practitioners operating in humanitarian contexts. The IMS was developed using participatory action research approaches spanning multiple stages of stakeholder consultation, including a desk review, regional workshops, key informant interviews [ 17 ], and Delphi techniques [ 18 ]. It was first piloted with four humanitarian organisations based in Ukraine, Afghanistan, Jordan, and Nigeria. Training on the IMS took place from June to August 2021 and involved a pre-training meeting, four training modules, and follow-up supervisory support and implementation consultations, delivered in line with the apprenticeship training model [ 19 ]. Within Module 1, attendees from leadership/management focused on background information on the IMS and why supervision is considered critical to MHPSS programming. As part of Module 2, supervisors/future supervisors were trained in types of supervision, how to structure sessions, ethics and boundaries, as well as practical skills such as self-care, reflective practice, effective facilitation, and building alliance. Supervisees attending Module 3 explored how to make the most of their supervision experience, and practical tools such as how to do case presentations and use role play effectively. The final module, Module 4, combined attendees once more to explore the implementation of the IMS, cultural adaptation, monitoring and evaluation, and next steps. All IMS Trainings were conducted in English and were held online due to the COVID-19 pandemic restrictions. Follow-up supervision (group and individual) and 1-on-1 implementation support was offered to all organisations who took part.

Unfortunately, the situations in both Afghanistan and Ukraine deteriorated shortly after the IMS training, with the events of 15 th of August 2021 and February 24 th 2022, respectively, changing the course of each country. The acute humanitarian emergencies that followed provided the undesired opportunity to examine the appropriateness, acceptability and feasibility of implementing the IMS within these two humanitarian contexts. The current study therefore aims to understand ‘what happened after the IMS training ? ’ by describing the (i) process of planning for and implementing the IMS post-training as well as in the acute stages of two humanitarian crises and the (ii) identification of challenges and lessons learned from the IMS’ implementation in both Afghanistan and Ukraine, with the goal of further developing and strengthening the IMS for future use within other humanitarian contexts.

Study design, procedures and participants

The current study employed a case study design. Participants were recruited between February and March 2022 through purposive sampling and included five MHPSS personnel (female = 4; male = 1) who had received training in the IMS and were directly involved in the implementation of supportive supervision using IMS guidelines in either Ukraine or Afghanistan. Two participants out of the total 16 IMS training participants from Afghanistan were employed by a non-governmental organisation (NGO) working in Afghanistan and three participants out of the total 14 IMS training participants from Ukraine were employed by an NGO working in Ukraine. Two of the participants held management positions within their organisation and the other three participants were supervisors. Two of the participants interviewed twice; once to discuss their initial implementation plan one month after the initial pilot training, followed by a six-month follow-up interview. Participant details can be found in Table 1 , with the participants who were interviewed twice denoted in bold text.

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https://doi.org/10.1371/journal.pgph.0002416.t001

Humanitarian contexts: Afghanistan and Ukraine

While Afghanistan has experienced decades of insecurity and conflict, leaving millions of people displaced and living in poverty, the humanitarian crisis escalated after August 15 th , 2021. The country is now experiencing a grave humanitarian crisis and international aid has largely been cut off, depriving people of necessities such as food and medicine [ 20 ]. According to the United Nations, 95 percent of Afghan people are now going hungry [ 20 ]. Health services in Afghanistan have also gotten worse, with many of the NGOs who had previously acted as the primary health service delivery mechanism forced to withdraw from the country [ 21 ]. Many Afghan workers have been forced to leave their jobs due to low wages or, in the case of female staff, are prevented from working altogether. Despite a high prevalence of psychological distress among the population [ 22 ], with trauma and exposure to violence acting as key determinants of mental health outcomes [ 23 , 24 ], mental health resources in Afghanistan remain scarce [ 25 ].

In Ukraine, over 13.4 million people have been displaced since Russia deployed its military into the country on February 24 th , 2022. More than 23,300 civilian casualties have been recorded in the country, including over 8,700 deaths [ 26 ]. Russian attacks have also destroyed much of the infrastructure in the country, leaving thousands of Ukrainians without basic necessities, and unable to access medical assistance [ 27 ]. As a country with a recent history of conflict and unrest, previous studies have highlighted the negative impact on the mental health of young people [ 28 ]. Increased levels of PTSD, anxiety and depression have also been found due to the trauma experienced as a result of war, such as exposure to violence and abuse, and the loss of family and friends [ 28 ]. Altogether, there is a need to provide proactive and preventative MHPSS services to the population of Ukraine, and to ensure that MHPSS staff are supported in this task.

