Blekinge Institute of Technology
Doctoral Dissertation Series No. 2007:04 School of Engineering
INFORMATION IN USE
ASPECTS OF INFORMATION QUALITY IN WORKFLOWS
Patrik Brandt TION IN USE TION QU ALITY IN W ORKFLO WS Patrik Brandt 2007:04 ISSN 1653-2090
This thesis is founded on the global growth of the service sector and its significance for society as a whole and for the individual human being. In the last decade, technology has changed the way services are created, developed and delivered in remarkable ways. The focus of the thesis is tech-nology in interplay with humans and organisations and the socio-economic-technical systems in which digital services play a central role. Challen-ges addressed by the thesis include requirement analysis, trustworthy systems, in- and outsourcing aspects, the proper understanding of information and its use in real world applications. With this in mind, the thesis presents a configurable metho-dology with the purpose to quality assure service oriented workflows found in socio-economic-technical systems. Important building blocks for this are information types and service supported workflows.
Our case study is of a call centre-based business called AKC (Apotekets kundcentrum). AKC con-stitutes a part of the Cooperation of Swedish Pharmacies (Apoteket AB). One of their main ser-vices offered to Swedish citizens is the handling of incoming questions concerning pharmaceutical issues. We analysed the interactive voice response system at AKC as a starting point for our investi-gations and we suggest a more flexible solution. We regard a socio-economic-technical system as an information ecology, which puts the focus on human activities supported by technology. Within these information ecologies, we have found that a
Service Oriented Architecture (SOA) can provide the flexible support needed in an environment with a focal point on services. Input from infor-mation ecologies and SOA also enables a struc-tured way of managing in- and outsourcing issues. We have also found that if we apply SOA together with our way of modelling a Service Level Agre-ement (SLA), we can coordinate high-level requi-rements and support system requirequi-rements. In the dissertation, we propose three attributes closely linked to information quality:
• Trustworthiness of the source
• Protection against falsification of information • The receiver’s competence to use obtained information in the appropriate and intended way.
The first attribute concerns the assessment of a source’s trustworthiness. The second regards the ascertainment that the information has not been falsified on its way from the source to the receiver. These two attributes can be related to the classic CIA-model for information security. The last attri-bute can be related to the use of information, and this thesis also focuses on this issue.
As a result, we propose a set of guidelines which represent our approach towards developing qua-lity assured systems. We also present two main ty-pes of validation for service oriented workflows: validation of requirement engineering and valida-tion of business processes.
Information in use
aspects of information quality in workflows
Patrik Brandt
ISSN 1653-2090 ISBN 978-91-7295-111-2
School of Engineering
Blekinge Institute of Technology
Printed by Printfabriken, Karlskrona, Sweden 2007 ISBN 978-91-7295-111-2
” Computers are incredibly fast, accurate and stupid; humans are incredibly slow, inaccurate and brilliant; together they are powerful beyond imagination.”
Contact Information:
Patrik Brandt
School of Communication and Design University of Kalmar
SE- 391 82 Kalmar
A
BSTRACT
This thesis is founded on the global growth of the service sector and its significance for society as a whole and for the individual human being. In the last decade, technology has changed the way services are created, developed and delivered in remarkable ways. The focus of the thesis is technology in interplay with humans and organisations and the socio-economic-technical systems in which digital services play a central role. Challenges addressed by the thesis include requirement analysis, trustworthy systems, in- and outsourcing aspects, the proper understanding of information and its use in real world applications. With this in mind, the thesis presents a configurable methodology with the purpose to quality assure service oriented workflows found in socio-economic-technical systems. Important building blocks for this are information types and service supported workflows.
Our case study is of a call centre-based business called AKC (Apotekets kundcentrum). AKC constitutes a part of the Cooperation of Swedish Pharmacies (Apoteket AB). One of their main services offered to Swedish citizens is the handling of incoming questions concerning pharmaceutical issues. We analysed the interactive voice response system at AKC as a starting point for our investigations and we suggest a more flexible solution.
We regard a socio-economic-technical system as an information ecology, which puts the focus on human activities supported by technology. Within these information ecologies, we have found that a Service Oriented Architecture (SOA) can provide the flexible support needed in an environment with a focal point on services. Input from information ecologies and SOA also enables a structured way of managing in- and outsourcing issues. We have also found that if we apply SOA together with our way of modelling a Service Level Agreement (SLA), we can coordinate high-level requirements and support-system requirements.
In the dissertation, we propose three attributes closely linked to information quality:
• Trustworthiness of the source
• Protection against falsification of information
• The receiver’s competence to use obtained information in the appropriate and intended way.
The first attribute concerns the assessment of a source’s trustworthiness. The second regards the ascertainment that the information has not been falsified on its way from the source to the receiver. These two attributes can be related to the classic CIA-model for information security. The last attribute can be related to the use of information, and this thesis also focuses on this issue.
As a result, we propose a set of guidelines which represent our approach towards developing quality assured systems. We also present two main types of validation for service oriented workflows: validation of requirement engineering and validation of business processes.
P
REFACE
I see this thesis as the final destination of a long and eventful journey. In spite of the fact that this journey ends here, I am not tired of travelling. Hopefully, my journey and the result of my work will inspire others to travel along the same road I have been travelling. In that case, I am sure they will see and experience some of the things I have noted, but I am also convinced they will see new things. This journey, like most other journeys, has been full of incidents and coincidences, some good and some bad and most of them impossible to predict before they turned up. There have also been moments when I have doubted my own capacity and my ability to solve the task. But I have always tried to do my best. Fortunately, I have not had to travel by myself since my travel companion Louise has always been there with me. But even though we have travelled together, I think that we have seen and gone through different things along the road. I believe that this is precisely what makes our collaborative effort truly useful. Louise, thank you for all the stimulating discussions, all the fun moments and for letting me have you as a travelling companion. We would never have found our way to the final destination without our guide and supervisor Professor Rune Gustavsson. Rune, your importance for me and for this work cannot be put into words. You will always be a great source of inspiration for me. I also want to thank our co-supervisor Päivi Jokela. Päivi, thank you for always being there when we needed you. This journey would never have been realized without the necessary funds. Therefore, I want to take this opportunity to thank the people and organisations that sponsored this project: Lars Malmborg at the Kalmar R&D Foundation, the University of Kalmar and Apoteket AB.
Along the road, other people have also contributed in various ways, or the journey would not have been possible. I have received invaluable help from my colleagues and friends in the Societies of Computation (SoC) group at Blekinge Institute of Technology (BTH), my colleagues at University of Kalmar, Tomas “F1” Johansson, Lars O Eriksson, personnel at AKC and Apoteket AB like Torsten Dahlberg, Bengt Åstrand and Tony Rydberg to mention but a few. Thank you for always answering all my curious questions. I also want to give special thanks to
our language expert Johan Höglund for valuable comments and guidance into the English language.
Last but not least, I want to thank my family and in particular my wife Elisabet and my two children Lovisa and Herman. Thank you for your indefatigable support and for your continuous faith in me. Without you, there would have been nothing!
