Janos J Sarbo

Jessica H Yang
email: j.h.yang@henley.ac.uk

Vitalizing Semiotics

Keywords: Semiotics, Sign aspects, Process model, Accounting narratives

The goal of organizational semiotics is to enable a better understanding of organizations by means of an analysis of documents, texts and communications as signs. Its theory is based on Peirce's sign concept, the relation of the sign with itself, with its object, and interpretant. In our view, this restricted use of semiotics may explain some of the limitations of organizational semiotics in practice. A shift of focus from signs as a relation to sign aspects involved in signs may enable a more practical model of interpretation, including organizations as interpreting systems. This is illustrated with an application of semiotics to accounting narratives.

Introduction

An oft-cited example of a paradigmatic shift is the planetary system by Copernicus and Kepler. If we ask which one of the two views, Earth-or Sun-centered is more practical, our answer must be that does not matter. In current technology both can be computed efficiently. Why, then, that we may find Kepler's elliptic system more attractive? It is because his model enables a 'natural' representation of the properties of planetary motion such as revolution time and distance. Tycho Brache's system of cycloids does not have that potential. Organization phenomena ask for natural modeling, analogously. As organizations are human and are subject to our perception, their models must be understandable. An approach complying with this condition is introduced by organizational semiotics [START_REF] Stamper | Information in business and administrative systems[END_REF], which considers organizations to be (sign) interpreting systems. In sign interpretation, the (potential) sign 1 , e.g., a text document, is establishing a relation with itself, with its object, and interpretant. We call this a sign-relation. Although this relational view may enable to reveal the constituents of an interpreted sign 2 , the practical use of this approach is limited, as it may not be able to explain how sign-relations arise, what process is involved.

According to [START_REF] Gazendam | Organizational Semiotics: a state of the art report[END_REF], organizational semiotics can also make use of the more refined concept of a sign type, e.g., for the analysis of media. Although we were not able to find publications of this kind of an analysis, we suggest that a sign-typical interpretation of phenomena, including organizations, may not be beneficial in practice either. It too is unable to give an account of the process involved in interpretation.

Through analyzing his concept of a sign, Peirce introduced sign aspects [START_REF] Peirce | Collected papers by Charles Sanders Peirce[END_REF]. Accordingly, signs can be defined by a relation of sign aspects involved in the relations of the (potential) sign with itself, with its object, and interpretant. Peirce called this a sign type. Bense [START_REF] Bense | Das System der Theoretischen Semiotik[END_REF] has shown that the Peircean sign aspects can be arranged in a hierarchy. Unfortunately, although all processes involve a partial ordering hence a hierarchy, a hierarchy is not a process.

Information processing is a process, trivially. However, contrary to signs, that are meaningful, information processing is computational (and meaningful from that perspective only). We suggest that this apparent contradiction between meaningful interpretation on the one hand, and computational information processing on the other, can be resolved by introducing a cognitively based model of human processing. Through mapping the events of this model to sign aspects, the involved computational process can be embedded in Peircean semiotics.

In business modeling there is little research which provides insight into how corporate narratives are actually interpreted apart from which signs are used. Corporate narratives in annual reports, press releases, and conference calls offer organizations the opportunity to communicate business messages with shareholders, analysts and media and to engage them in corporate narratives in a persuasive and compelling way. Top management collects stories from their everyday organizational life, and restructure and incorporate them into corporate reports. Stakeholders read these reports to decipher a deeper understanding of organizational life.

Top management views narratives as a powerful managerial tool to make sense of their decisions [START_REF] Weick | Sensemaking in organizations[END_REF] whilst stakeholders convince themselves of organizational decisions through narratives [START_REF] Gabriel | Storytelling in Organizations: Facts, Fictions, and Fantasies[END_REF]. From the perspective of organizations, corporate report is an effective management process, which transfers organizational ideology to society [START_REF] Boje | The storytelling organization: A study of story performance in an officesupply firm[END_REF][START_REF] Boyce | Organizational story and storytelling: a critical review[END_REF]. If their stories are logically sound, stakeholders will be more easily persuaded and convinced. Everything established through reasons is in the realm of logos and it covers not just deductive reasoning but also inductive and abductive reasoning.

The persuasion process reflects whether audiences are able to read, comprehend and make judgment based on their understanding and interpretation of the narratives. The validity and plausibility of argumentation is key to appeal to audience's logos, which can be analyzed through the aspects of three types of reasoning: deductive being always plausible; inductive being probably plausible; and abductive being hypothetically plausible. As a result, the plausibility of arguments in the text can be identified, which influences the decision-making and sense-making process.

Process Model

A cognitively based model of human processing has been introduced in [START_REF] Sarbo | Knowledge in Formation: A Computational Theory of Interpretation[END_REF], amongst others. Below we restrict ourselves to an overview of the basic ideas (Fig. 1). The condition for human interpretation is an interaction between a stimulus or effect (q1), on the one hand, and the brain or interpreting system occurring in some state (q2), on the other. Interpretation makes use of memory or context information (C). The collection of uninterpreted qualities, [q1 q2 C], is the input for information processing. The goal of interpretation, as a process, is to establish a relation between q1 and q2, in the context of C. The above input representations can be assigned a Peircean sign aspect: [q1], representing the state as a constituent, the sign aspect icon; [q2], expressing the effect as a single occurrence, the sign aspect sinsign; [C], pointing to background information corresponding to q1 and q2, the sign aspect index. The abstract concept q1, standing for the state, as a possible for any effect, can be assigned the sign aspect rheme; q2, representing the habitual rule involved in the input effect, the sign aspect legisign. Finally, (q1, C), the possible state in context, or the subject of the interaction can be assigned the sign aspect dicent; (q2, C), the rule-like effect in context, or the predicate of the interaction, the sign aspect symbol; and the relation between subject and predicate, representing the input by a proposition which is a premise, the sign aspect argument.

Fig. 1. Process model (left), Peircean sign aspects (middle) and their mundane terms (right).

There is an isomorphic relation between the process model and the hierarchy of sign aspects. For instance, [q1] can be mapped to the sign aspect icon, and in turn, the term likeness

The events of the process model can be assigned an aspect of 'naive' reasoning 3 . An example is the interaction event between q1 and [C]. The state, interpreted as a qualitative possibility (for an effect) is completed by an effect. As information about the effect is fetched from C, this interaction event has the aspect of deduction. Analogously, the event, in which, q2, expressing the input as a habitual effect, is tested for a state represented by C, has the aspect of induction. The interaction between q1, as an actual event or existent (cf. subject), and q2, as a conventional effect (cf. predicate), represented by a proposition which is hypothesis, has the aspect of abduction. The existence of the aspects of the three types of reasoning is an expression of the completeness of the process model, from the perspective of 'naive' reasoning.

Semiotic Analysis: a Case Study

In this section we offer a semiotic analysis to a sample text in three ways: from a signrelational, a sign-typical and a sign-aspectual perspective, and compare the results. The text in question in Fig. 2 is a paragraph extracted from [10].

(s1) Over the next three years we (S) will be making significant investment (P) in the infrastructure we need to make the customer experience fair, responsible, easy and personal for all our customers -whether face-to-face, by telephone or online. (s2) The opportunities (S), both for our customers and our business, are outstanding (P); but (s3) our growth strategy (S) will always be driven by (P) the desire to put the customer first in all things. (s4) We (S) intend to grow (P) at a pace and in a way that guarantees our customers an uninterrupted, seamless service. Fig. 2. A sample paragraph. Sentences are labelled by bold face symbols. For later analysis, syntactic subjects and predicates are marked by an (S) and (P) symbol, respectively

Sign-relational Analysis

For our text (sign), in Fig. 2, we are in search for an object and interpretant. By definition, the object of the sign is what it is standing for and replacing. Arguably, this is "the chairman's intention to provide increasingly better customer services in the coming three years". The interpretant of the sign is the meaning mediated by the sign, in the agent's interpretation. There may be different interpretants (and interpretations), depending on the agent's knowledge (cf. context), his/her mood, emotions, etc. By assuming an optimistic agent, the interpretant could be: "The hypothesis that through significant investment the customers will be more satisfied in the future, can be true". The concepts, (potential) sign, object, and interpretant, follow from a categorical analysis of Peirce's notion of a sign. As part of the interpretation process, the (potential) sign determines an interpretant, and eventually, an object. Determination is always in this order, by virtue of the condition that interpretation is by an agent, as an interpreting system.