Data collection

For security reasons and given the difficulty in obtaining in-country ethical approval in the setting of acute humanitarian crises, interviews were conducted online via Zoom [ 29 ]. All interviews were audio-recorded after receiving permission from the participants and were stored on a secure computer, accessible only to the research team, in a password-protected file. Audio files were deleted permanently once transcription was completed. All participant data was encrypted and stored on OneDrive, accessible only to research team during the study. Interviews lasted between 30–60 minutes and were conducted by the first (NA) or second (MR) authors in English. Semi-structured interviews were chosen because they allow the delineation of key topics but also provide enough flexibility for the open-ended exploration of ideas and themes [ 30 ]. Questions explored the impact of the humanitarian emergencies on the participants and their work, the role of supportive supervision and the IMS during humanitarian emergencies, whether the IMS was appropriate, acceptable and feasible to implement during acute humanitarian contexts and discussing the facilitators and barriers to implementation as well as lessons learned from the implementation of the IMS in these acute phases of an emergency.

Data analysis

Interviews were transcribed verbatim in English. Data was anonymised at the point of transcription with participants being represented by unique codes. Thematic analysis using Braun and Clark’s [ 31 ] six-phase framework was applied to the interview transcripts in the following manner. First, the transcripts were compared to the audio-recordings to ensure accuracy and data familiarisation. Second, each transcript was examined systematically for code identification. Codes were then compared to each other to find overlapping ideas and create subthemes. Fourth, additional subthemes were elicited by re-evaluation of each transcript. Fifth, each subtheme was defined with a clear descriptive name. Finally, direct quotations were included to support each subtheme. Subthemes were joined and grouped into themes.

Ethics statement.

This study received ethical approval from Trinity College Dublin Health Policy and Management/Centre for Global Health Ethics Committee on January 17 th , 2020. All participants provided written consent in English prior to their interviews. Participants were asked for approval for the use of their anonymised quotes prior to publication.

The themes and subthemes from the thematic analysis of qualitative interviews from the five participants in this study are summarised in Table 2 . Participants identified the steps of developing and planning the implementation of supportive supervision per the IMS method, the barriers faced during this process, and their initial impressions of implementing the IMS supportive supervision in the acute phases of a humanitarian emergency.

https://doi.org/10.1371/journal.pgph.0002416.t002

Planning for implementation

Participants discussed during their interviews the particular challenge of implementing supervisory structures within their organisations when none had previously existed, highlighting that they were ‘starting from scratch’, often wondering how to start, when to start, with whom to start and with what resources. That said, participants identified key steps and processes in their implementation planning, including a needs analysis, human resource allocation, contextualisation, advocacy, monitoring and evaluation, dissemination and scale up, and sustainability measures.

I. Needs analysis.

As an initial step, participants emphasised the importance of evaluating and understanding the needs of their team members directly in order to create the most appropriate and effective supervision structure. The two main aspects of this needs analysis identified by Participant B were exploring expectations , or the importance of evaluating the expectations about supervision from all members of their team, especially supervisees, and to use these expectations as part of the implementation plan, and identifying gaps in the current organisational structure to ensure that the implementation plan addresses them directly:

‘I see it generally as the way the objective of IMS, what the expectation of our supervisees will have from our end so in that case definitely it is useful to work with our team what could be their expectation, and based on their expectation, we need to set goals.’ ‘One of the key components [in our implementation plan] is emotional support because this is something missing when we were having the supervisory role in our organisation.’

II. Human resource allocation.

Most of the participants highlighted the challenge of having a limited number of qualified staff knowledgeable in implementing supportive supervision. As Participant E described, ‘ to finalise and adapt these materials and IMS tool , from our side , we just need additional human resources , people who will be able to spend more time sitting together with me , developing the whole supervision system . ’ Participants thus emphasised the importance of building human resource capacity in their implementation plans by using experienced staff, both internal and external to their organisation. As Participant A explained, ‘When there’s only two of you , I’m really wanting to just try and think how I can use the people that were in the previous training , and how I can use [the IMS trainers] as I create the implementation plan . ’ Although they acknowledged that all staff would benefit from the IMS training, deciding ‘who do we prioritise as needing this training’ was a concern given the financial constraints limiting the number of staff that could be trained in supportive supervision practices and the need to account for high staff turnover in their organisations. As stated by Participant A: ‘we need to do as many people who can train or who can facilitate as possible or else, soon as I leave, it kind of will die.’ In addition, Participant E emphasised that those they select to train in supervision ‘need to be paid and we actually need these people for supervision’ , pointing to the need for protected roles as supervisors.