The future will show if there are to be any more journeys. Patrik Brandt
Kalmar March 2007
T
ABLE OF CONTENTS
PREFACE I
TABLE OF CONTENTS III
CHAPTER 1 INTRODUCTION 1
1.1SETTING THE SCENE 1
1.2THE PURPOSE OF THE THESIS 2
1.3OVERVIEW OF THE THESIS 2
1.4RESULTS 5
1.5OWN CONTRIBUTIONS 5
1.6ASSESSMENT OF THE LICENTIATE THESIS 8
1.7THESIS STRUCTURE 8
1.8GUIDELINES TO THE READER 9
CHAPTER 2 BACKGROUND 13
2.1INPUT AND FINDINGS FROM THE LICENTIATE THESIS 13
2.2SUMMARY OF CHAPTER 15
CHAPTER 3 CASE STUDY 17
3.1BACKGROUND 17
3.2THE VIRTUAL ORGANISATION FOR AKC 19
3.2.1AGENTS 20
3.2.2GOVERNING AND CONTROLLING AUTHORITIES AND AGENCIES 21
3.2.3OWNER STRUCTURE 22
3.3LEGAL FRAMEWORK 22
3.4PRESENT STRUCTURE OF AKC’S INTERACTIVE VOICE RESPONSE 24
3.5ANALYSIS OF ERROR REPORTS 26
3.6TOWARDS A CONFIGURABLE METHODOLOGY 29
3.6.1OWN CONTRIBUTIONS TOWARDS AN ASSURED WORKFLOW AT AKC 30
3.7CHALLENGES 34
CHAPTER 4 SERVICES AND SERVICE DEVELOPMENT 39
4.1INTRODUCTION 39
4.2THE CHANGE OF THE SERVICE CONCEPT 40
4.3SERVICE DEVELOPMENT IN APOTEKET’S CONTEXT 41
4.4QUALITY ASPECTS OF THE SERVICE CONTEXT 45
4.5CONNECTION TO THE REMAINING PART OF THE THESIS 47
4.6SUMMARY OF CHAPTER 49
CHAPTER 5 THEORETICAL ASPECTS OF INFORMATION
AND COMMUNICATION 51
5.1INTRODUCTION 51
5.2REPRESENTATION, INFORMATION AND KNOWLEDGE 52
5.3SITUATIONS, TYPES AND INFORMATION EXCHANGES 54
5.3.1SITUATIONS AND TYPES 54
5.3.2EXCHANGING INFORMATION 57
5.4SEMANTICS 58
5.5INFORMATION FLOWS, SITUATIONS AND TYPES AT AKC 60
5.6INFORMATION AND INFORMATION SECURITY 64
5.7INFORMATION QUALITY AND INFORMATION ASSURANCE AT AKC 67
5.8THE ROLE OF SERVICE-ORIENTED ARCHITECTURE,SOA 68
5.9SUMMARY OF CHAPTER 70
CHAPTER 6 METHODOLOGICAL ISSUES 71
6.1INTRODUCTION 71 6.2MODELLING PROCESS 73 6.2.1CONTEXT LEVEL 73 6.2.2CONCEPT LEVEL 74 6.2.3ARTEFACT LEVEL 77 6.3SUMMARY OF CHAPTER 79
CHAPTER 7 OUR APPROACH 81
7.1CHALLENGES REVISITED 81
7.2IDENTIFICATION OF WORKFLOWS AT AKC 83
7.3IDENTIFICATION OF TASKS AT AKC 88
7.5ENSURING INFORMATION QUALITY AT AKC 95
7.6A SET OF GUIDELINES 97
7.7SUMMARY OF CHAPTER 98
CHAPTER 8 MODELS OF VALIDATION AND
CONCLUSIONS 99
8.1INTRODUCTION 99
8.2MAIN TYPES OF VALIDATION FOR SERVICE-ORIENTED WORKFLOWS 100
8.2.1VALIDATION OF REQUIREMENT ENGINEERING 101
8.2.2VALIDATION OF BUSINESS PROCESSES 104
8.3OTHER VALIDATION ASPECTS 106
8.4CONCLUSIONS 107
8.5SUMMARY OF CHAPTER 109
CHAPTER 9 FUTURE WORK 111
9.1THOUGHTS ON FUTURE WORK 111
GLOSSARY 117
REFERENCES 121 Figures
FIGURE 1.1GENERIC ARCHITECTURE FOR SOCIO-ECONOMIC-TECHNICAL SYSTEMS. ...3
FIGURE 3.1THE VIRTUAL ORGANISATION OF AKC. ...20
FIGURE 3.2TREE-STRUCTURE FOR THE INTERACTIVE VOICE RESPONSE-BASED ... WORKFLOW. ...25
FIGURE 3.3CRITICAL POINTS IN A WORKFLOW...29
FIGURE 3.4PERSPECTIVES ON A SOCIO-ECONOMIC-TECHNICAL SYSTEM. ...36
FIGURE 4.1WEB SERVICE COMPONENTS [35]...45
FIGURE 4.2WHERE THE DIFFERENT METHODOLOGIES AND THEORIES ARE USED IN THIS WORK...48
FIGURE 5.1TYPES AND INFORMATION FLOWS [4]...56
FIGURE 5.2A CONVERSATION DIAGRAM [4]. ...57
FIGURE 5.3MAIN SITUATION TYPES AT AKC. ...60
FIGURE 5.4HAND-OVER CHALLENGE. ...62
FIGURE 5.5A MESSAGE EXCHANGE WITHOUT COMMON GROUND...65
FIGURE 5.6BASIC COMPONENTS OF SERVICE-ORIENTED ARCHITECTURES [46]...69
FIGURE 6.1REVISED COMMONKADS MODEL...72
FIGURE 6.2MODIFIED TASK MODEL (TO THE RIGHT) IN RELATION TO THE SOCIO -ECONOMIC-TECHNICAL SYSTEM (TO THE LEFT)...74
FIGURE 6.3OVERVIEW OF THE COORDINATION MODEL WITH SLA...75
FIGURE 6.4OVERVIEW OF THE COMMUNICATION MODEL [5]. ...76
FIGURE 6.5GENERAL LAYOUT OF A DIALOGUE DIAGRAM [5]. ...77
FIGURE 6.6SOA AS A SUPPORT FOR CUSTOMER ORIENTED WORKFLOWS...78
FIGURE 7.1CHALLENGES FOUND IN SOCIO-ECONOMIC-TECHNICAL SYSTEMS. ...83
FIGURE 7.2DIVISION OF AKC’S BUSINESS PROCESSES INTO SMALLER ELEMENTS. ...84
FIGURE 7.3A NORMATIVE WORKFLOW. ...85
FIGURE 7.4THE ACTUAL WORKFLOW AT AKC. ...86
FIGURE 7.5FROM WORKFLOW TO SUBTASK...88
FIGURE 7.6.TYPES AND INFORMATION FLOW [4]...91
FIGURE 7.7CRITICAL HAND-OVER SITUATIONS IN THE OVERALL WORKFLOW...91
FIGURE 7.8A DIALOGUE SITUATION EXTRACTED FROM THE OVERALL WORKFLOW...92
FIGURE 7.9SERIAL DIALOGUES...93
FIGURE 7.10A CONVERSATION DIAGRAM FOR AKC...94
FIGURE 8.1ARCHITECTURE FOR VALIDATION EXPERIMENTS...100
FIGURE 8.2REVISED COMMONKADS MODEL...101
FIGURE 8.3WORKFLOW GENERATED SERVICES. ...105
TABLES TABLE 1.1OWN CONTRIBUTIONS. ...6
C
HAPTER
1 I
NTRODUCTION
In this chapter, we introduce the background to this thesis by presenting our work in a larger context, namely the remarkable global growth of the service sector. Based on this, we discuss the purpose of the thesis, the relevance of socio-economic-technical systems and our areas of interest respectively. The achieved results are presented as well as individual contributions and assessment of our previous Licentiate thesis. The chapter concludes with a structure of the thesis and some guidelines to the reader.