We conclude that a sign-relational analysis may enable a systematic approach to phenomena, including organizations. Inevitably, this is an important result by organizational semiotics, as opposed to the traditional approach by Artificial Intelligence, for example, enabling ad-hoc representations, typically. However, the potential to reveal the nature of the constituents involved in a sign-relation and the conditions of their process of determination is beyond the possibilities of this paradigm. Practical models of (meaningful) interpretation ask for a more refined concept of a sign, which is the subject of the next section.

Sign-typical Analysis

The Peircean sign aspects can be arranged in three up-right diagonals (cf. Fig. 1). In a right-to-left order, these diagonals are an expression of the sign aspects involved in the sign's relation with itself, with its object, and interpretant. (Interpreted) signs can be characterized by a relation of sign aspects taken from each one of the three diagonals. Such a relation is called a sign type 4 . An example is a dicentic indexical legisign. The relation of the sign with itself, or simply the sign in itself, has the sign aspect legisign. This is when the sign is perceived is as a rule. For instance, the perception of (the quality of) falling, during walking. The quality of falling is not perceived simply as a quality (cf. qualisign sign aspect), nor only as a quality occurring now (cf. sinsign sign aspect). We habitually know what we have to do and 'generate' motor reactions necessary for the next step in a rule-like fashion. The relation of the sign with its object is indexical. This is when the sign is not directly representing the object, except by telling where we may find information about it. The sign functions as a pointer. Finally, the relation of the sign with its interpretant is dicentical. This is when the agent is interpreting the sign as a statement, like an expression of an interaction as a (f) actual existence.

We suggest that the text, in Fig. 2, is an instance of the sign type explained above. Let us begin with the sign aspect of the text in itself. The phrases, such as making significant investment and outstanding opportunities, are an expression of an abstract, habitual activity or event (cf. legisign sign aspect). These phrases are more than an expression of temporal information characterizing single events (cf. sinsign sign aspect), or that of an appearing, yet uninterpreted quality (cf. qualisign sign aspect).

The relation of the text (sign) with its object is indexical. This is witnessed by the phrases such as opportunities and growth strategy, pointing at a set of possibilities without explicitly listing them (over the next three years is an indexical expression of temporal information). The readers -if interested -are invited to look into the list by themselves.

The relation of the text (sign) with its interpretant is dicentical. The phrases, desire to ... and intend to ..., amongst others, are statements of a future act, including its modality. There is no intention for these expressions to be used as an argument, e.g., a premise in a subsequent logical reasoning.

From a categorical stance, sign aspects amount to sub-classes of the constituents involved in a sign-relation. This way of sub-classification can be done recursively, which may explain why sign-types are 'maximal' from an informational stance. A sign-typical analysis of a sign can be complex, it may need proficiency. We are not aware of the existence of a systematic approach. Sign types themselves do not answer the question: how from (formal) relations between text-phrases, meaningful interpretation may arise. From this, we conclude that sign-typical analysis may not be practical for the goals of organizational semiotics either.

Sign-aspectual Analysis

Sign-relations are more than a collection of relations involved in the sign. According to Peirce, the sign is in an irreducible relation with its object, and interpretant, or in mundane terms, there is a qualitative change involved in the sign. As we are interested in a semiotically inspired model of signs which suits a computational interpretation as well (cf. a process), we must realize that sign-relations and sign-types are beyond our reach. This holds for sign aspects too. They can be interpreted as signs that are inthe-making, which understanding complies with Peirce's theory of interpretants 5 .

We assume that, by virtue of their dependency, more complex sign aspects can be perceived through sign aspects that are simpler. For instance, an interpretation of a dicentic relation of the sign with its interpretant may arise 'bottom-up', from a rheumatic interpretation of the same relation, and an indexical interpretation of the relation of the sign with its object.

Although sign aspects are unfinished signs hence qualitatively more complex than mathematical relations, through focusing on the process involved in their interpretation we may get insight in its events, as dyadic relations. It is like making a cake using its receipt, but not having the possibility to taste the ingredients nor the cake itself. This restricted view on signs may not be useless nevertheless. Through formally analyzing their receipt we may be able to derive (formal) properties of meaningful interpretation and check their (formal) correctness. An example, in syntactic language processing, checking meaningfulness from a syntactic perspective, is testing whether a text complies with the SV(O) rule, in English.

Below we offer a sign-aspectual analysis to our running text. We assume that a syntactic analysis of the input sentences into subjects and predicates is already available. See Fig. 3. Modifiers are marked as context information (this is not indicated in this diagram). Our analysis is restricted to a 'naive' reasoning interpretation of the sample text. To this end, a pair of subsequent sentences are interpreted as a state and an effect that are in an interaction. Sentences, represented as a proposition, A 'IS' B (where A is short for (q1, C), B for (q2, C), and 'IS' is used as a linking term) are stored in memory as relations, (A,B). Information processing is sentence-wise. We assume that, in 'naive' reasoning processing, constituents of a relation are fetched from memory and represented as a state (A) or an effect (B) which is in focus, or as a state (~A) and an effect (~B) which is complementary. 6For completeness' sake we mention that our model enables three kinds of an analysis. The first one, 'summarization', merges a pair of sentences into a single sentence. Arising sentences are interpreted as a sign. As for a 'naive' reasoning analysis, summarization enables information involved in a conclusion to be represented explicitly. The second one, sequential processing, is a 'degenerate' version of the first one. Arising expressions, including conclusions, are represented by a sign aspect, e.g., a qualisign. Language processing is an example of this way of interpretation. The third one, considers input sentences to be qualities of a single phenomenon. Conclusions are not explicitly represented.

An analysis of our text, following the second approach above, is depicted in the diagrams Fig. 4 -Fig. 6. Interactions between sentences are referred to by their labels, e.g., (s1,2)-(s2) designates an interaction between (s1,2), the result of an analysis of (s1)-(s2), and (s3). That the conclusions of 'naive' inferences are not represented as a sign complies with actual language use, according to which, the reader is assumed to be able to draw conclusions by himself.

How in sentence processing, memory relations, (A, B), are represented by our model can be derived from a syllogistic interpretation of the sentence interactions. This is illustrated by Fig. 4. In this and later diagrams we can make use of the free order of premises enabled by Aristotelian syllogistic.

Fig. 4. A syllogistic interpretation of sentence interactions (left) and corresponding

Aristotelian figures (right). In this diagram, quantification is omitted. We assume that in an inference (left) the two expressions of the common term (in italics) can be unified

The analysis, depicted in Fig. 5, reveals that (s1)-(s2) has the aspect of deduction. There is an increase of information in the relation between q1 and C only. We learn that investment is also known as opportunity. All other events (relations) represent information already available in the premises. The process, displayed in Fig. 6, shows that (s1,2)-(s3) has the aspect of induction. There is an increase of information in the relation between C and q2 only. We inductively learn that the growth can be a measure of the effect put customers first. The analysis, in Fig. 7, illustrates that (s1,2,3)-s(4) has the aspect of abduction. There is an increase of information in the relation between (q1,C) and (q2,C) only. We learn that we can be the subject, and intend to invest … the predicate of a hypothetical proposition of the input interaction.