III. Contextualisation.

Many participants emphasised the importance of adapting the IMS implementation plan to make it as acceptable and appropriate to their context as possible through translation and organisational and contextual adaptation . For many, this meant the need to translate the IMS Handbook and resources from English to the primary language of their context to improve their staff’s understanding of the supervisory guidelines and to increase their staff’s contribution to the implementation of supervision in their organisation. As reported by Participant C: ‘ It would be great to make a translation from the Handbook in Ukrainian , it will be easier to ask the colleagues to read it and try to have a discussion with colleagues who don’t know English about the supervision and maybe the ideas of these colleagues will be helpful for us like using supervision in everyday work . ’

Participants also noted the important process of organisational and contextual cultural adaptation of the IMS. As described by Participant E: ‘ It is not a book that you can just take and use in the original version because information needs to be adapted to the specific context and for each organisation . ’ In addition to the cultural adaptation of the guidelines themselves, Participant A discussed in their interview the importance of culturally adapting the supervisory training sessions as well: ‘ Sometimes with trainers within our context , they’ll take things very literally so if in the manual it says you need to do two days with leadership they’ll be like okay two days when that’s already been done a year ago and you don’t need to re hash it . ’

To this end, both participants A and E made attempts to include elements of supervision into existing trainings and structures as preliminary steps to IMS implementation. Participant A reported that during a routine training session for counsellors: ‘ I took that as an opportunity to introduce them to what is supportive supervision because many of them are supervisors . So I took that beginning intro session [From IMS Handbook] and added it to the training . So that when I say we are doing this type of training , they are already familiar with the ideas . ’ She noted that not only would this provide them with initial knowledge of supervision that could be built upon in future trainings, she was also able to identify staff particularly interested in supportive supervision who could serve as future advocates for implementation activities. Similar to Participant A’s approach, Participant E advocated for adding elements of supportive supervision, extracted from the IMS Handbook, to their existing organisational structure because she did not think that ‘ this supervision mechanism can be or should be a separate system or structure . ’ Her proposed solution was as follows:

‘Maybe doing supervision not as supervision but each volunteer when they conduct their regular volunteer meetings, they can add to these meetings to make it more supportive. For example, You can ask them: How do they feel? Do they need additional support? Or do they want to discuss a specific case for example?…If we can use the knowledge [from the IMS] to conduct group meetings better, to provide a person who will be a supervisor with skills on how to better manage hard emotions, how to better support their peers, that will be enough.’

IV. Advocacy.

Participants also discussed the need for evidence-based advocacy measures within their organisations to highlight the importance of supervision for all staff members . All participants emphasised the importance of having a supervision structure in place, especially in chaotic and stressful humanitarian contexts. As described by Participant A: ‘t his is our advocacy point is saying in humanitarian contexts when you have no time , this is when supervision is actually so critical .’ Participant D felt that supervision is so critical that it should be ‘ an obligatory standard ’, embedded within the organisational workflows and procedures rather than an elective process. While acknowledging the high initial costs associated with implementing supervision, Participant D also felt that the benefits of improved capacity and staff retention would be economical in the long term:

‘We are not losing money with supervision but we are saving money because let’s say we train 10 people and the cost of the ToT [training of trainers] is high but in the end, if we are not supporting them, we will only have 1 or 2 left and then again we will need to hire more people and then provide another ToT and this will cost more than before. They [management] also like to save money.’

All participants reported that advocacy measures should be focused on management and leadership, citing the importance of supervision for all staff members within every department and at all levels of the organisation. As Participant A described, ‘we also just have to have a few more of those leadership meetings to get a few more people on board understanding , even the line manager , doesn’t see how it benefits the team because at the moment , I think they think it’s benefitting me so actually to show it’s for everyone . ’

Participant A also noted that time was also needed to align management’s vision of supervision to that advocated by the IMS: ‘ we have scheduled to sit and discuss what is their vision with supervision because I think it is a bit different to mine . I think it is going to be more of that kind of checklist supervision where IMS is not about that . And figuring out , to get buy in , how this supportive supervision is actually needed and different to what they had envisioned but does feed into it . It’s not separate but it can just strengthen it .’ To ensure leadership commitment, she reported that much time was spent having ‘ 1-on-1 conversations with key members of our staff that would need to support it . Support it meaning giving their staff the time for training as well as the money for the training .’