1.1 Setting the scene
In the opening sentences of the Seventh Framework Programme for 2007-2013 by the European Commission, one can read that Europe faces an urgent need to reshape its economy and society to be able to meet the
challenges of the 21st Century. This fact is based on the globalisation of
markets and the ever faster pace of technological change. Furthermore, we also have to modernise public services and tackle emerging challenges within different areas, e.g. the health sector [1]. Globalisation, the increasing automation, the growth of the Internet and the dynamic componentisation of business are driving the reconfiguration of service value networks at a scale and pace never seen before in history. The opportunity for innovation, research, development, realisation of business and societal value and delivery of new information and business services has never been greater [2].
This not only holds for the term “service” that today is most commonly associated with Web services or Service-Oriented Architectures, (SOA); there has been a remarkable growth in the service sector as a whole since it has dominated the economic activity for the last 50 years [2]. Our society today is increasingly built upon digital services and soon we will fully enter a digital service society where these services will play a central
role in our daily lives. When this happens, they will be a natural and important part of the socio-economic-technical context in which people and machines co-operate.
This development of the service sector and the challenges that Europe faces is behind our interest in digital services, the main topic of this thesis. We argue that one of the overall purposes of digital services is to mediate information, which makes information a fundamental part in this context. Hence the title “Information in use”. With this title as a starting point we then chose to focus on two different aspects which we think are of great importance, namely aspects of information quality in workflows where digital services are a vital part and also in- and outsourcing aspects of digital services. In this thesis we have used a customer care centre (Apotekets Kundcentrum which from now on will be referred to as AKC) which is part of the Corporation of Swedish Pharmacies (Apoteket AB which from now on will be referred to as Apoteket) as a case study. Apoteket is the sole retailer of pharmaceutical products in Sweden. Today, some of the services at AKC are digital and the ratio of these are increasing within the organisation. However, the results presented are also valid for other types of businesses that use digital services in their daily work. The results of the research are based upon the same core, but are presented in two different theses written by Patrik Brandt (Information in
use: aspects of information quality in workflows) and Louise Östlund (Information in use: in- and outsourcing aspects of digital services) [3] respectively. The results
from these theses are closely related and can be seen as one unit, but can also be read individually or as a complement to each other.
1.2 The purpose of the thesis
The overall purpose of this thesis is to find ways to assure the quality of the information flow between a customer and a human agent at, for example, AKC. Assuring the information flow in a situation where the customer or AKC’s personnel interact with digital services, is also of interest. Beside the overall purpose, Louise Östlund’s thesis deals with in- and outsourcing aspects of digital services and Patrik Brandt’s thesis exemplifies how information quality can be achieved in workflows where digital services play a central part.
1.3 Overview of the thesis
As mentioned before, services are central to this thesis. These services in turn support work- and information flows and it is of great importance that these are quality assured, especially in a context like the one at AKC
since they deal with and mediate pharmaceutical information. In order to manage requirement elicitation and requirement engineering that support identification of workflows and services, we have used a configuration of different tools, methodologies and theories. Figure 1.1 illustrates how these are involved in our work, and it also shows how the methodologies and theories have been used and how they are connected. More thorough descriptions of the components that are shown in the figure are given in the forthcoming Chapter 4 Services and service development, Chapter 5
Theoretical aspects of information and communication, Chapter 6 Methodological issues and Chapter 8 Models of validation and conclusions respectively.
Figure 1.1 Generic architecture for socio-economic-technical systems.
Figure 1.1 illustrates our socio-economic-technical system. In the upper part we find the workplace consisting of people (e.g. customers, employees) together with an idealised, normative workflow in an organisation. The workflow is realised when a number of tasks are carried out; some of these by humans and others by machines. We have drawn a line around the people and the workflow that shows that this is a part of the organisational context in which they work, i.e. the workplace. This workplace is also our object of study, and it is supported by and closely related to an underlying technical structure. In our effort to understand the workplace, we are helped by different theories and methodologies. We
CommonKADS Support-system requirements High-level requirements Support Ethnographical aspects Infosense aspects Service Oriented Architecture Information Ecologies
Service Level Agreement Service bundle Other aspects Workplace Workflows Customers Customers
have chosen to focus on the Infosense theory [4], the CommonKADS methodology [5] and also ethnographical aspects to a certain extent. We are aware of the fact that other relevant aspects exist, e.g. economic, human behaviour, human computer interaction and so on, but we have chosen the ones that are relevant to the purpose of the thesis. Another reason not to add more aspects than the ones we have outlined is that we need to minimize the aspects considering the complexity in socio-economic-technical systems. However, we will return to economic aspects related to in- and outsourcing of services in Chapter 8 Models of validation
and conclusions.
To be able to analyse a complex socio-economic-technical system, we need to consider the sociological and the technical aspects of this system because they are closely related and interwoven. For instance, the requirements for support that people have in order to perform different tasks in the workflow, must match the possibilities the underlying technical infrastructure can offer. Accordingly, there are a number of requirements that must be fulfilled to achieve a well-functioning workflow. We have divided these into high-level and support-system requirements. These concepts are well-known within the area of software engineering, but are in those situations influenced by technical aspects and are often restricted to requirements that are directly measurable. In socio-economic-technical systems however, we see that very crucial trust-related requirements come from the part of the figure above the dotted line, a section we refer to as information ecologies since these requirements act as support in the process of performing tasks correctly. The part of the figure below the dotted line must then complete certain technical functions to fulfil the support-system requirements, and some technical functions are furthermore a part of the support-system requirements. In our case, the technical part of the system is based upon an SOA. The high-level and support- system requirements meet in a Service Level Agreement, (SLA), which acts as an interface between the sociological and the technical part of the system. The SLA is derived from CommonKADS meta models and it collects different kinds of services to something we call a service bundle, that supports and coordinates the workflow.