In Fig. 5 -Fig. 7, because of their less important meaning, the positions [q1] and [q2] are left unspecified. The position [C] is used for a representation of 'common terms', separated by a comma symbol. Temporal information involved in predicates, and the aspect of negation involved in the coordinator symbol 'but', are omitted. Events involving an increase of information are designated by a horizontal line. Fig. 5. A 'naive' reasoning analysis of (s1)-(s2). The final representation can be paraphrased as 'we have outstanding investment opportunities' Fig. 6. A 'naive' reasoning analysis of (s1,2)-(s3). The final representation can be paraphrased as 'through our investment (opportunities) customers will increasingly be put first' Fig. 7. A 'naive' reasoning analysis of (s1,2,3)-(s4) Fig. 8. Analysis of the entire text, in Fig. 2, as a single phenomenon. The position [C] is used for an expression of complementary information. We assume the existence of lexical information: desire~intention, investment~opportunity

We selected our running text in a random fashion, although under the condition that its content is clear and meaningful to us as a reader. Our analysis shows that meaningfulness of our text (from a naive reasoning perspective) can be a consequence of the aspects of deduction, induction and abduction that are involved. This illustrates what we may learn by making use our process model and sign-aspectual approach.

The processes depicted in Fig. 5 -Fig. 7 can be combined into a single process, through considering the text to be a single phenomenon (cf. sentence), and the constituent sentences to be qualities (cf. words). The result of this, third type of an analysis, is displayed in Fig. 8.

Towards a Measure of Plausibility

Interpretation may terminate hence exist as a process, only if a propositional representation of the input is obtained. From this it follows that interpretation processes must involve all three types of 'naive' reasoning aspects. Note that representation of a reasoning aspect can be omitted, e.g., in the case of an incomplete sentence. More interesting is the case in which a reasoning aspect is represented repeatedly. This is when a text, consisting in a number of sentences, can be analyzed in a single instance of the process model. How is this related to plausibility? Fig. 4 illustrates the three figures of syllogistic. According to Aristotle, inferences of the form of Fig. 1 are naturally truthful; those of Fig. 3 and Fig. 2 (in this order) are increasingly less plausible. This feature of syllogistic is respected by our theory as well. We assume that our model is capable of processing inputs (cf. premises) that conform to Fig. 1. Inputs corresponding to the other two figures need to be transformed into Fig. 1, through a conversion of the minor premise, in the case of Fig. 3, and that of the major premise in the case of Fig. 2.

According to Peirce, in a syllogism, the major premise stands for information that we already know, the minor premise must be an account of an observation. The representation of known information, such as habitual or rule-like knowledge, can be extensive. This means that conversion of the major premise can be difficult (it boils down to the definition of an inverse relation). This is opposed to conversion of the minor premise, which can be simple (e.g., a paraphrasing of a relation from active to passive). We assume that the complexity of the transformation required is negatively proportional to the truth perception or plausibility of an inference (cf. sentence interaction). Roughly, the more it takes to interpret, the less its plausibility will be. A consequence of the different transformations is an increase of information in different events of the process and a difference in the degree of plausibility of those events.

The relation between the truth of the syllogistic figures and the reasoning aspect of the events of our process model, depicted in Fig. 4, allows the definition of a measure of plausibility. Events expressive of the aspect of deduction can be assigned a high value of plausibility, those of the aspect of induction and abduction an increasingly lower value. Plausibility can be represented by a sum of those values. In a simpler approach, the input text is analyzed into relations that correspond to the structure of the three syllogistic figures. An experimental validation of the proposed measure of plausibility is on our current agenda.

Conclusion

Organizational semiotics recognizes the importance of sign theory and applies semiotics to real problems (this is an important element behind the successful research, e.g., at the University of Reading, UK). However its reach is limited by virtue of the restricted use of semiotic theory. We suggest that a process interpretation of the Peircea hierarchy of sign aspects may open new perspectives. We reinforce our hypothesis with an analysis of an extended example.

The potential of the proposed model for organizational semiotics, in particular, for an analysis of business documents, is discussed. This model is oriented toward the processes involved in the texts interpreted as signs. We conclude that organizational semiotics could benefit from a shift of focus from signs as a relation to the sign aspects involved in signs.

In future research, there would be value in designing an experiment to investigate whether sign aspects affect plausibility and understandability. It contributes to business research by introducing a formal textual analysis approach and bringing corporate narrative research to pragmatic level.

As the used concept of a sign involves interpretation, the terms, sign, interpreted, or meaningful sign, are synonymous.

[START_REF] Gazendam | Organizational Semiotics: a state of the art report[END_REF] Signs, offered for interpretation, are called a potential sign.

The term 'naive' is used as a synonym for 'inborn'.

Not all combinations of sign aspects may define a sign type[START_REF] Peirce | Collected papers by Charles Sanders Peirce[END_REF]. A treatment of this part of Peircean theory lies outside of this paper.

This important result is an achievement by A.J.J. van Breemen[START_REF] Sarbo | Knowledge in Formation: A Computational Theory of Interpretation[END_REF].

This enables a proposition to be reversed. In language, this is known as passivation.


Aimee Jacobs
email: aimee.jacobs@indstate.edu

Yu-Chun Pan

Sanaa Askool
email: saskool@dah.edu.sa

An Organisational Semiotics Perspective to Co-Design of Technology Enhanced Learning

Keywords: Technology Enhanced Learning, Co-Design, Organisational Semiotics, Learning Design, Learning and Teaching, Information Systems

While Co-Design approaches have been used in designing technology enhanced learning (TEL) by different scholars, research is needed to understand the relationships between technologies, design and practice. This paper presents organisational semiotics (OS) as an approach for Co-Design of Technology Enhanced Learning. This perspective will provide an insight into the Co-Design of technology and learning in higher education.

Introduction

There has been a growing interest and demand in utilising technologies in an educational context to enhance learning and teaching practices [START_REF] Selwyn | The use of computer technology in university teaching and learning: a critical perspective[END_REF]. Such practices are often called Technology Enhanced Learning (TEL). Some studies have shown that the use of TEL technologies has a positive impact on learning engagement and outcomes [START_REF] Shieh | The impact of Technology-Enabled Active Learning (TEAL) implementation on student learning and teachers' teaching in a high school context[END_REF][START_REF] Shieh | Technology enabled active learning (TEAL) in introductory physics: impact on genders and achievement levels[END_REF]. However, previous research suggests that there is a disconnection between technologies, research, design and practice [START_REF] Hannafin | Design-based research and technology-enhanced learning environments[END_REF][START_REF] Keppell | Assuring best practice in technology-enhanced learning environments[END_REF], and therefore the full potential of IT/IS is not fully utilised [START_REF] Manca | Is it a tool suitable for learning? A critical review of the literature on Facebook as a technology-enhanced learning environment[END_REF].Some researchers also argue that the use of technologies does not guarantee the enhancement of learning outcomes [START_REF] Fewkesa | Facebook: Learning tool or distraction?[END_REF].

The misalignment of IS and business requirements has resulted in a Co-Design approach. In educational context, this misalignment represents the gap between learning and teaching practices and supporting technological systems. Therefore, designing a TEL application needs to address different challenges ranging from learning theory to software engineering, which can be a key challenge for developers.

The main contribution of this paper is the organisational semiotics (OS) analysis for TEL Co-Design focusing on both technical and social aspects. The article meets this aim by discussing the current research environment for TEL and Co-Design along with the challenges, and proposes OS as a well-suited solution for Co-Design of TEL.

Context and Motivation

Technology Enhanced Learning

Despite the popularity, there is no universally agreed definition of what TEL means. TEL emphasises on the learning experience of learners and the teaching experience of staff [START_REF]University of the West of England: Technology Enhanced Learning Strategy and Implementation Plan 2012-2017[END_REF]. Whilst different parties have different definitions of TEL [START_REF]HEFCE: Enhancing learning and teaching through the use of technology: a revised approach to HEFCE's strategy for e-learning[END_REF][START_REF] Walker | Survey of Technology Enhanced Learning for higher education in the UK[END_REF], the various definitions all address the use and effect of technology in an educational environment. Therefore, this paper adapts other researchers' views and defines TEL as "the use and effect of any kind of IT applications in learning and teaching environment". TEL has been increasingly adopted in educational organisations ranging from primary schools to higher education. Many researchers [START_REF]HEFCE: Enhancing learning and teaching through the use of technology: a revised approach to HEFCE's strategy for e-learning[END_REF][START_REF] Quentin-Baxter | A model for evidencing the benefits of technology enhanced learning in higher education in the UK[END_REF][START_REF] Keller | Learner motivation and e-learning design: A multinationally validated process[END_REF][START_REF] Law | Learning motivation in e-learning facilitated computer programming courses[END_REF] identify the drivers and benefits of TEL, including inclusion and diversity, stakeholder engagement, personal development, performance improvement, and innovation. It is important to consider the drivers and benefits which play a crucial role in the development and deployment of TEL applications.

