A research primer on design case studies

Editors from the HERD: Health Environments Research & Design Journal presented on a decade of case studies at the recent 2025 International Summit & Exhibition on Health Facility Planning, Design & Construction™ in Atlanta. After much discussion, the editors agreed on a 2009 definition of “case study” from a book published by Sage Publications Ltd., Case Study Research in Practice, by Helen Simons. It’s defined as “an in-depth exploration from multiple perspectives of the complexity and uniqueness of a particular project, policy, institution, program or system in a ‘real life’ context.”

Case studies can incorporate multiple methods and document multiple sites or patient units, although the focus is typically a single topic. They are not always considered research, which is intended to be generalizable.

There are three broad categories of time frames: A retrospective case study uses historical data. A snapshot captures a moment in time, such as day-in-the-life scenarios. A diachronic study considers changes over time. There also are three broad categories of case study types: A descriptive case study describes something. There are no inferences or causal statements. An explanatory case study is an initial explanation of the how or why that is behind something. Once you understand the reasons behind a condition, you can make changes. Exploratory case studies are sometimes a first step within a larger research project. These case studies often focus on the what and who of a topic, rather than the how and why.

Let’s look at a few of the many examples presented, which are cited in the footnote below.

Kirk Hamilton summarized a 2020 study by Halpern and Anderson that described the life cycle of a 2007 renovation, which won a Society of Critical Care Medicine design award in 2009. The design was intended to explore new concepts, including the use of electronic privacy glass and copper as an antimicrobial for high-touch surfaces like bed rails and door handles. This study identified multiple areas that needed to be changed, improved or redesigned over 13 years of everyday use. This is an example of a descriptive study addressing the past.

In a second example, Debbie Gregory reviewed a 2017 study by Karvonen and colleagues — an explanatory case study. The team looked at how patient flow could inform layout planning for a musculoskeletal surgery unit. The team identified 26 main activities on the unit and gathered a year’s worth of patient routes documented through to-from data. The current state was presented in a table that documented the highest patient flow routes — those to and from the orthopedic ward and three areas: X-ray, operating rooms (ORs) and the plaster cast room. The team used the data to generate an ideal layout to minimize transfer distances, with estimates suggesting a 50% reduction in transfer distances for inpatients and a 30% reduction for outpatients.

Finally, I shared an exploratory case study from 2020 by Shultz and colleagues. This incorporated simulation to establish workflow in the OR. A full-scale, high-fidelity mock-up was constructed during schematic design, and iterative testing was used as changes were made in the design. Link analysis and spatial mapping were completed to identify movement and equipment use. The evaluation yielded 29 design recommendations, resulting in a design for a square, 650-square-foot universal OR.

In HERD, many authors share their insights, and a case study is an ideal way for teams to publish their work.