My area and purpose in this thesis is to exemplify how information quality can be achieved in workflows where digital services are of vital importance. Since workflows within a socio-economic-technical system
contain a number of tasks that are linked together and carried out by both humans and machines, jointly as well as in interplay, it is of utmost importance that the different aspects of information quality in workflows are reflected in both human and machine perspective. We have found that the theoretical framework we call Infosense (cf. Chapter 5 Theoretical issues
on information and communication) is well suited to this purpose. The starting
point for my contribution is the high-level requirements and the support-system requirements that exist in the environment where the services are intended to act as a support.
The results of my work can be seen as a complement to the jointly developed guidelines concerning analysis, implementation and use of digital services in workflows from an information quality point of view. The results should also form the basis of what we have chosen to call models of validation. The challenge these models and my results present, is that they must be comprehensible to those who possess the knowledge that is needed to realize and implement the digital services in question. As a technical basis for my reasoning I have assumed that the underlying environment is built upon an SOA. The reason for this is of course our focus on digital services but also the several advantages an architecture of that kind offers, such as platform independence, the possibility to, with relatively small changes, reuse already existing applications and systems and a flexible service supply.
1.4 Results
A result of this thesis is the compilation of a number of key methodologies that can be configured to analyse workflows and socio-economic-technical systems. Another result, arising as a consequence of compiling key methodologies, is the development of guidelines which serve to first identify fundamental information types within workflows and then identifying necessary service types to support these workflows. The service types can then be bundled together to specific service bundles, which then can be analysed and executed with respect to performance, to other support-system requirements and also to high-level requirements. In this way, we have met the challenge to create a reusable way of analysing workflows and socio-economic-technical systems.
1.5 Own contributions
While working on this thesis, we wrote papers and gave conference contributions to address different issues related to the AKC context. A
Licentiate thesis has also been written around the same theme. Our contributions are listed in Table 1.1.
Table 1.1 Own contributions.
Nr. Title Authors Way of presentation
1. Communication – a comparative study of Langefors, Shannon & Weaver Brandt, P. & Wennberg, L. (2002) Systems Science – A Theoretical Approach. ISSN 1651-0275 ISBN 91-974341-2-4
2. Risk Analysis in Contact
Centres Brandt, P., Révay, P. & Wennberg, L. (2003) The 4th International Conference of PhD Students, Hungary. 3. The importance of analysing communication channels from an information security perspective – a case study
Wennberg, L., Brandt, P. & Révay, P. (2004) MicroCAD 2004, International Scientific Conference, Hungary.
4. System Thinking in Risk
Analysis Brandt, P., Révay, P. & Wennberg, L. (2004)
The Forty-Eight Meeting of the International Society for the System Science, USA.
5. Informatisk forskning om riskanalysprocess applicerad på Apoteket AB:s kundcenterverksamhet Brandt, P. & Wennberg, L. (2004)
Licentiate Thesis, Blekinge Institute of Technology. ISSN 1650-2140 ISBN 91-7295-044-7 6. Information Security – an application of a systems approach Wennberg, L., Brandt, P. & Révay, P. (2006)
Kybernetes: The International Journal of Systems &
Cybernetics, Vol.35, Issue 6.
7. Information Agent Support in Life Critical Situations Gustavsson, R., Brandt, P., Lundberg, J. & Östlund, L. (2006)
Submitted to: The Journal of the Brazilian Computer Society – Special Issue on Software Engineering for Multi-Agent Systems
8. The Call Centre, a Complex Critical
Information System – but for what kind of
information?
Brandt, P., Gustavsson, R., & Östlund, L. (2006)
Submitted to: The Journal Of Strategic Information Systems.
One common denominator for the first six contributions is that they are (in one way or another) built upon a system-theoretical approach, with emphasis on the General System Theory, GST [6]. However, this theory is no longer suitable for the approach presented in this thesis, since we are now focusing on and analysing socio-economic-technical systems where
we need to model information types, workflows, support-system requirements, and high-level requirements. With this approach, we are not modelling in- and output or feedback loops etc, for which GST might be helpful.
In Table 1.2 we list the contributions from Table 1.1 in relation to a number of subject fields, which we consider to be the main field for the dissertation work. Depending on their relevance to the dissertation work they have been assigned plus signs (+) where three plus signs indicate a strong relevance and no plus sign signifies no relevance.
Table 1.2 Relevance for the dissertation work.
Nr.
Communi-cation Information Services Workflows outsourcing In- and
1. +++ +++ 2. + + + 3. +++ ++ 4. ++ ++ (5.)1 6. + + ++ ++ 7. ++ +++ +++ +++ ++ 8. +++ +++ +++ ++
The contributions listed above as well as this entire thesis is a result of our research project where we have studied AKC for a number of years. During the study, we have had several meetings and workshops that involved representatives from AKC and its main organisation Apoteket. We have also established contacts and meetings with other organisations, e.g. Kalmar County Council. Their responsibilities include the public medical service and they thus have a connection to Apoteket’s main business which is pharmaceutical products. These contacts have been of great value to us in the work with testing ideas and results. During our work, we have found that digital services will be of great importance in the future; especially for businesses and organisations like the one mentioned above. Moreover, our research about and approach to digital services and information has also created interest elsewhere. An example of this is our own university where they see a possibility of introducing this approach into undergraduate and masters studies combined with
continuous research together with our research group, Societies of Computation, SoC, at Blekinge Institute of Technology [7].
1.6 Assessment of the Licentiate Thesis
The Licentiate thesis [8] has resulted in a number of debriefings, workshops and meetings with involved persons from Apoteket. These occasions have in turn resulted in discussions between representatives from Apoteket and us about important questions at hand for AKC and its future business. Initially, the questions we discussed concerned different risks identified in the Licentiate thesis but these discussions have now moved on to other issues. They now focus not only on the new services that have gradually been added to AKC’s business but also on the future role of AKC and its importance as a part of Apoteket. Lately, the discussions with Apoteket has been characterised by the ongoing debate about the deregulation of Apoteket’s monopoly. These discussions are at present being carried on by the Swedish Government. The final decision had not been taken at the time of writing, but regardless of the outcome, AKC will play an important role for Apoteket as a whole.
During the writing of the thesis in general and the doctoral thesis in particular, a continuous dialogue has been kept with Apoteket in the form of idea seminars, video conferences, interviews etc. in which a form of validation did take place. At these occasions, new ideas were tested as they came up. We see Apoteket’s and AKC’s role in this project as an interesting and engaged study object, from which we have been able to collect real examples that have an important connection to the public welfare in Sweden.