Co-Design and Technology Enhanced Learning

The development of TEL applications has continuously attracted plenty of initiatives. The motivations behind this development include improvement of learning and teaching quality, fulfilment of learner expectations, and improvement of administrative processes [START_REF] Walker | Survey of Technology Enhanced Learning for higher education in the UK[END_REF]. Co-Design is one of the most popular participatory development methods that actively involves users for IS development [START_REF] Steen | Human-centered design as a fragile encounter[END_REF][START_REF] Sanders | Co-creation and the new landscapes of design[END_REF]. Co-Design has been used for the collaborative nature of designing activities that tackles the development of IS which includes the change of business requirements. Yet, existing requirements for IS development cannot be considered for Co-Design [START_REF] Liu | Co-Design of Business and IT Systems -Introduction by Guest Editors[END_REF], as they do not consider the changing nature of requirements. Moreover, Co-Design research has been criticised by different scholars [START_REF] Tollmar | Towards CSCW design in the Scandinavian tradition[END_REF]. First, it is considered as "expensive" in the design process as it needs numerous meetings and discussions. Second, it is complex to deploy due to its lack of formalisation. Moreover, it focuses on the early design stage and puts few efforts on the later stages.

Current Learning theories support the importance of the social aspects in an organisational domain, however, Siemens [START_REF] Siemens | Connectivism: A learning theory for the digital age[END_REF] suggests that these theories lack the ability to capture the cognitive operations that are now performed by technology such as information storage and retrieval that were previously performed by learners. This indicates the disconnection between learning and teaching practice and supporting technological systems. Educational organisations should emphasise the quality of the technology use and the way it supports achieving learning objectives, rather than only use of technology [START_REF] Marshall | Change, Technology and Higher Education: Are Universities Capable of Organisational Change[END_REF].

Based on these challenges, OS methods could improve the understanding of the requirements for TEL design. Additionally, OS provides a framework to bridge the gap left by current learning theories and the social aspects of technology. The following section introduces OS and the OS methodologies used as a framework.

Theoretical Background: Organisational Semiotics

OS is the study of organisations using concepts of semiotics [START_REF] Liu | Semiotics in Information System Engineering[END_REF]. OS is positioned to meet the needs of both the technical and social aspects in an organisational domain [START_REF] Liu | Virtual, Distributed and Flexible Organisations[END_REF]. These aspects make it well suited to meet the needs lacking in current design and theories for TEL. OS is first introduced by Stamper [START_REF] Stamper | Information in Business and Administrative Systems[END_REF] based on Peirce [START_REF] Peirce | Collected papers of Charles Sanders Peirce: Pragmaticisms and pragnoaticism and scientific metaphysics[END_REF]'s work on semiotics. Signs are formulated through a sign mediation process known as semiosis [START_REF] Nauta | The Meaning of Information[END_REF]. OS has been applied in various domains, e.g. IS design [START_REF] Stamper | Understanding the roles of signs and norms in organizations-a semiotic approach to information systems design[END_REF], knowledge management [START_REF] Pan | Three Dimensional Norm-Based Knowledge Management for Knowledge Intensive Business Service Organizations: An Organizational Semiotics Perspective[END_REF], and social media readiness assessment [START_REF] Jacobs | Assessing Organisational Readiness for Enterprise Social Media in Information Intensive Organisations[END_REF].

The OS perspective, which concentrates on the relations between the IT system, and organisation, offers a range of methods to analyse and design organisations [START_REF] Liu | Semiotics in Information System Engineering[END_REF]. The OS framework, also known as the semiotic ladder, supports the view of inseparability of technical and social aspects of an organisation (or an information system) through the use of the six branches of semiotics diagnosis [START_REF] Liu | Semiotics in Information System Engineering[END_REF]. This framework aids in classifying signs within the multi-layers of an organisation from the two views of human information functions and IT platform. The OS framework allows an investigation into the human as well as the technological aspects of TEL, as many researchers [START_REF] Siemens | Connectivism: A learning theory for the digital age[END_REF] [28] suggest it is necessary to capture the learning process as well as the social and contextual factors and the value of what is being learned through technology. The following section provides the OS analysis for TEL Co-Design.

Organisational Semiotic Perspective to TEL Co-Design

The current TEL design approach focuses on how to create technologies to support learning and teaching environment. As previously discussed, there are two major issues in this approach. Firstly, technologies and human behaviours have the capabilities to influence and shape each other. Secondly, whilst Co-Design method has been applied to TEL application development, the current level and scope of user involvement might not necessarily be sufficient, as there are more participants than teachers and learners. This research addresses these two issues by applying OS to further analyse the activities in educational environment where technologies are used.

Learning System and Technical System in TEL Environment

In order to fully understand the relationship between human agents and technologies in TEL environment, this paper establishes the definitions of informal and formal learning system and technical system. Informal and formal learning systems refer to the culture, structure, process, people and information in learning and teaching environment. It includes all the human activities, controlled by either formal or informal norms, performed by participants in order to achieve the learning objectives. On the other hand, technical system refers to the IS that supports and enhances the operations of learning systems. As shown in Fig. 1, technical system is part of informal and formal learning system. Human participants utilise the data and information stored and processed in the technical system in order to perform in learning system. Through the lens of OS, the environment can be considered as a meta-system including all the six layers of the semiotic ladder. The OS analysis of the TEL environment can be categorised into six distinctive layers (Fig. 2). The analysis of the learning system and technical system identified the requirements for TEL in the human information functions and the IT platform respectively. This analysis of TEL may provide the foundation for TEL Co-Design.

Social World: Wider access to education, inclusion and diversity, stakeholder expectation, learner employability, government requirements… Human Information Functions (Informal and Formal Learning System) Pragmatics: Motivated autonomous learning, engaging learners, improving learning outcomes, enabling learners to learn, facilitating virtual group discussion… Semantics: Requirements for progression, course description, learning objectives, ability to communicate with others… The IT Platform (Technical System) Syntactics: Learning progression procedure, assignment submission guidance, semester schedule, teaching materials… Empirics: Website, learning platform, portal, internet connectivity, connection speed and liability, archives, network of devices, structured data… Physical World: PC, laptop, mobile phone, tablet, server, cables, database…

Discussion and Conclusion

TEL changes how learning and teaching processes can be managed and delivered. However, the use of IT/IS to enhance learning can lead to some challenges in the communication and interaction process between students and instructors. Moreover, Informal learning system: social interaction, inclusion, diversity, stakeholder engagement... Formal learning system: process, learning procedure, policies... Technical system: TEL applications using technology to enhance learning creates a lack of ownership of design, because participants with diverse responsibilities and tasks influence the common paradigm in the classroom. This could be due to a lack of requirements engineering methods that could reflect negatively on the system's analysis and design.

The use of technology and its effects in the educational context has prompted significant interest in the development of TEL applications. However, there is a gap between learning system (learning and teaching practice) and technical system (TEL applications), as many TEL developments fail to recognise learning system and technical system as one integral unit. Co-Design approach has also been deployed in the development of TEL applications. However, Co-Design itself presents challenges, as it is expensive and lacks formality for users to follow. Considering these challenges, OS can be considered a suitable perspective to investigate the TEL environment and its application development because it concerns both social and technical aspects of IT/IS.

By applying OS perspective, the OS framework analysis for TEL provides a comprehensive insight into the key requirements for TEL Co-Design. The analysis identifies the interlinked requirements at the six OS layers. The requirements at higher layers need to be supported by the requirements at lower layers for the IT platform to support the human activities. The understanding of how requirements at different OS layers support each other could allow TEL requirements to be analysed in this manner. Furthermore, Co-Design requires the collective effort of participants at various levels in order to maximise the effectiveness of the design product.