Many participants highlighted that the advocacy measures presented to management and donors needed the availability of data demonstrating the benefits of supervision. As stated by Participant A: ‘I really need to think through what we want to be measuring , because I think for me that’s really critical so that I can prove its , not that I can say its 100% supervision but to show some sort of evidence . ’ Once evidence has been amassed in support of supervision, participants gave recommendations for the best way to deliver this information to management and donors. Many participants suggested concise and comprehensive promotional information such as ‘one page like an elevator pitch ’ (Participant A) or a ‘ less than one-minute video’ (Participant B). Participant E recommended that this advocacy document should mention ‘what is supervision , how it will be applied , why it is important , and if you have any results to add to that and show them how it will look like . ’ Participant D suggested similar content with an emphasis on ‘very simple language and I highlighted outcomes , what they will have in the end ? Why need to put it [supervision] ? They [management] understand the most when I talk to them with numbers . ’

Participants also mentioned that receiving follow up support from technical experts in supervision was not only instrumental in their implementation activities but could also be an important advocacy tool. For example, Participants B and E mentioned the presence of IMS technical team at advocacy meetings with management to help facilitate discussions and provide expert information and data.

V. Monitoring and evaluation.

Participants emphasised the importance of monitoring and evaluation tools with indicators chosen to demonstrate the impact of their supervision system. Participants mentioned several indicators that they believe would be impacted by instituting supportive supervision in their organisations such as ‘ the level of skills and level of personal psychological wellbeing of our volunteers’ (Participant C) and ‘wellbeing , motivation , skill building and feedback mechanism’ (Participant D). By checking ‘baseline and then after supervision , some end line to see results if this is helpful for them’ (participant E), this process would help to answer questions such as ‘do they feel better with supervision ? Are they ready to go again and again to be a volunteer ? Do they need better support ? What kind of support can we provide to them to make them feel better as a volunteer ? ’ (Participant D) . Not only would this build evidence in support of supervision but could also be used internally to track the professional development and emotional status of their staff, allowing an individualised approach and thus, ‘ catering supervision to fit the needs of the supervisees’ (Participant D).

VI. Dissemination plan and scale up.

Participants reported that since they were creating a new supervision structure within their organisations, they would need to start small , prioritising those most affected by the humanitarian crisis to ‘make the IMS system work for an emergency response’ (Participant E) and scale up slowly over time to reach best practice. All participants mentioned that their initial implementation plan was considered a pilot project within their respective organisations, with the potential for future expansion after advocacy measures and proof of benefit.

‘In terms of scaling up quickly, which I suppose they want to do, but I can’t do that. We are starting with a very small group and then hopefully with advocacy and showing staff feeling more supported, we can do more stuff either later this year or early next year but then kind of after that point you want to start moving and making it bigger… we already talked about with them about how to progress to best practice.’ (Participant A)

VII. Sustainability.

After the initial pilot training, all participants described their ultimate goal of strengthening the capacity of their supervision system to ensure sustainability . All participants acknowledged that the supervision system cannot be sustained in the long term with only a few people trained in supervision. As stated by Participant A: ‘ I’m the one who will push it , but my lifespan with this office is not forever . ’ Participant B felt that the best way to achieve this was in a cascade fashion via ‘ the apprenticeship model and based on that , we can also build the capacity of our front-line staff . ’ Participant E also felt that this method of training would be the most expedient and effective in a humanitarian emergency: ‘ I hope that with this training of trainers , we will be able to , in the following months , prepare more supervisors and more how supervision will be working for the big demand of all the volunteers and instructors involved in the emergency responses . ’

Barriers to implementation

Participants highlighted multiple barriers affecting the implementation of supportive supervision, most prominent the direct impact of humanitarian emergencies including the redirection of staff and resources towards other forms of assistance, high staff turnover, insufficient time, and the lack of an existing supervisory structure in their organisations.

I. Impact of humanitarian emergencies.

Participants discussed the deleterious effects that humanitarian emergencies have on MHPSS activities, organisational priorities and support, staffing and protected time for supportive supervision. As stated by Participant B: ‘the country was in a coup , and our operation was also suspended due to the conflict and the changes of regime for months . ’ Participants reported that when operations restarted, the focus was often not on supervision and MHPSS, but on emergency response. ‘I think it changed because we had originally planned to develop the MHPSS activities but in the last few months , I have been working in the provision of emergency response and react to acute needs . It has not been in the area of development at all . My work has been meeting the basic needs of people with a huge scale of people that need to be supported’ (Participant E) . Participants also discussed in their interviews the shift in organisational priorities during an acute humanitarian crisis as stated by participant E: ‘ In terms of supervision , what we have now and what we planned , we haven’t implemented it at all . . . . And MHPSS is not a first priority in emergency… I just think in an emergency context , supervision is not a priority . ’

Moreover, staff shortages present prior to the acute phases of an emergency were even more prominent during the early phases of each crisis.