1.7 Thesis structure
The remaining part of this doctoral thesis is structured as follows:
In Chapter 2 Background, we present the background to this thesis and in Chapter 3 Case Study we describe the case study object AKC, together with issues related to socio-economic-technical systems. These issues are furthermore based on analysis of the existing interactive voice response system and error reports. In Chapter 4 Services and service development, we present an overview of services and their development with special focus on digital services. In Chapter 5 Theoretical aspects of information and
communication, we discuss theoretical aspects of information and
communication by using Devlin’s theory of information (Infosense)[4], and in Chapter 6 Methodological issues we present methodological issues
based on the CommonKADS methodology [5] which we have also revised to some extent. In Chapter 7 Our approach, we give further details about our approach to the case study and how we have put theories and methodologies into practice. In Chapter 8 Models of validation and conclusions we discuss these models of validation as a way to bring forward quality assured socio-economic-technical systems. In Chapter 9
Future work we make our conclusions and discuss future work and other
approaches such as related work, which is followed by a Glossary that defines the central terms for this thesis. These central terms are marked with an asterisk (*) when they appear for the first time in the forthcoming chapters. The thesis concludes with a list of References used in this thesis and an Appendix.
1.8 Guidelines to the reader
In contrast to Section 1.7 above, where we give a very short description of each chapter in this thesis, we want to use this section as an opportunity to highlight some chapters that are central to this thesis. To be specific, these are Chapter 3 Case study, Chapter 7 Our approach and Chapter 8
Models of validation and conclusions.
In Chapter 3 Case study, the reader finds a background description of AKC and a discussion about different effects as a result of AKC’s establishment. This continues with the virtual organisation for AKC, which constitutes an identification of agents that are directly or indirectly involved in AKC’s business. We also present a more detailed description of these agents and their roles respectively. An important component in AKC’s business is the National Pharmacy Register, in which data of the customers’ total use of pharmaceutical products are stored. Obviously, this is considered to be a very sensitive register and is therefore guarded by a number of rules and regulations which are presented in the section about legal framework. Another component presented in this chapter is AKC’s interactive voice response, which is the customer’s first contact with AKC’s service supply. This interactive voice response and its structure turned out to be important for our work, and these elements are therefore discussed further in the chapter. We also put forward real examples of mistakes made within Apoteket’s context. These examples are extracted from error reports from The National Board of Health and Welfare in Sweden and can be seen as examples of insufficient information quality. Chapter 3 also includes a section called Towards a
to different aspects of socio-economic-technical systems like AKC, namely socio-related, technical and economic challenges.
In Chapter 7 Our approach, methodologies and theories are put into practice and are thus applied to our case study object AKC. In this chapter, we describe our approach to business processes and how we divide them into smaller parts, namely workflows, tasks and dialogues. Next, the identification process of workflows at AKC is described and the actual workflow at AKC is presented as a result of performed ethnographical studies. Together with this, the importance of the interactive voice response is once again discussed, since it activates AKC’s workflows and will also have an impact on the overall work procedure. In accordance with our division of business processes into smaller parts, the next step is to break down the identified workflow into tasks, which are described and also connected to the CommonKADS methodology. A great part of the chapter is devoted to the identification of information types, information flows and dialogues at AKC. In connection to this, the CommonKADS methodology is used once again but this time in combination with Devlin’s Infosense theory.
According to us, the tasks are performed by means of certain dialogues and we have found that critical hand-over situations take place when information is to be transmitted between these dialogues. Considering this fact, we pursue a discussion about what takes place in a specific dialogue situation, the complexity that occurs when serial dialogues appear and so on. We also discuss the complexity of problems that arise as a result of possible misinterpretations and we state how important it is to ensure information quality in a consultative business like AKC. The chapter concludes with previous challenges revisited, where we suggest six overall information types as a proposal of how to categorise the existing information types in AKC’s digital information system. These six information types can also be used to great advantage to reorganise AKC’s supply of services and also act as a foundation for a new way of structuring in the interactive voice response as well. We also propose a set of guidelines towards developing systems with assured qualities, developed by our research group SoC.
Finally, in Chapter 8 Models of validation and conclusions, we discuss models of validation in relation to the earlier presented socio-related, technical and economic challenges. We also present three main types of validation of service-oriented workflows, with input from the set of guidelines
presented in Chapter 7 Our approach. In the chapter we mainly focus on validation of requirement engineering and validation of business processes but we also discuss other validation aspects, such as automation.
C
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2 B
ACKGROUND
In this chapter we present findings from our Licentiate thesis, which forms a background to this thesis. As a result of the Licentiate thesis, we present three important main tasks that constitute a foundation for AKC’s business processes and service supply.
2.1 Input and findings from the Licentiate thesis
We have in our previous published Licentiate thesis [8] emphasised the importance of using a holistic perspective when it comes to security issues and risk analysis processes together with larger organizational changes and integration matters in particular. In relationship to the latter, we especially refer to integrations of different communication channels. The holistic approach that was used in the Licentiate thesis was influenced by the way of thinking that is emphasised within General Systems Theory, (GST) [6]. This was applied to our reasoning on security where we accentuate that it is not one single component that constitutes a secure organisation; instead a number of co-operating factors put in a larger context together contribute to increased security. In the Licentiate thesis, important sustainable socio-economic-technical aspects, in the shape of interactions between people, organisation and technology, are also put forward. These socio-economic-technical aspects are important in order to be able to offer different business related services* with support from suitable infrastructures. The application area for the Licentiate thesis was AKC, which at that point had just been established. Our focus was then turned to an overall reasoning about security with a starting point in risk analyses of this kind on “new” business within Apoteket.
In this thesis the application area is the same, i.e. AKC. However, we are no longer using GST or other system aspects that have a more “pure” approach found within e.g. mechanical, sociological or biological systems. Instead, our way of looking at systems* in this dissertation is characterized by a socio-economic-technical perspective, i.e. we are interested in the co-operation between humans and technology. In these open socio-economic-technical systems, the input or output that people usually refer to when discussing systems, does not exist; what drives these systems are the internal processes like workflows* and information flows. The same line of thought is also found in Nardi and O´Day’s Information Ecologies where an information ecology is viewed as a system of people, methodologies, technologies and values that co-exists in the same environment [9].
After a couple of years in operation, we would argue that AKC has established its organisation and located its role within Apoteket. The fundamental thought is that there should be no difference for the customer if he or she chooses to turn to AKC or to a traditional local pharmacy. The service supply and the total experience should be the same. During the time we studied AKC, we identified three main tasks* where AKC:
• Mediates products that are available both with and without prescription and information belonging to them
• Functions as a portal for healthcare
• Promotes better use of pharmaceutical products among Swedish citizens
Mediating pharmaceutical products has been a core business for Apoteket from the very beginning and lately the information belonging to these products has also been increasingly important. This importance is not unrelated to the fact that great returns from the information on how to use pharmaceutical products have been noticed, both from a national-economic perspective and from a health perspective. Together with this, invested resources have enabled the offer of preventive measures into something that can be seen as a portal for healthcare. Here we refer to the possibility of the customer to search for advice and help, concerning health and self-care at Apoteket’s homepage (www.apoteket.se). Through these main tasks, Apoteket offers a number of services, a concept which we consider of vital importance when we study AKC and its business.
