Tales of the expected: a case-study in health service management

Scientific approaches, such as operational research and health economics, have failed to resolve many of the problems confronting managers of health services. This is partly because of assumptions about the value-free nature of information and partly through paying little regard to power conflicts in care systems. The case-study method offers a means of understanding some aspects of these conflicts and could therefore improve the effectiveness of scientific methods in influencing decisions. An example of a case-study involving perinatal care in an English health district is described in an attempt to demonstrate the practical benefits that could accrue to managers hoping to see their macro-study findings effecting change.