Kurt Sandkuhl
email: kurt.sandkuhl@uni-rostock.de

Marite Kirikova
email: marite.kirikova@cs.rtu.lv

Analysing Enterprise Models from a Fractal Organisation Perspective -Potentials and Limitations

Keywords: Enterprise Modelling, Fractal Organisation, Practices, Business Analysis

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

Introduction

Work presented in this paper brings together approaches and experiences from two different research fields in computer science; enterprise modelling and fractal organisations. In enterprise modelling, one of the traditional application purposes has been to understand the current situation in an enterprise or organisation under consideration in order to identify or explain business problems and to propose improvements [START_REF] Harmon | The Scope and Evolution of Business Process Management in vom[END_REF]. Many methods, approaches, tools and work practices aiming at supporting this purpose were developed in areas such as business process reengineering [START_REF] Davenport | Process Innovation. Reengineering Work Through Information Technology[END_REF], process improvement [START_REF] Humphrey | Software Process The improvement -A Personal View: How it Started and Where it is Going, Software Process The improvement and Practice[END_REF], enterprise knowledge modelling [START_REF] Lillehagen | Active Knowledge Modeling of Enterprises[END_REF] organisational renewal [START_REF] Burke | Organisational Development -A Process of Learning and Changing[END_REF], or and information systems development [START_REF] Lillehagen | Active Knowledge Modeling of Enterprises[END_REF]. This large body of knowledge forms one basis for the work presented in this paper. In this context, our focus is on business analysis, i.e. on analysing enterprise models to identify organisational improvement potential.

High turbulence of business environment requires from organizations such features as agility [START_REF] Jordan | Requirements for next generation manufacturing systems in proceedings of the[END_REF], and viability [START_REF] Hoverstadt | The Fractal Organization: Creating Sustainable Organization with the Viabable System Model[END_REF]. Both of these features require means for achieving a good balance between complexity and simplicity in organizational management and operations. Fractal organizational structure is proposed by several researches, e.g. [START_REF] Sandkuhl | The Early Phases of Enterprise Knowledge Modeling: Practices and Experiences from Scaffolding and Scoping[END_REF], [START_REF] Hoverstadt | The Fractal Organization: Creating Sustainable Organization with the Viabable System Model[END_REF], and [START_REF] Warnecke | The Fractal Company: A Revolution in Corporate Culture[END_REF] as an enabler of agility and vitality.

Fractal organisation structures have received much attention in areas like manufacturing industries or enterprise engineering. Among the advantages of fractals, their flexibility, robustness and easy adaptation to new business challenges are considered as interesting for many application domains. Does it make sense to apply fractal organisation principles when analysing businesses i.e. is it feasible to do this and does it give useful results pertinent to analysis purpose? What are the potential benefits and limitations of doing this?

The contribution of this paper is [START_REF] Harmon | The Scope and Evolution of Business Process Management in vom[END_REF] to adapt fractal organisation properties for use in analysis of enterprise models, [START_REF] Davenport | Process Innovation. Reengineering Work Through Information Technology[END_REF] to present practical examples from industrial cases showing the pertinence of the fractal organisation properties, and (3) to identify potentials and limitations of using the fractal organisation perspective in enterprise model analysis.

The paper is structured as follows: Section 2 will introduce the fractal paradigm as the background for our research. Section 3 investigates how the properties of fractal organisations can be interpreted in analysis of enterprise models, i.e. an adaptation of the properties of fractal organisation for enterprise modelling is proposed. In Section 4, we use the adapted properties proposed in section 3 for analysing real-world enterprise models in order to illustrate pertinence. Section 5 discusses the results of applying the fractal organisation perspective and identifies potentials and limitations of using this perspective. Section 6 summarizes the work and gives an outlook on future work.

Background of Fractal Paradigm

The start of the use of fractal paradigm in context of organizational structure and behaviour can be traced back to 1992 [START_REF] Warnecke | The Fractal Company: A Revolution in Corporate Culture[END_REF]. The overall number of research papers available on this topic is not very large, the number of books is 2 [START_REF] Hoverstadt | The Fractal Organization: Creating Sustainable Organization with the Viabable System Model[END_REF], [START_REF] Warnecke | The Fractal Company: A Revolution in Corporate Culture[END_REF]. In the first edition of [START_REF] Warnecke | The Fractal Company: A Revolution in Corporate Culture[END_REF] H. J. Warnecke suggests fractal organization of enterprise as essential means for survival in turbulent environment. In this work a fractal is defined as independently acting corporate entity whose goals and performance can be precisely described. H. J. Warnecke defines and describes the following basic properties of fractal organization:  Self-similarity -fractals are self-similar, each performs services;  Self-organization -fractals practice self organizations (1) operatively -procedures are optimally organized by applying suitable methods and (2) tactically and strategically -fractals determine and formulate their goals in dynamic process and decide upon internal and external contacts. Fractals restructure, regenerate and dissolve themselves.  Goal orientation -the system of goals that arises from the goals of individual fractals is free from contradictions and must serve the objective of achieving corporate goals.