Therefore, we want to state that the main tasks for AKC amounts to delivering different kinds of services, some digital, to their customers. Considering the fact that Apoteket is active within the area of pharmaceuticals and healthcare, it is of utmost importance that the delivered services are of the highest quality. This can, according to us, be maintained through the assurance of high information quality. The focus in this thesis has thus been the assurance of central workflows in critical business processes*, and we find examples of these kinds of flows and processes within AKC.
2.2 Summary of chapter
In this chapter, the following is discussed:
• In the Licentiate thesis, General Systems Theory was applied, but this theory is now left behind
• In the Licentiate thesis, important sustainable socio-economic-technical aspects in the shape of interactions between people, organisation and technology were put forward
• Three main tasks at AKC have been identified, arguing that it:
o Mediates products that are available both with and without
prescription and information belonging to them
o Functions as a portal for healthcare
o Promotes better use of pharmaceutical products among
Swedish citizens
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3 C
ASE STUDY
In this chapter we discuss what the establishment of AKC has resulted in, both for Apoteket as an organisation and for their customers. We also highlight legal frameworks that have had an effect on AKC’s business, principally in relation to the National pharmacy register. We identify the virtual organisation for AKC together with involved agents and we outline the present structure of the interactive voice response. We also put forward examples of real mistakes made within Apoteket’s context, and we use these examples to suggest alternative structures that may result in better workflows. The chapter concludes with a discussion of a configurable methodology and a presentation of three central challenges: socio-related, technological and economic.
3.1 Background
The establishment of AKC has brought with it a number of positive effects, both for the overall organisation and for the customers. For the customers, AKC provides an increased accessibility to some of the services offered by Apoteket as well as independence of time and space. Only 10 % of the incoming events* at AKC, have been redirected to the local pharmacies [10] and AKC had up until November 2005 handled 6 280 000 events [11]. This has in turn decreased the workload at the local pharmacies, which has resulted in more time left that could be spent on the customers for e.g. counselling in self-care issues [10]. Furthermore, the traditional paper prescriptions are now to a larger extent being replaced by a new type of information management in the form of electronic prescriptions. Their number is constantly increasing and during the summer of 2005, over 1 million electronic prescriptions were served per month [12]. The underlying idea of these electronic prescriptions, according to Apoteket’s annual report for 2002, is partly to free up resources in order to focus on the right things at the local pharmacies, to
avoid mistakes and to increase the service level towards the customers [13]. According to Apoteket, the fact that an electronic prescription is written directly into the computer and then transmitted to Apoteket’s computer systems, minimises the risks for typing errors and misinterpretations [14].
However, this steering of customer event-flows towards what we would like to call a portal of services shows an important responsibility and commitment from Apoteket’s point of view, e.g. when it comes to maintaining the customer’s confidence in their trade mark. Deliveries and services are supposed to work in the same secure and controlled way as before, despite the fact that customers and personnel at AKC no longer are at the same geographical spot. This can give rise to a number of difficulties like authentication, accountability, traceability, semantic problems in dialogue* with the customer, lack of body language, the possibility of demonstrating various pharmaceutical products like inhalers and so on. Furthermore, the constant stream of incoming calls and the amount of information generated for AKC, should give rise to an increased investment in quality assurance and control. Especially since AKC, like many other call centres, have a vision of having the shortest queue time possible and that each customer event should be handled as quickly as possible. This vision has been translated into a number of goals that state that a customer event should be limited to a certain time period. The time each customer event takes is thus monitored by the system. The given question in this situation is: how far can we automate things without jeopardising the customer’s security and well being? Thus, one should consider whether there should really be a time limit at all for more advanced customer events in an organisation of this kind.
To establish contact with AKC, a customer uses one of the communication channels that are currently connected to AKC, i.e. telephone, e-mail, fax or Apoteket’s homepage. If the customer chooses to establish contact with AKC by telephone, he or she will first be met by an interactive voice response which is a part of the digital information system* at AKC. The interactive voice response is constructed and structured in such a way that the customer must make a number of choices depending on the nature of the event (a mapping of this structure is found in Appendix A). After that, the digital information system forwards the event to a human agent* with the right competence to handle the event. This action is based upon the choice made by the customer. A human agent at AKC can be a pharmacist or a
non-pharmacist, where the pharmacist is the only person allowed to handle and give answers to events concerning prescription pharmaceuticals; the remaining events can be handled by a non-pharmacist. Some of the events can be dealt with automatically and do not require any direct involvement of a human agent, e.g. questions about opening hours. With regard to the incoming event, the digital information system tools and services are used when searching for answers to the customer’s question. A human agent can also ask another human agent for further information to be able to help the customer, or can hand over the event completely to the other agent. The final stage in this workflow is when the answer is communicated to the customer.
3.2 The virtual organisation for AKC
To assure the quality of information- and workflows, we must define what we would like to call the virtual organisation for AKC (cf. Figure 3.1). This is necessary in order to identify those agents* that are needed to perform the different services offered by AKC and also to identify other authorities and agencies which have a governing and controlling function on AKC. By doing this, we can more easily establish which parties are directly or indirectly involved in the workflow and which authority rules the organisation must conform to. Figure 3.1 can be seen as a refined and extended figure of the workplace* depicted in Figure 1.1. It describes the virtual organisation, where the area within the line includes those agents that are directly involved in the earlier described overall workflow at AKC. Outside this line, various governing and controlling authorities and agencies that have an indirect effect on the same workflow can be found. Here, the owner structure around AKC can also be found. The acronyms in Figure 3.1 are explained in the next sections, Section 3.2.1 Agents and Section 3.2.2 Governing and controlling authorities and agencies.
Figure 3.1 The virtual organisation of AKC. 3.2.1 Agents
We have found that the following agents are active within AKC: Customer
Those that use AKC’s services are divided into private customers (individual persons) and contract customers (county councils, municipalities and companies), that buy products and services from Apoteket through different contracts. [15]
Pharmacist
In Sweden, the term ”pharmacist” is a generic term for pharmacists, dispensers and others with a pharmaceutical education [16]. It is also one of three active professional categories at AKC.
Non-Pharmacist
This term describes the remaining two professional categories at AKC, juniors and self-care agents, i.e. persons without a pharmaceutical education.
• Pharmacist
• Non-Pharmacist • Customer
• DIS
Authorities and agencies:
• SDIB • NBHW • MPA • PBB • MRB Owner structure:
• The Swedish Government • Apoteket AB
Digital Information System, DIS
The underlying technical architecture, which supports AKC’s business.
3.2.2 Governing and controlling authorities and agencies
We have found that the following governing and controlling authorities and agencies are indirectly connected to AKC:
The Swedish Data Inspection Board, SDIB
The Swedish Data Inspection Board is a public authority tasked with protecting the individual's privacy in the information society without unnecessarily preventing or complicating the use of new technology [17]. The National Board of Health and Welfare, NBHW
The National Board of Health and Welfare is the Swedish national expert and supervisory authority for social services, public health, infectious diseases prevention and the health services. The Board seeks to ensure that efforts in these areas are of good quality and are distributed according to need. The work must also be cost effective within allocated resources and in accordance with the legislation [18].