‘I mean we’ve also had a large staff turnover, so like the one person that was trained that was quite strategic because they needed to be doing supervision for counsellors, he left’ (Participant A) ‘When we have humanitarian responses and other projects, we have a limited percentage of the project allocated towards staff so usually one person does a lot. . . . you will not have additional resources to also have a supervisor to provide supervision for volunteers’ (Participant E)

During a humanitarian crisis, humanitarian practitioners are often inundated with multiple competing demands on their time, ‘rushing to implement activities and provide support’ (Participant B). These competing tasks and excessive workloads resulted in the delayed implementation of supportive supervision per participant A. A self-described ‘ supervision fan’ who ‘thinks it [supervision] is a priority’ and that the ‘ IMS has given us every resource we need ’, she noted that:

‘I think that is something within a humanitarian context that makes it difficult to carve out time and so often it gets bumped because when staff do not even know how to implement even a basic activity , it has to become a priority over supervision … I think that has been one of the biggest challenges : finding time to fit everything . You know , we are just juggling the whole time .’

II. Lack of a pre-existing supervision system.

Prior to the IMS training and implementation, the two organisations from Afghanistan and Ukraine did not have a structured or standardised supervision process in place. Participants reported limited organisational understanding of and support for supervision, which they believe led to the under-prioritisation of resources needed for supervision, hindering effective implementation. ‘After seeing all the other things that need to be done , I’m like is that actually a realistic outcome ? Because part of me is like I’m so desperate to get this [supervision system] up and get people going but then am I setting myself up for failure ? I don’t want to start without having all of these things already in place’ (Participant A) . In addition, participants described the resistance from management and leadership to implement supportive supervision. As stated by Participant E: ‘Sometimes , it is hard to explain , for example , why we need supervision ? Because they don’t understand what supervision looks like . They [management] don’t have that clear picture and even if I were to try to provide them with a general understanding , it does not work 100% as we expect it to . ’ Consequently, participants reported that supervision was often inconsistent and primarily focused on managerial tasks, rather than the emotional support or professional development of staff, with a lack of continuity in terms of who facilitated supervision sessions.

Participants also remarked that the process of implementing IMS supportive supervision was time intensive. The additional time needed for the follow up support sessions with technical experts to guide implementation activities made it challenging to attend these sessions consistently in the peak of the humanitarian crisis. Participants felt these sessions were an important resource and expressed their appreciation for the flexibility and availability offered by the technical experts in meeting their needs (for example, switching to text-message check-ins, changing times, etc.). Participants also noted that protected time was needed for training to strengthen capacity and additional time was needed post-training to build supervision into the workflows, which was also difficult within humanitarian contexts. Participant A remarked that time was needed to hire and train staff who would be responsible for rolling out the supervision system. Participant E agreed: ‘If we will change the person who is responsible for the development of the whole IMS system , then this process will need to be first because we only hired the new person 2 days ago who will be more involved in establishing the supervision system . ’ Furthermore, s taff who were supposed to be involved in implementing supervision were also overwhelmed with large workloads and competing responsibilities during the height of a humanitarian emergency, causing delays in implementation.

‘The biggest barrier that can be in writing any training programs because in my unit there is only three persons and we have a lot of volunteers and you have a lot of different tasks so if I had the possibility to just be sitting and writing the supervision manual and writing the new training I would be very happy but for now, unfortunately, no possibility for this I would say.’ (Participant C)

Without a precedent for supervision in their organisation, participant E noted that it was difficult to convince staff, already overwhelmed, overloaded and exhausted, to participate in supervision sessions, noting ‘ we do not have any time and people are still working and are still able to do their work , manage everything with low resources without supervisions … They do not have time for rest and for sure , they do not want to spend additional time for supervision… . … Maybe it is easier to explain to people what is the impact and why supervision is needed when people have less work , less stress for example . ’ This experience was shared by participant A who felt that the time constraints and excessive workloads resulted in a lack of protected time to perform supervision effectively: ‘ It’s all related to time because supervision , the practice all takes time and so again , it’s always in a humanitarian context like we don’t have time , I’m trying to see how to make it a priority .’

Impressions of supervision implementation

Participants also reflected on their efforts to implement supervision within their respective organisations, with noted impacts on staff knowledge, confidence, perceived support, team dynamics and wellbeing. They also evaluated the IMS Handbook in terms of its effectiveness, acceptability and applicability, offering key suggestions for its improvement.