A limitation, however, is that the research framework is based on literature review without empirical studies. However, the proposed demonstrates the relationships between technologies, design and practice which will allow greater integration of technical system into the process of learning system and it is expected to offer guidelines for analysing TEL solutions. Further research can be applied to a case study of an organisation in higher education.

In summary, this paper focused on the improvement of TEL grounded in OS as it applies to both higher education as an organisation and TEL. The analysis highlights TEL requirements through the six layers in OS framework focusing on semantic, pragmatic and social aspects of teaching and learning without ignoring the technical aspects. OS could foster researchers and practitioners understanding of the systems requirements by driving the analysis and Co-design of TEL tools.

Fig. 1 .

 1 Fig. 1. Informal and Formal Learning System and Technical System

Fig. 2 .

 2 Fig. 2. Organisational Semiotic Framework for Technology Enhanced Learning


Sanjayan Solangasenathirajan
email: s.solangasenathirajan@pgr.reading.ac.uk

Keiichi Nakata
email: k.nakata@henley.ac.uk

Characterisation of an Electronic Booking System in the National Health Service: A Semiotic Perspective

Keywords: Critical realism, Organisational Semiotics, Boundary objects, Computer supported co-operative work, Electronic referrals, National health service

des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Introduction

Interoperability of healthcare systems at the macro, meso and micro levels is high on the research agenda and in practice within the National Health Service (NHS) of England. Much of the effort and activity has been focused on the technical integration of systems through core services, linking of datasets, definitions and technical interfaces [START_REF] Clegg | The biggest computer programme in the world...ever!: time for a change in mindset[END_REF]. Even though, the NHS struggles to achieve effective integration and interoperation locally, within or across organisations in the local health community, or nationally across regions and geographies. Lack of social collaboration in the technical design, development and implementation of systems could be seen as a barrier to healthcare systems interoperation.

An understanding of the interfaces, and the behaviours and perceptions of the stakeholders who take an interactive role within and around these collaborative systems is required, to understand the socio-technical aspects of co-ordinated system utilisation and the variance of interpretations and barriers to perceived benefits, which result in negative effects. This paper seeks to characterise the role of such a system in its society and the assumed responsibilities of those actors within it. Through the analysis of the human information context it is postulated that a greater understanding of the intrinsic nature is developed to establish the requirements from co-coordinative domains.

NHS Electronic Booking System

A number of core national information systems are currently in use by the NHS in England, of which one facilitates the electronic transmission of referral and appointments booking information across NHS organisations nationally. Its fundamental use is to refer a patient from a primary care organisation to a secondary care organisation, and to support the transfer of clinical information, service selection and appointments booking. This information system is based on core clinical Directory of Services, from which referrers and patients can choose and book an appointment date and time of their preference, in a clinical service of their choice. The system is populated by clinical service definitions from providers of NHS services and integrates with the patient administration systems, so that appointment slots can be polled and made available to the referrals and appointments system. Additionally, referrers can initiate the creation of a referral and attach content from within their GP clinical system. Access is based on user roles and governed by Role Based Access Controls on smartcards used to access the system. Users of the system have referring, service provider, commissioning and further supporting roles with the appropriate functionality. The information within this system can be utilised to understand 'future outpatient' activity and the demands and trends of populations on secondary care clinical services. This information system can be classified as one which acts as a focal point for the interoperation of a number of clinical information systems and co-operative work [START_REF] Schmidt | Taking CSCW seriously[END_REF] of a variety of stakeholders in the formal and informal system [START_REF] Stamper | Information in business and administrative systems[END_REF]. The electronic referral and appointments booking system can be treated as an 'artefact' that sits between and forms many 'boundaries' with organisations and their actors. The actors in these organisations take on a number of roles in which they play a part in the function of the system. These use cases can be technical, non-technical, facilitating or beneficiary.

Design Intentions

The electronic referrals and appointments booking system is utilised in the NHS as part of a core provision of national information services. The core principle was to enable direct access and booking from primary care to secondary care. More specifically: to support patient choice of clinical service and appointment date/time; to support clinical Service Providers to triage and accept referrals that are clinically appropriate only once the patient has been provided an appointment; to facilitate advice and guidance in supporting a referral decision thereby reducing first outpatient appointments through activity diversion and reducing waiting times. Up to date and accurate definition and publication, provides a shop window for Service Providers, for referrers navigating and identifying their services.

System Characterisation

Fig. 1 illustrates the system as a mediating artefact in a network of stakeholders and organisations (indicated the first level), and systems/functions within that organisation.

Fig. 1. Stakeholders of the NHS electronic booking system

The system is at the core of interfacing organisations working to co-ordinate activity to facilitate the process of patients 'choosing' and 'booking' an appointment within a Provider service of their choice. Clinical Commissioning Groups play a beneficiary role in the use of management information, delivery of policy and governance over national performance and quality targets. General Practice and the Service Providers play technical and non-technical roles, with the end users acting with the system and management stakeholders playing non-technical roles in the informal system. The Commissioning Support Unit plays a facilitating role in operational support to General Practice, strategic enablement to the Clinical Commissioning Groups and an interfacing role to support and bring awareness of the electronic booking system. With view of the system as an artefact, differences in local and regional norms cause variation in these multiple domains. This leads to a great degree of permutation in use, from design intention.

Boundary Objects

The national electronic referrals and appointments booking system can be treated as an artefact, classified as a boundary object [START_REF] Star | Institutional ecology, "translations", and boundary objects: Amateurs and professionals in Berkeley's Museum of Vertebrate Zoology, 1907-39[END_REF] in-use, which is comprised of systems acting as repositories and ideal-type concepts provided by definitions. These definitions could be formalised or interpreted to convey different meaning based on the context in which it is being used. A boundary object may be performed differently across multiple sites, times, practices and participants, with varying effects [START_REF] Suchman | Human-machine reconfigurations: plans and situated actions[END_REF]. Boundary objects perform a brokering role [START_REF] Fischer | Creating Success Models of Cooperative Problem Solving[END_REF] involving translation, coordination and alignment between the interfaces and perspectives of specific Communities of Practice [START_REF] Wenger | Communities of practice: learning, meaning, and identity[END_REF]. Boundary objects facilitate cooperation between intersecting communities by maintaining a common identity while satisfying the informational needs of each [START_REF] Star | Institutional ecology, "translations", and boundary objects: Amateurs and professionals in Berkeley's Museum of Vertebrate Zoology, 1907-39[END_REF][START_REF] Star | This is not a boundary object: Reflections on the origin of a concept[END_REF] and provide a locus for communication, conflict, and coordination [START_REF] Yakura | Charting Time: Timelines as Temporal Boundary Objects[END_REF] and for actors with diverse goals to work together [START_REF] Briers | The role of actor-networks and boundary objects in management accounting change: a field study of an implementation of activity-based costing[END_REF].

The interaction between a user and a system is a conversation in a vocabulary and language determined by the input the system is able to accept and process. Many systems (e.g., help systems, documentation systems) are oriented toward the system rather than toward the user: information is structured around a description of the system, not necessarily around an analysis of the problems users address when using the system [START_REF] Arias | Transcending the Individual Human Mind -Creating Shared Understanding through Collaborative Design[END_REF]. As the electronic booking system is dependent on the co-ordination and collaboration of multiple stakeholders, variation in utilisation and system failure can be caused by neglect by one of the communities it is intended to bridge [START_REF] Sapsed | Postcards from the Edge: Local Communities, Global Programs and Boundary Objects[END_REF]. Boundary objects require a joint field and incorporation into local practice to become boundary objects-in-use [START_REF] Levina | The Emergence of Boundary Spanning Competence in Practice: Implications for Implementation and Use of Information Systems[END_REF] and have material aspects that afford or constrain boundaryspanning practices [START_REF] Howard-Grenville | The incompatibility of knowledge regimes: consequences of the material world for cross-domain work[END_REF]. They enable knowledge transfer and the translation of meaning and interests, but their boundary-spanning effectiveness or role may vary across settings or time [START_REF] Star | Institutional ecology, "translations", and boundary objects: Amateurs and professionals in Berkeley's Museum of Vertebrate Zoology, 1907-39[END_REF][START_REF] Carlile | Transferring, Translating, and Transforming: An Integrative Framework for Managing Knowledge Across Boundaries[END_REF][START_REF] Carlile | A Pragmatic View of Knowledge and Boundaries: Boundary Objects in New Product Development[END_REF].