The Pharmaceutical Benefits Board, PBB
The Pharmaceutical Benefits Board (PBB) is responsible for determining whether a drug or other items covered by the pharmaceutical benefits scheme is to be subsidised. This means that the PBB replaces the National Social Insurance Board in the task of pricing medicines. The PBB is also in charge of reviewing all current medicinal products and determining whether the product will continue to be listed on the pharmaceutical benefits scheme [19].
The Medical Products Agency, MPA
The Medical Products Agency (MPA) is the Swedish national authority responsible for regulation and supervision of the development, manufacturing and sale of drugs and other medicinal products. Their task is to ensure that both the individual patient and healthcare professionals have access to safe and effective medicinal products and that these are used in a rational and cost-effective manner [20].
The Medical Responsibility Board, MRB
The Medical Responsibility Board (MRB) is a national authority which assesses medical negligence. If healthcare staff is at fault, for example pharmacists, the Board can take disciplinary action against them [21].
3.2.3 Owner structure
The owner structure connected to AKC is as follows: The Corporation of Swedish Pharmacies (Apoteket AB)
Here, we refer to the main organisation of which AKC constitutes as a part.
The Swedish Government
The Swedish Government owns Apoteket AB.
3.3 Legal framework
Apoteket’s service supply is constantly increasing and one of the new services is the National pharmacy register which can be used by the patient/customer, prescribers and pharmacists. The register contains data* of a customer’s total use of pharmaceutical products. This was made possible when a new law (2005:258) concerning a National pharmacy register [22] came into force on the 1st of July 2005. Broadly, this implies that a new personal register is established and it also implies the following (freely translated) [23]:
“The register will contain data of prescribed pharmaceuticals that a particular patient collects from a pharmacy. The purpose of the register, which shall be kept by Apoteket AB, is to collect all information about the patient’s pharmaceuticals, regardless of who prescribed the pharmaceutical or at which health care unit this was done. The data in the registry is supposed to be used by patients, prescribers and pharmacists at pharmacies. The registration of the data itself shall be made without the consent of the patient. However, access to the data in the register is dependent upon the explicit consent of the patient. The law also contains provisions about the content of the register, direct access, search concepts, information, emendation and damages.”
According to 4 § in the Law of the National pharmacy register, this
register may only contain data about (freely translated) [22]:
“1. day of purchase, article, amount, dosage, and 2. the name and personal identity number of the registered”
As of July 1st 2005, these data are thus registered directly in connection
with purchase of prescribed pharmaceuticals. The registration is automatic and without the customer’s consent. Consent is, on the other hand, required when prescribers or pharmacists need access to these data. The national pharmacy register is available for customers at Apoteket’s
homepage and to access this, the customers need to log in and identify themselves using a form of electronic identification. After that, they can access a list of the prescripted pharmaceuticals they have bought during the last 15 months.
Considering the content of the new register, we believe that it must both be regarded and managed with great sensitivity. Therefore, it is important to have a high level of accountability in the systems and to be able to trace who has requested certain data and why. It should also be simple for the customer to check who has made a request like this. The problem and importance of achieving the right balance between security and availability is clearly reflected here. In the event of a dispute concerning wrong treatment caused by handing out misinformation and/or the wrong pharmaceutical products, being able to find the accountable party will be very valuable when the evidence is submitted. Again, Apoteket’s responsibility will be important since the possibility of accountability partly reflects the work on information security within the organisation. In information security, classification of information is also included, i.e. what degree of protection should be assigned to which type of information. Considering the increasing service supply at Apoteket, and having in mind the type of information that is processed and transmitted in the systems on a daily basis (personal data, information about pharmaceutical products, credit report information and so on), an even more important task for Apoteket is to actively pursue the work with classification of information. This work also creates the possibility to survey the total amount of information, the degree of protection it has been assigned and how sensitive it is. The connection with integrity issues becomes evident; what should be protected and in what way? If this is overlooked and an unwanted situation arises, e.g. in the form of personal data leaking out, the confidence and trust that customers have in the trade mark Apoteket could very quickly be damaged. Rebuilding what has been lost in a situation like that would take, if at all possible, a very long time and would require the mobilisation of vast resources.
Furthermore, one can read the following in the government bill from the Swedish government about the establishment of a national pharmaceutical register (freely translated) [23]:
”A good, secure and cost-effective treatment presupposes that the patient and the prescriber in the treatment situation have access to correct information about different
alternatives of treatment, pharmaceutical products, the patient’s recent prescriptions and also other important data concerning the patient.”
Since the government bill declares that prescribers and patients should have access to the correct information, it makes great demands on the party that delivers and supplies this information. The party that delivers the information must therefore constantly and actively work with and have control over the security mechanisms that are involved in this process. These mechanisms include information security, accountability, network security, physical security and so on. This is to, as much as possible, be able to guarantee the quality of the information that is delivered.
In the case we are studying, Apoteket is the information delivery party and the types of security related tasks mentioned above are, according to us, not a part of their core business.
3.4 Present structure of AKC’s interactive voice response
With the above discussion in mind, the challenges are many and they are all in some way related to issues about information. Therefore, one overall challenge will be to assure that information flows and workflows generated within the organisation support the three main tasks mentioned earlier in Chapter 2 Background:
• Mediates products that are available both with and without prescription and information belonging to them
• Functions as a portal for healthcare
• Promotes better use of pharmaceutical products among Swedish citizens
At present, this is a difficult mission since the workflow more or less is constructed and generated in an ad-hoc manner from the interactive voice response that meets a customer when he or she contacts AKC. After studying and outlining the interactive voice response in February 2006 (cf. Figure 3.2 and Appendix A), our field studies indicated that it had a non-dynamic structure in the sense that it is difficult to add new services or options without impairing user-friendliness. Furthermore, the present structure is also divided into two levels for reasons that we are not aware of. This situation calls for a more flexible structure, which in turn can act as a foundation for more flexible models* for the implicit workflows that are connected to the interactive voice response. Because we have studied
something that exists, i.e. the interactive voice response and its present information types, we have also been able to validate our field studies. A validation* means that a hypothesis about a phenomenon (real thing) is found to be true. Our hypothesis is that the implemented voice response system can be modelled in a purposeful way using information types. The validation process consists of two parts:
1. Adequacy. The information type model is adequate for modelling relevant (from our perspective) aspects of the existing system.
2. Modelling power. The information type model is rich enough to allow us to address some shortcomings of the existing system as well as providing a grounded suggestion that may improve the system (assuring service qualities).
Figure 3.2 below outlines the interactive voice response at AKC.
Figure 3.2 Tree-structure for the interactive voice response-based workflow.