I. Improved access to knowledge.

Participants reported that after implementing their supervision pilots using information from the IMS Handbook, their staff had improved access to knowledge about supervision.

‘The Handbook is very clear and the definition of supervision and different types of supervision is very good for the general understanding of what supervision should look like , for what purpose , what steps and questions we should make with our supervisees . ’ (Participant E )

II. Improved confidence and perceived supervision.

Participants reported the improvement in their staff’s perceived confidence in conducting supervision and noted receiving more support from their own supervisor. As stated by Participant A:

‘When I spoke to them about supervision, they felt that personally, one: it had made them feel more capable… they were meeting with the counsellors at least once a month, they went and did some live supervisions and gave feedback, so I feel like, even though it had been short, they had implemented it and were feeling a lot more confident in providing it.’ ‘ They said they felt more supported from their [own] supervisor because that supervisor was in the training as well . ’

III. Enhanced team cohesion.

Participants also described in their interviews a cultural shift within the teams exposed to supportive supervision with positive team dynamics emerging.

‘They might not even realise that its due to the IMS but because of the IMS strategy of training , it’s quite a reflective process … they are incorporating components of aspects within their team to create a sense of unity , a sense of like I can ask for help when I need it not just this sense of I’m the boss and you listen to me . ’ (Participant A)

IV. Focus on staff wellbeing.

Participants described the focus on providing emotional support and enhancing staff wellbeing. As stated by Participant B: ‘In one suboffice , you can see that for the wellbeing of their staff , they have a space for having social activities even within the office , there are playgrounds for the staff when they are having some stress , they can come together and play for their wellbeing . ’

V. Helpful tool for advocacy.

All participants noted that the IMS Handbook was a helpful tool to advocate for supervision within their organisations. Participant D stated that: ‘I used the IMS to get the definitions : What is supervision ? How it can be provided ? What are the types of supervision ? I used it for the background , to define the different types of supervision , for how long ? How many people ? Etc . So , I used it A LOT . ’ Likewise, Participants A and E reported using the IMS Handbook to advocate for increased human resources for supervision.

‘I already have used the Handbook and extracted quotes for proposals and things even in terms of advocating for staff to be like ‘the global standard says’, so I think that in itself has been really helpful.’ (Participant A) ‘It [IMS] is something to help them understand how many staff are needed because usually it is done by volunteers but it can’t just be done and controlled by volunteers, you need staff who will be responsible to conduct supervision.’ (Participant E)

VI. Blueprint for implementation.

Participants discussed the role of the IMS Handbook as a framework for implementing supervision within their organisations, with the hopes of achieving best practice. As reported by Participant A: ‘ It’s quite good in that it [IMS Handbook] doesn’t just throw information at you and say : ‘off you go and figure it out yourself’ . It gives you time to think on how are you going to implement it . ’ Participant D confirmed that the IMS Handbook establishes the standard for how supportive supervision should be done: ‘I really appreciate you starting this process and I don’t need to tell anyone anymore to believe in supervision . And now I will say : ‘look , this is the standard of our work , so no excuses . ’

VII. Applicability across sectors.

Participants A and B remarked that the benefit of the IMS Handbook went beyond the MHPSS sector and was applicable in other sectors within humanitarian contexts. Participant A reported that, in addition to MHPSS unit, their child protection team and ‘ even the health and nutrition team have added it [supervision] to their organogram , so it is there , it is in place , which is a massive achievement . ’

VIII. Suggestions for the IMS handbook.

Several participants suggested the inclusion of practical examples and guidelines, especially regarding emotional support and self-care, because this was identified as a significant gap in organisations prior to the implementation of supervision.

‘Which type of emotional practices would be the best option based on our context? Whether it could be giving more space maybe after like having an emergency response and maybe some time to relax before coming back to the office, but this is something there is a gap and how we can propose some emotional support exercises that are good for the wellbeing of our own staff?’ (Participant B) ‘I am just thinking about the IMS Handbook and it is not clear how to work with hard emotions. And especially during an emergency response, if for example, you are speaking and dealing with people who have seen somebody die or was affected by some, I don’t know, explosion… So, it is not clear how to calm this person and what to do for example… And also, what to do for this supervisor who is providing this kind of supervision, after the supervision is ended, they have to calm down, self-care for the supervisor.’ (Participant E)