Studies have shown that artefacts can fail as boundary objects when they do not fully or rightfully capture multiple meanings and perspectives [START_REF] Akkerman | Boundary Crossing and Boundary Objects[END_REF]. This interpretive flexibility leads to a misalignment between the IT structure and work process needs and arrangements, and the dynamic between ill-structured and more tailored uses of the objects [START_REF] Star | This is Not a Boundary Object: Reflections on the Origin of a Concept[END_REF].

Even though the current system has been in operation for approximately 10 years, the utilisation nationally varies to a great extent. Issues from system conception still manifest themselves as ongoing issues to date [START_REF] Greenhalgh | Choose and Book: A sociological analysis of resistance to an expert system[END_REF], thus engagement from end users and managers in some places has remained poor and perceptions formed and embedded through bad experience, relationships or interactions [START_REF] Peltu | How a Sociotechnical approach can help NPfIT deliver better NHS patient care[END_REF]. Boundary objects provide a bridging function but additionally need supporting awareness practices [START_REF] Schmidt | Cooperative work and coordinative practices contributions to the conceptual foundations of computer supported cooperative work (CSCW)[END_REF]. The system is characterised as a boundary object so as to facilitate the conceptualisation of the multiple connected domains, and analysis of their contributory elements.

In this paper we study boundary objects through a semiotic lens. This is appropriate as, for example, the integrative semiotic framework [START_REF] Mingers | An integrative semiotic framework for information systems: The social, personal and material worlds[END_REF] provides a method of analysis of the environmental and social context so that a greater understanding of user requirements can be developed in contribution to gaining intellectual buy in [START_REF] Edgley | Critical realist review: exploring the real, beyond the empirical[END_REF]. Moreover, the semantic and pragmatic levels of the semiotic ladder [START_REF] Stamper | Organisational Semiotics: Informatics without the Computer? in Information[END_REF] provide aspects of assessment into the characteristics of the boundary object. The pragmatics provide an insight into the communicated intentions of the boundary object and how this influences actors. The semantics looks to uncover individual and the wider collective meaning derived from various signifying factors, in the way so to uncover further issues in the informal system, and contributory factors in domain norms resulting in impedance of innovation and system failures. Subsequently to reveal the gaps between system design, governance mechanisms and situated use.

A Semiotic Analysis of NHS Electronic Booking System as Boundary Object

The study was approached by conducting semi-structured interviews to capture the semantic and pragmatic views of the system from its users and stakeholders and to provide a basis for cross examination of these findings with the design intention of the system. This semiotic analysis is to determine the success of the system in fulfilling its design intentions and in highlighting and understanding the causes for failure, where it is not used as intended. Ethnography is used to support or negate this analysis in observing stakeholders in use or co-ordination around the focal system, to provide a basis for highlighting and commenting on the successes and failures from the semiotic perspective.

Signification

Each has a part to play in the design intention of the system, in that which is signified and that which is interpreted by the various stakeholders. The system as a boundary object artefact signifies its design intentions. The expected use of the system is interpreted and observed by the various actors in accordance with their existing tasks, practice and position, as illustrated in Fig. 2.

Fig. 2. Siginification of system as boundary object

Superficially, the system is observed as merely providing a means to transfer referral information from one organisation to another. However, it serves different meanings and intensions for different stakeholders, e.g., facilitating the strategic objectives of patient choice, waiting time targets, and activity diversion. This is primarily influenced by local governance within the informal system.

Semiotic Analysis

The semantic and pragmatic perspectives of each system role, as adopted by stakeholders in the information system has been summarized in Table 1.

The system process models the series of tasks that occur for end user interacting with the system from its design intentions. This is described from the GP perspective as illustrated in Fig. 3. In practice, these tasks can be carried out by different users, such as a Medical Secretary at differing time points. The 'book appointment' process releases any attached clinical information to the Service Provider, the referral attachments also need to have been attached into the electronic booking system. Due to the variety of clinical systems used in General Practice there are multiple methods by which the letter and clinical documents can be attached. Process variations and the timeliness of working through the process in Fig. 3 directly impact the efficacy of the process in Fig. 4.

Fig. 4. Service Provider triaging

In order for the 'review booking' process to take place the 'patient books appointment' and 'attach referral letter and clinical documents' sub processes in Fig. 3 need to have taken place in the time prior to the triaging of the booking. Timeliness of sub processes is key to the success of the system, without which the system fails. Where in Fig. 3 the processes in dashed lines are not carried out completely or routinely, adverse effects such as the GP clinical system recording that a booking has been created when in fact no booking has been created occur. Also, where bookings are rejected these are not picked up and therefore the patient has not progressed in receiving any care.

Contextualisation of Semantic and Pragmatic Issues

Referrers

GPs view the system as one which can support or impede the day to day clinical duty.

Referring a patient is in some cases perceived as a task carried out by administrative staff. This transfer of information is in some cases supported by additional technologies, such as Dictaphones. Referral attachment content is produced by a variety of methods given the variety of up to 5 different GP clinical systems in use by practices, and within a GP clinical system, the particular way in which the patient details and referral prose is added. This leads to inconsistencies in the structure, quality of content impacting on the way that it is accessed and usefully perceived on the Service Provider side.

Where the shortlisting of services takes place there is inconsistency in the number of choices that are provided, and in some cases in merit of the choice discussion having already taken place externally to the system, only one choice would be shortlisted. The directory only publishes planned care services, so accommodates for a proportion of total GP referrals.

If the referral is not made prior to the patient leaving the practice following consultation, then the patient booking letter has to be posted to the patient so that their appointment can be booked. The cost incurred in generating and posting, negates any perceived benefit of the system. In some instances the appointment is booked without consultation with the patient and subsequently removing any requirement to generate the booking letter. This approach heavily relies on the Service Provider contacting the patient with appointment details, and negates intended system use around choice and ability for patients to manage their booking.

Service Providers

In Service Provider organisations the triaging consultant can directly access their referral through the system web interface and accept or reject that particular booking, as illustrated in Fig. 4. They are also enabled to access their 'advice and guidance' requests. Some instances describe where consultants never access the system and have the referrals passed to them in paper format, where they have been retrieved by administration staff. Service Providers do not always (have the capacity) to poll available clinic slots, so this can lead to subsequent manual processes where the patient has to be contacted and appointed manually.

In Service Provider organisations, there is also similar variation in each stage of the activity. Whereby some processes are carried out by clinical or administrative staff, in either centralised or distributed functions throughout the organisation.

Worklists determine the management and administration tasks that occur in the use of the system or in the management of events that have arisen from unintended circumstances. For example, if a referral is rejected as clinically inappropriate by the Service Provider, this then populates on a worklist in the GP practice. This should result in the patient being contacted by the GP practice about this cancellation. The adverse impacts of not monitoring this worklist are unforeseen by practices, and only experienced by the Service Provider and Patient, when a rejected appointment is attended.

In bridging all of this activity the system exhibits behaviour of a boundary object in use, whereby it facilitates an interfacing role. Each of the use cases contributes to a variety of interpretation and use of the artefact. Because of the local variances the sign conveys a different interpretation to observation, as intended. The overall use of the system changes over time and in instances can be influenced by external factors in the informal system. The stakeholder map in Fig. 1 highlights the external composition to a boundary object, in addition to that characterised within.