As it is today, a number of options are enumerated to the customer and these options are in turn connected to different services offered by AKC. This implies that if AKC wants to extend their number of services then this will affect the number of options enumerated for the customer over
Private customers
Level 1
Make reservations with a health coach or measure your blood pressure
Quit smoking Opening hours
Private customers Level 2 Prices, stock or if your prescription is ready Counselling about pharmaceuticals Prescripted
pharmaceuticals Prescription-free
pharmaceuticals Advice concerning anti-smoking Pharmaceuticals for animals Calling from the
public medical service
Ideas or
complaints Apoteket Plus opening hours Automatic
service
the phone; either in the form of a new option in the interactive voice response or in the form of a new telephone number which in turn will have its own interactive voice response. This in turn will result in an expansion of the tree-structure, which then will continue to grow; either with a new branch or with a new leaf on an existing branch. The interactive voice response will thus become more complex. This is something one wants to avoid, since it will in the end have an effect on how many services that can be added to the supply presented in the interactive voice response; too many options are impossible to handle for the customer. This may also have a disturbing affect on the organisation’s overall workflow, since we believe that increased complexity will lead to a greater likelihood of a customer choosing a wrong option and that human agents more often need to redirect events or re-categorize them.
3.5 Analysis of error reports
Some examples of real mistakes that can be related to issues of information and which also demonstrate its complexity, can be found in error reports about mistakes made in Apoteket’s context; reports collected from The National Board of Health and Welfare (cf. Appendix E). Evident examples of insufficient information quality are found in this report. The reported mistakes were made by educated and trained personnel like pharmacists, dispensers, and prescribers. The report reveals serious incidents between year 2002 and 2006 from which we have chosen a few examples (freely translated):
• Misinterpretation of dosage instructions from FASS2
• Incorrect dosage was prescribed on the pharmaceutical label, which led to the dispensing of a higher dose than recommended • Incorrect dosage in the prescription and also on the
pharmaceutical label; 20 dosages three times a day instead of 20 ml three times a day
• Delivery of print-outs of two e-prescriptions at a pharmacy to a patient, of which one of the prescriptions was intended for a person other than the patient. Afterwards, both prescriptions were served at another pharmacy in the patient’s name
• Serving of the wrong e-prescription because of inverted numbers in the patient’s personal identity number
2 FASS is a reference book with detailed information about pharmaceuticals for sale in
Sweden. FASS comes in three versions; one for hospital staff, one for the public and one for veterinarians. FASS can also be found on the Net [25].
• Serving of e-prescription where the doctor had stated the wrong information about the patient (was logged on to another patient’s medical journal)
• Wrong information in Apoteket’s article register caused by serving a pharmaceutical with the wrong concentration, which was prescribed as an e-prescription
• Registration error led to purgative (Cilaxoral) being served instead of prescribed eye drops (Ciloxan)
• Mix-up of tetanus vaccine (for veterinary use instead of human use)
• Mix-up of prescriptions. Daughter served with Fluoxetin 20 mg x 1 (antidepressant), meant for her mother. The eight year old daughter took the pharmaceutical for six days.
Some of the examples listed above can be directly connected to the human factor and then principally in connection with misinterpretations; others are a result of the wrong representation in the digital information system. In the list above we also find cases that are entirely caused by mix ups of pharmaceuticals as physical products. We have not mentioned the latter aspect before, since AKC does not handle physical products in the same ways as the local pharmacies do, where the pharmaceuticals actually are distributed to the customers. A possible explanation for these mix-ups can be found in the similarity between boxes and containers of some pharmaceuticals. Sometimes there are similar boxes for different pharmaceuticals and sometimes it is difficult to distinguish their concentrations (e.g. 5 mg or 1 mg) for the same reason; especially if there are other stress factors involved [24].
Returning to the discussion about information quality in Section 3.3 Legal
framework, we clearly see the consequences of an unsatisfactory
framework. In a business concerned with people’s health, there can be serious effects caused by the lack of assured information flows. This should not be acceptable within this sector. As shown in the examples listed above, it is not merely the lack of information quality that is the cause of these scenarios; with the human factor always present, there will always be human mistakes which we cannot foresee.
These real examples demonstrate what can occur when information is wrongly interpreted or misunderstood. The examples given above are obtained from local pharmacies, but they could just as well occur at AKC since the overall work procedure is the same (they use the same digital
information system, they are governed by the same rules and regulations etc.), with the exception that AKC does not physically handle pharmaceutical products. The outcome of mistakes like these shows the importance of constantly pursuing the work of assuring information quality. The error reports describe examples of serious error types, and a set of principles is needed to deal with them in the future. From the perspective of our view of information described in Chapter 5 Theoretical
aspects of information and communication, we discuss issues related to these
error types in Chapter 7 Our approach and Chapter 8 Models of validation and
conclusions.
To sum up, the actual workflow at AKC is activated when a customer uses the interactive voice response which thus has a great influence on the rest of the workflow. This mechanism may at first seem rather insignificant when discussing information quality, but once again we want to call attention to the fact that the interactive voice response actually initiates and activates AKC’s business processes. After studying and mapping the structure of this interactive voice response, we found that it is very inflexible and presents too many options to choose from and that this is true for private customers as well as for professional customers (these two categories have separate telephone numbers when contacting AKC). This structure makes it difficult to expand the service supply without affecting the overall number of choices towards the customers. What we want to achieve, is an underlying structure that is dynamic and flexible with the possibility to easily add or remove services. We believe that this is important, since we have noticed that the structure in the interactive voice response is also mirrored in the structure of the underlying event handling system. Considering that AKC will probably offer a number of new services in the near future, there is a risk that the tree-structure in the interactive voice response will grow accordingly. The same will happen with the event handling system, i.e. the number of event categories will increase and the system will be more complex and difficult to work with. If the interactive voice response system presents too many options to the customer to choose from, the chance that the customer selects the wrong alternative will increase. This may lead to. a human agent re-categorising the incoming event, and this will, in turn, slow down the overall workflow or channel the event to a human agent with the wrong competence and so on. This also has to do with common ground; if the right alternative is chosen in the interactive voice response from the beginning, the interactive voice response can give the right input to the dialogue and facilitate the building of a common ground.
3.6 Towards a configurable methodology
The challenges mentioned above include people, information and technology in some way, i.e. they concern socio-economic-technical systems. Thus, Figure 1.1 will once again be useful in explaining what we mean with quality assurance of information flows and workflows at AKC. The figure also points out that an overall picture is needed to observe relevant scientific methodology* areas and that one single method or one single approach is not enough. The figure describes when suitable methods and approaches are relevant and that all of them may not always be used together; they are used when they are needed. By this, we can also achieve a more sustainable methodology.
Figure 3.3 Critical points in a workflow
As shown in the Figure 3.3, workflows constitute a part of a socio-economic-technical system. These workflows are in turn built upon a number of interconnected tasks which are performed either by humans (in this case called human agents) or machines. When one task is executed, a transition to the following task occurs and in most cases the result from one task is used as input to the next task in the workflow. The dotted circles in Figure 3.3 mark these transitions and according to us
CommonKADS Support-system requirements High-level requirements Support Ethnographical aspects Infosense aspects Service Oriented Architecture Information Ecologies
Service Level Agreement Service bundle Other aspects Workplace Workflows Customers Customers