This study aimed to describe the process of implementing supportive supervision using the IMS method within two acute humanitarian emergencies, identifying barriers to implementation and extracting pertinent lessons to apply to future iterations of the IMS. Consistent with the literature [ 4 – 6 , 8 , 16 ], participants highlighted the significant need and desire for supportive supervision given the overwhelming stressors and workloads experienced in humanitarian contexts. However, the speed of implementation was hampered by the lack of a pre-existing supervisory structure within their organisations. Participants delineated the necessary steps to prepare for a successful implementation: identify gaps, clarify expectations, prepare and train human resources, contextualise guidelines to both organisations and culture, advocate for supervision using evidence gathered from monitoring and evaluation, followed by dissemination with conditions needed for scale up and sustainability. Given the chaotic nature of humanitarian contexts where time and resources are limited and priorities shift rapidly, participants advocated for flexibility, adjusting to the needs of the context and offered solutions such as starting small and integrating elements of supervision into the pre-existing system with the aim to ultimately develop a strong supervisory structure. These findings make an important contribution to the literature given the current paucity of data describing process considerations for integrating supportive supervision during acute humanitarian emergencies. The IMS Handbook [ 10 ] was created to fill this gap and provides important information on how to work towards best practice in supportive supervision within an organization and these detailed steps for implementation, as described by participants, serve as a practical addition to the IMS Handbook, applicable to diverse humanitarian contexts.

Results also highlighted advocacy as central to the success of implementing supportive supervision. This is consistent with Ryan et al. [ 32 ] who found that inconsistent or poor implementation of supportive supervision within an organisation was directly impacted by the poor understanding of and commitment to supportive supervision by management and leadership. Efforts should be made to promote and demonstrate the benefits of implementing supportive supervision, using some of the suggested mechanisms identified by participants such as educational videos, pamphlets and technical experts as sources of information and support. Which of these method(s) is optimal to achieve organisational buy-in for supportive supervision, however, remains unknown.

Consistent with the inclusion of emotional support as one of the three main priorities for supportive supervision within the IMS Handbook [ 10 ], participants underscored the significant need for emotional support during humanitarian contexts given the stressful and overwhelming work of MHPSS in fragile states. Also reflected in previous studies [e.g. 6 , 33 ], this finding is particularly important given the documented risk for MHPSS practitioners of developing mental health conditions and secondary traumatisation [ 7 ]. Even when supportive supervision could not be fully implemented, participants described efforts made to incorporate aspects of emotional support for their staff in various ways from raising awareness about the psychological impacts of humanitarian contexts on humanitarian MHPSS practitioners, to providing direct support and offering additional resources for follow up support. Given the high unmet needs and limited resources within humanitarian emergencies, identifying the most effective delivery format for emotional support within humanitarian contexts would be an important area for future research.

In addition to creating true advocates for supportive supervision as evidenced by participant D’s belief that it should be an ‘obligatory standard’, results highlighted several benefits of the IMS supportive supervision system including increased access to knowledge, improved confidence and perceived supervision, and increased wellbeing; all of which have been previously noted as advantages of supportive supervision [ 6 , 11 – 13 ]. Though the literature documents the positive impact of supportive supervision on the quality and sustainability of MHPSS services provided by staff who receive supportive supervision, more longitudinal data is warranted.

Practical implications

It is the hope that the findings of this study will not only be used by partner organisations to optimise their supportive supervision practices but to also encourage other organisations in diverse humanitarian contexts to recognise the importance of supportive supervision and prioritise its inclusion into organisational structures, using lessons learned from participants in this study and accessing the freely available IMS Handbook and supplemental materials as guidelines to move towards best practice.

Limitations and considerations for future research

This study is not without limitations. The study has a small sample size and may not represent the perspectives of all who participated in the IMS training and implementation. However, recruitment during a humanitarian emergency is challenging and every effort was made to recruit from the core group primarily involved in implementation in each context. In addition, there were more female than male participants and results may therefore not account for differences in the experiences and perspectives of each gender. Furthermore, none of the participants were supervisees, as a perspective key to capture in future studies examining a newly implemented supervision structure. Another limitation is that only two participants were able to give follow-up feedback six months into the implementation of the IMS supportive supervision. Given the time it takes to implement a new system, especially in the chaotic environment of humanitarian emergencies, it would be beneficial to have a more longitudinal examination. Finally, interviews were conducted in English and though participants were fluent in this language, for many, English is not their primary language, which could have impacted on the perspectives expressed during the interviews.

Conclusions

This study examines the process of implementing supportive supervision in humanitarian contexts, a much-needed mechanism to protect the wellbeing of MHPSS humanitarian practitioners and preserve the quality and sustainability of their services. Participants delineate the steps and preparations needed for successful implementation and identify the impediments of implementing supportive supervision, highlighting the need for cultural and contextual adaptation, language translation and advocacy to advance an organisation’s supervisory structure towards best practice. The IMS was felt by participants to provide a useful framework to guide the implementation of supportive supervision and advocate for supportive supervision within humanitarian organisations in diverse contexts.