Discussion

The processes and protocols that take place locally are bound to the semantic, pragmatic and social norms of the stakeholders in that particular local instance. This is influenced and constrained by historical and current factors attributed to the signification of the focal system. The malleability of the system from its design intentions, as a boundary object has lent to a multitude of process variations, omissions and workarounds attributed to the ways in which it is interpreted and observed. This flexibility has increased its adoption in tune with local needs, but resulted in deviation from design intention. This also questions whether the design intention was correct, but also for its continuous evolution. Importantly, where beneficiaries as key influencers have least intellectual buy in, resulting interpretations of the system in that instance are subject to greater variation. In these cases, greater facilitation, interfacing and support is required to enable system design intention. Activity at the boundary is instrumental in shaping the semantics of the system, in setting expectations and resolving misunderstandings. The practical aspects of the system are addressed by collaborating with the group in representation of the system to minimize the emergence of group related issues. The wider social group works in isolation in each organisation, and within an organisation within departments. Internally, the system exhibits its own semiotic characteristics which impact on its wider social use. The greater role of beneficiaries and facilitators is under recognised in the implementation and utilisation of these boundary objects. A subsequent focus is required on the impact of the non-technical stakeholders, and in their use cases that affect the efficacy of the technical system design intentions and innovation governance [START_REF] Deschamps | Innovation Governance: How Top Management Organizes and Mobilizes for Innovation[END_REF].

Conclusion

A system classified as a boundary object signifies that which has varying interpretations and observations, impacted by its semiotic attributes. These affect the way in which the system fulfils its design intentions, and the subsequent effects of system malleability. Activity at the boundary and the stakeholders in the informal system are primary to influencing the instance of the system. The transition to a new open source system provides an opportunity to observe the participation in design. There is a need to bridge natural user protocols, to systems and governance protocols. Where co-design of system intentions takes place there is a reduction in its need for malleability, and cocreation of values based on learned incentives. Further work is required to investigate the factors affecting the efficacy and subsequent utilisation of the system and improving long term acceptance. In uncovering the factors that impact this we can seek to resolve the tensions between the normative values, forms of authority and order imposed by the system.

Fig. 3 .

 3 Fig. 3. Referrer booking

Table 1 .

 1 Analysis of human information functions

		Semantic		Pragmatic
	GP	A comprehensive listing of locally	Facilitates the clinically appropriate identification
		and nationally available services,	of services for patient referral and appointment
		appointment dates/times. With	booking. Facilitates advice and guidance from
		ability to seek advice from	secondary care
		secondary care colleagues
	Medical	Comprehensive listing of locally	Facilitates the clinically appropriate identification
	secretary	and nationally available services,	of services for patient referral, automated digital
		appointment dates/times	referral attachments and appointment booking
	Practice	An electronic referral and	Monitor and manage referral activity
	manager	appointments system
	Consultant	An electronic referral triaging and	Electronically review incoming referrals and
		advice and guidance provision	advice requests
		system
	Outpatients	An	electronic	appointments	Directly book appointments and manage slot
	Manager	booking system		availability
	Service	Digitally define services within	Shop window of services
	Manager	specialty


Vania P A Neris

Kamila R H Rodrigues
email: kamila_rodrigues@dc.ufscar.br

Design of Therapeutic Information Systems as Indicating through Signs

Keywords: Therapeutic information systems, Semiotics, Organizational Semiotics, Human-Computer Interaction

Therapeutic information systems are tools to support healthcare professionals to treat their patients, aiding on their rehabilitation, helping them to understand their condition and the treatment procedures, or even motivating themselves to persist on ongoing treatments. Although the importance of digital therapeutic systems, the design of this type of system is still a challenge. Inspired by the Organizational Semiotics, Baranauskas and Bonacin proposed a framework to conduct work in interactive systems design. In the proposed approach, these authors argue in favor of designing as a social process which focuses on problem setting as well as on problem solving. This paper brings reflections of an instantiation of this framework in the context of therapeutic systems and presents the results of an application in a real scenario with patients affected in their mental health.

Introduction

Digital therapeutic information systems are tools to support healthcare professionals to treat their patients. These applications may help patients in different ways, such as aiding on their rehabilitation, helping them to understand their condition and the treatment procedures, or even motivating themselves to persist on ongoing treatments. Healthcare professionals may use therapeutic applications to help the patients express their feelings, relax, or improve their own abilities and personal relationships [START_REF] Cheung | Therapeutic Games And Guided Imagery: Tools for Mental Health And School Professionals Working With Children, Adolescents, And Their Families[END_REF].

Although the importance of digital therapeutic systems, their design is still a challenge. The proposal of a design solution cannot be done without considering the individuals in treatment, their physiological and physical conditions, their relationships with family and society and the medical and health care protocols. Semantic, pragmatic and social issues should also be considered. The nature of therapeutic systems demands a sociotechnical approach to its design and development.

We share with those that understand design as an activity to solve problems in a scenario that is socially and dynamically constructed [START_REF] Fischer | From Domain Modeling to Collaborative Domain Construction[END_REF][START_REF] Kyng | Designing for Cooperation: Cooperating in Design[END_REF][START_REF] Baranauskas | Design-indicating through signs[END_REF]. Therapeutic systems, in particular, are generally in an evolutionary scenario with patients with specificities, health care professionals with different backgrounds, medium and long term treatments. Moreover, according to Cheung [START_REF] Cheung | Therapeutic Games And Guided Imagery: Tools for Mental Health And School Professionals Working With Children, Adolescents, And Their Families[END_REF], the involvement of different stakeholders -such as family -results in more effective treatments, often with better results.

Inspired by the Organizational Semiotics (OS) and by a sociotechnical view, Baranauskas and Bonacin [START_REF] Baranauskas | Design-indicating through signs[END_REF] propose a framework to conduct work in interactive systems design. In the proposed approach by these authors, designing is a social process which focuses on problem setting as well as on problem solving. It involves a dialogue not only with design materials, but primarily among individuals (designers, developers, users and other stakeholders) in which different views of designing and different ways of framing design situations are contrasted. Several artifacts (informal, formal and technical) are used as communication and mediation tools with the participants during this process of designing the interactive system.

This paper brings reflections of an instantiation of this framework in the context of therapeutic systems and presents the results of an application in a real scenario with patients affected in their mental health.

This paper is organized as follows: Section II comments about the socio-technical view to the interactive systems design. Section III describes an academic extension project that has allowed the conduction of studies using Organizational Semiotics and Therapeutic Systems in the mental health context. Section IV describes a design as indicating through signs to Therapeutic Systems. Section V presents conclusions and future works.

Theoretical References

Baranauskas and Bonacin [START_REF] Baranauskas | Design-indicating through signs[END_REF] take Semiotics beyond the study of how we use signs for communication to include the shared knowledge and mutual commitment derived from communication in designing. These authors understand that design is about being engaged directly in a specific design situation. This "situatedness" locates the design process in a nested structure in which the informal, the formal and the technical layers of information and interaction co-exist [START_REF] Baranauskas | Design-indicating through signs[END_REF]. Fig. 1 is based on the "Organizational Onion" from OS and illustrates the Baranauskas and Bonacin [START_REF] Baranauskas | Design-indicating through signs[END_REF] proposal. According to the authors, a problem setting is part of the design situation understanding and requires articulation in forms that can be appropriated and assessed by people involved in designing. The design process involves exploring the reality that constitutes the design situation. Ontology is an important aspect of what the involved group understands as constituting reality. The ontology charting allows a discussion on meaning and on what the group considers to be important aspects of reality in that particular design situation. System prototyping refer to the group's idea on how to shape their intervention in the situation, based on their ontology and problem articulation. Prototyping overcomes some of the problems of requirement specification oriented methods, which usually assume that system design can be based solely on observation and detached reflection [START_REF] Baranauskas | Design-indicating through signs[END_REF]. Moreover, there is very little account of how prototypes are related to the current and future work practices of users. It is equally important that the people involved share a representation model of the work domain to be supported by the prospective system. Meaning-making is constructed as a result of cooperation between designers, developers, interested parts and prospective users of the technology being designed [START_REF] Baranauskas | Design-indicating through signs[END_REF].

The design work in these three layers is established in parallel and co-evolves; a problem understanding is revealed as the group works on the semantics and solution ideas. Therefore, design is conceived as a social process of expressing meaning, communicating intentions and constructing knowledge, to be carried iteratively and interactively by designers and a group of stakeholders in a participatory style [START_REF] Baranauskas | Design-indicating through signs[END_REF][START_REF] Schuler | Participatory design: perspectives on systems design[END_REF].

A Design Challenge in the Context of the Mental Health

The Spiritist Hospital of Marilia (in Portuguese Hospital Espírita de Marília -HEM) is a philanthropic hospital whose primary objective is to offer tranquility and welfare for its patients for 66 years. A multidisciplinary therapeutic team -with psychiatrists, psychologists, social workers, nurses, and occupational therapists -work together to treat the patients [START_REF] Rodrigues | Personas-Driven Design for Mental Health Therapeutic Applications[END_REF][START_REF] Rodrigues | Enriquecimento de personas para apoio ao design de aplicações terapêuticas para a saúde mental[END_REF].

In 2013, the HEM's board invited us, computing researchers, to develop a computational solution that could assist therapeutic treatments conducted at the hospital. Since then, we have conducted collaboratively studies with the health professionals of the HEM. The teams have been meeting at least three times a year to discuss, evaluate and validate the artifacts generated during the project.

Two therapeutic games were defined collaboratively between stakeholders and are in development for the HEM: one to be used to support the treatment of patients with depression and the other to support the treatment of teenagers chemical dependency.

Considering the framework proposed by Baranauskas and Bonacin [START_REF] Baranauskas | Design-indicating through signs[END_REF], we have been studying its adoption and instantiation to the design scenario described here. Next section presents our current view.

Design as Indicating through Signs to Therapeutic Systems

The framework proposed by Baranauskas and Bonacin [4] serves to interactive systems in general and we acknowledge with their ideas. Our proposal here is based on our experience in the specific scenario of therapeutic systems and aims to instantiate their proposal to support further therapeutic systems design processes.

Since we have been working in this scenario, we have identified three main aspects as essential for these systems:

1) Therapeutic systems are complementary tools to support the therapists' work. They may contribute to the treatment, many times supporting only one aspect of the felling better process. Therefore, they should have a well-established therapeutic objective to be defined by the health care professionals and clarified between the entire design and development group.

2) Depending on the condition and procedures, it might be difficult to generalize personal characteristics of each patient. Therefore, therapeutic systems should be highly flexible. This is important both to healthcare professionals and to patients. On the one hand, the professionals might want -or need -to customize the system to the treatment goals. Such changes might include modifying the user interface, adding new interaction mechanisms or new functionalities. On the other hand, patients' interaction needs may vary; thus, a single non-modifiable interaction scheme may not suit everyone [START_REF] Rodrigues | Personas-Driven Design for Mental Health Therapeutic Applications[END_REF]. 3) One intrinsic characteristic of computer based systems is that they are good on repeating actions and storing data. This can be useful to therapists to recognize even small changes in the patient's behavior. Therefore, logging meaningful patients' actions and report them to therapists may support analysis and decisions in treatments. Reflecting on these aspects and considering the opportunity we had to work in a very multidisciplinary team, with health care professionals from different background, we propose the instantiation illustrated on Fig. 2.

The informal layer relies, among others, on the customs, values and intentions of each individual. In the therapeutic system scenario, the particularities of each patient should come from a holist view, i.e., considering information from himself, but also from the family and close people, health care professionals, as well as academic and demographical studies. Therefore, the Participatory Design [START_REF] Schuler | Participatory design: perspectives on systems design[END_REF] goes further users and designers and may consider a larger spectrum of stakeholders, including professionals from different knowledge areas.

Aiming to know these stakeholders and use their information to support the domain articulation and problem setting, adopting a holistic view but focusing on the individuals, we have proposed a Personas Enrichment Process [START_REF] Rodrigues | Personas-Driven Design for Mental Health Therapeutic Applications[END_REF].

Cooper [START_REF] Cooper | The Inmates Are Running the Asylum: Why High Tech Products Drive Us The Inmates Are Running the Asylum: Why High Tech Products Drive Us Crazy and How to Restore the Sanity[END_REF] defines Personas as concrete and realistic representations -based on real or fictitious details -to create faithful representations of users of a system. Personas allow designers to document, organize and represent the diversity of possible users of a system [START_REF] Junior | User modeling with personas[END_REF]. Designers might include demographic, economic, and behavioral data onto a Persona to map relevant data into a detailed representation of users [START_REF] Masiero | Multidirectional knowledge extraction process for creating behavioral personas[END_REF]. They may describe physical and mental characteristics of users, their histories, and daily and professional activities.

Fig. 2. Design as indicating through signs to Therapeutic Systems

In the therapeutic systems design scenario, data may encompass, among others, the patient's clinical profile, therapeutic techniques and procedures for the treatment, and the expected effects that the application will have on the user. The process uses the Stakeholder Analysis Chart [START_REF] Kolkman | Problem Articulation Methodology[END_REF][START_REF] Melo-Solarte | Resolução de problemas e colaboração a distância: modelo, artefatos e sistema[END_REF] (step 1) and the Evaluation Frame [START_REF] Baranauskas | Guiding the Process of Requirements Elicitation with a Semiotic-based Approach -A Case Study[END_REF] (which one should not confuse with the Valuation Frame) (step 2 with other artifacts), to provide a sociotechnical vision regarding the design problem. Moreover, the process also supports the identification of the therapeutic objectives for the system.

In the HEM context, the stakeholders involved worked collaboratively with representatives of every group of professionals in the hospital to perform steps 1, 2 and 4 of the Personas Enrichment Process. The computer science members of the design team performed the step 3 -the creation of the Personas to represent the focus group for the application. Six different Personas were created. Each persona symbolizes information such as the clinical profiles of the patients, and relations of patients with the stakeholders and technology. Therefore, at this point, the existing Personas are able to aid the design team on making conscious choices regarding the design. The Organizational Semiotics' artifacts explored also provide further information, and allow the team to anticipate problems and work to address them.

In the formal layer, it is important to identify the health procedures and protocols which also underline the therapeutic objectives. Considering the therapeutic scenario, the aim in this layer relies on replace meanings and intentions in the treatment to actions by the actors involved. This leads to interaction scenarios in which the desired action will happen. The scenarios come from a collaborative work with stakeholders having in mind the Personas created. The collaborative work asks for an instrument to formalize the interaction scenarios that could be understood by people from different knowledge domains.

We, therefore, proposed a modeling language (still without a name) with symbols that represent an interaction scenario. It is important that the scenario be not confused with screens or user interfaces. In a further moment in the design, a scenario or sub-scenario may have multiple screens to represent it. For instance, in the proposed language there are stamps indicating flexible aspects, as a number of options that may vary from patient to patient according to the therapist choices. It is also possible to indicate that the patient actions need to be recorded for further analysis by the therapist or explicitly indicates a therapeutic objective, as in this case the memory recovery.

Finally, in technical level system flexibility and data logging aspects need to be addressed. Flexible features can be implemented considering cognitive and physical aspects of the patients that are important to be respected during the interaction.

In the HEM context, we considered patients with vision problems (due to low vision or advanced age) that could have interface elements such as images and texts in an increased size. Moreover, depressed patients tend to have difficulty with choices. Thus, we chose to let the health professionals select the amount of options to choose from, according to the need of each patient. Moreover, the therapist also has the option to print a report with selected information from each patient.

Conclusion and Future Works

This paper presented an instantiation of the framework proposed by Baranauskas and Bonacin [4] to the domain of therapeutic information systems. Some particularities of therapeutic systems were considered and reflected in a continuous design process. Some artifacts, understood as mediator tools, were presented to illustrate the emerged knowledge in this specific domain.

The information systems created are now being used and monitored. We hope they will serve as a complementary tool for healthcare professionals of a HEM. As future work, we plan to apply the framework proposed here in other therapeutic scenarios.

Fig. 1 .

 1 Fig. 1. The structure of design as indicating through signs from different layers[START_REF] Baranauskas | Design-indicating through signs[END_REF]

Acknowledgments. The authors would like to thank the healthcare professionals and administrators of HEM on the effective participation and contributions to this research project. We would like to thank the UFSCar's Dean of Extension for their financial support.