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Acknowledgments

Many thanks to our participants for their time and valuable contributions to our project.

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Lessons Learned from Case Studies

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To summarize, it appears, from the 15 cases studied, that a certain number of tell-tale traits can be distinguished beyond the specificities of each case.

To begin, we must distinguish between slums located on the periphery – which critically lack basic equipment and connections – and those in central areas, where the residential environment is severely dilapidated. Strong pressure from property developers in city centres and difficulty acquiring land are crucial issues. Whether planning for the territory as a whole or for more occasional development work, urban transformations impact both current slum populations and those to come. It is essential to identify the players involved and the way these changes are then implemented, be it within the framework of dialogue or as a result of power struggles, even conflicts. Either way, urban authorities play a vital role in heeding the slums. Certain studies highlight the key role of community associations – and external partners, NGOs and universities to a lesser extent – in developing alternative strategies at the local level, given that political ambitions are often tied to the private interests of national or foreign property developers.

The analyses of the 19 authors of this work provide keys for identifying the problematics of slums and their pivotal role in territorial, social, economic and political dynamics. The analyses likewise dispel the chaotic image of slums, and propose instead that we view them as element revelatory of an urban planning style that is far from embodying the principles of sustainable development.

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Bolay, JC., Chenal, J., Pedrazzini, Y. (2016). Lessons Learned from Case Studies. In: Bolay, JC., Chenal, J., Pedrazzini, Y. (eds) Learning from the Slums for the Development of Emerging Cities. GeoJournal Library, vol 119. Springer, Cham. https://doi.org/10.1007/978-3-319-31794-6_20

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Public Health Buckeyes: Angela Falconi

BSPH student combines passions for health care, policy

Falconi has been involved in CPH research and is an active member of Ohio State's Pilipino Student Association.

Meet Angela Falconi, a fourth-year student specializing in  environmental public health who aspires to advocate for others through public health policy.

What inspired you to pursue a public health education?

Growing up, I was surrounded by both medicine and public policy because of my parents. Since I was six, my father, a politician and elected official, had me act as his unofficial campaign staff—knocking on doors with him to speak to voters, sitting in on city council meetings and accompanying him to various events. My mother, a pediatric physician, inspired me to pursue a career in medicine by showing me the impact that she’s made on her patients and always encouraging me to learn more about the health care field. When choosing my major, it felt natural to me to combine policy and health into public health.

What public health topics are you passionate about?

“Your zip code determines your health.”

This is one of the most important phrases I have learned in my public health courses, and as a volunteer at Helping Hands Health and Wellness Center, a free clinic which provides health care services for the uninsured and underinsured. I see the realities of this phrase in the patients who I work with. 

As an aspiring elected official, I want to create health care reform which helps individuals the health care system has failed to provide with affordable service.

You spent last summer in Washington, D.C. interning in the U.S. Senate. What was that experience like?

I worked (there) through the IMPACT program, created by the US-Asia Institute in coordination with the Embassy for the Philippines for Filipino students interested in public policy. Working and living in D.C. was one of the best experiences I have had in my undergraduate career because I was able to learn about and research health care policy on the national stage, which is exactly what I hope to do in my future career.

What have you enjoyed most about being involved in research as a student?

I am a research assistant for the Consumer Access Project which utilizes a secret shopper survey of Affordable Care Act (ACA) insurance marketplace plan networks to study these barriers and inequities, including disparities related to race. I have loved getting to work with  Wendy Xu as she has helped me learn more about the research process as well as how everyday Americans experience the health care system.

What kind of extracurricular activities are you involved in?

The Pilipino Student Association (PSA) has been my home away from home since the start of my time at Ohio State. It has not only allowed me to learn more about my Filipino culture, but I met my best friend through this organization. I have been involved in PSA in numerous roles: culture night coordinator, vice-president internal, president and now dance leader. 

As dance leader, I lead PSA’s tinikling team. Tinikling is a dance which involves two people beating, sliding, and tapping two bamboo poles on the ground while two people dance above the sticks, trying not to get caught in between them. Our latest performance from PSA’s culture show “Barrio” was in October. I choreographed, taught and performed the modern part of this dance!

What are your goals for the future?

I hope to not only assist individual patients as a physician, but I also hope to help others on the national scale by being an advocate as an elected official. I hope to apply the experiences and lessons that I have learned from my time at Ohio State into my future career in the field of health policy.

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