 Dynamics (in other sources named as dynamics and vitality [START_REF] Canavesio | Enterprise modeling of a project-oriented fractal company for SMEs networking[END_REF]) -( 1) the fractals are networked via an efficient information and communication system. They themselves determine the nature and extent of their access to data; (2) the performance of a fractal is subject to constant assessment and evaluation. P. Hoverstadt's book [START_REF] Hoverstadt | The Fractal Organization: Creating Sustainable Organization with the Viabable System Model[END_REF], written 16 years later than [START_REF] Warnecke | The Fractal Company: A Revolution in Corporate Culture[END_REF] applies the fractal paradigm as the basis for use Viable Systems Model [START_REF] Beer | Platform for Change[END_REF] in enterprise management.

In different researches dated from 1993 to 2011 the fractal paradigm has been applied in the following contexts:  Manufacturing/product development [START_REF] Qin | A study of inter-enterprise quality control function selforganization reconfiguration based fractal networks[END_REF], [START_REF] Bin | Configuration unit for product self-organizing configuration design and its application[END_REF], [START_REF] Strauss | The new industrial engineering revisited, information technology, business process reengineering, and lean management in self-organizing fractal company in proceedings of 95[END_REF], [START_REF] Danli | A ship manufacturing model for fractal-based green supply chain[END_REF]  Organizational networks [START_REF] Xu | Similarity in tacit knowledge of supply chain and interfaces[END_REF], [START_REF] Chen | Research on the self-organization model of fractal supply chain[END_REF], [START_REF] He | Research on evaluation model for self-similarity of fractal supply chain in International Conference on Educational and Information Technology[END_REF], [START_REF] Danli | A ship manufacturing model for fractal-based green supply chain[END_REF], [START_REF] Mun | A VO formation process of a project-based organization with trust evaluation using goal achievment probability[END_REF]  Service oriented systems [START_REF] Zhao | The fractal management of SOA based services integration[END_REF], [START_REF] Traverson | Contract management in viewpoint specifications: Experiment in the Electrical Network and SOA domains[END_REF], [START_REF] Nayak | Modeling business services for implementing global business services delivery platforms[END_REF]  Agent oriented systems [START_REF] Xu | Fractal and mobile agent-based inter-enterprise quality tracking and control[END_REF], [START_REF] Gustavsson | The road towards multi-hypoyhesis intention simulation agents architecture-Fractal information fusion modeling[END_REF]  Business process and workflow management [START_REF] Strauss | The new industrial engineering revisited, information technology, business process reengineering, and lean management in self-organizing fractal company in proceedings of 95[END_REF]  Competence, responsibility, motivation, and goal management [START_REF] Deng | Research on the fractal company modelling based competence[END_REF], [START_REF] Kloppm | Fractal lines, Manufacturing and Engineering[END_REF], [START_REF] Li | An analysis of the double module fractal structures of enterprises and its forming motivations and mechanisms in Proceedings of International workshop on Chaos-Fractals Theories and Applications[END_REF], [START_REF] Zh | Self-organization based DSS framework[END_REF], [START_REF] Mun | Trust evaluation model for fractal-based virtual enterprises using goal achievement probability in Proceedings of the 2007[END_REF], [START_REF] Mun | A VO formation process of a project-based organization with trust evaluation using goal achievment probability[END_REF]  Knowledge and decision making management [START_REF] Xu | Similarity in tacit knowledge of supply chain and interfaces[END_REF], [START_REF] Zh | Self-organization based DSS framework[END_REF]  Quality control [START_REF] Qin | A study of inter-enterprise quality control function selforganization reconfiguration based fractal networks[END_REF], [START_REF] Xu | Fractal and mobile agent-based inter-enterprise quality tracking and control[END_REF]  Enterprise architecture [START_REF] Malan | The art of change: Fractal and emergant[END_REF]  Information systems and software engineering ( a survey of related work in information systems development is included in [START_REF] Kirikova | Towards multifractal approach in IS development[END_REF]), [START_REF] Stecjuka | Best practices oriented business process operation and design[END_REF] The above list of topics shows that many organizational aspects are researched from the point of view of the fractal paradigm; however there is no analysis on applicability of fractal paradigm in enterprise modelling practice. Usefulness of the paradigm in each of the above mentioned enterprise perspectives suggests that use of the paradigm could bring particular benefits in enterprise modelling. The fractal paradigm does not focus on isolated aspects of an organisation, but defines properties cross-cutting processes, organisation structures and information flows, to name just a few examples. Such a multi-perspective approach including different aspects is also essential for enterprise modelling, since in enterprise modelling it is important to understand dependencies and connections between different organisational aspects (e.g. processes, organisation structure, competences or enterprise architecture), because organisational changes or problems usually affect several aspects.

Fractal Organisation Properties for enterprise model analysis

Based on the properties and characteristics of fractal organisations described in section 2, this section investigates the adaptation of these properties for use in business analysis. The assumption made for work presented in this paper is that the "as is" situation in an enterprise already has been captured and documented in a model, i.e. we focus on analysis of models rather than on developing them. In this context, adaptation of properties includes two aspects:  How to interpret the property in the context of business analysis?  How to operationalize this interpretation for practical use, i.e. what questions to investigate in an actual analysis case and how to perform the analysis?

In the remaining part of this section, we will discuss the properties of fractal organisations from section 2 with their interpretation in business analysis and the operationalization. The focus will be on self-similarity, goal orientation, selforganisation, and dynamics.

Self-similarity

As discussed in section 2, self-similarity is a repetition of a particular pattern of organization structure at different scales of a particular organizational dimension or at different scales of several organizational dimensions simultaneously. If such a pattern exists in some organization unit of the same scale, but not in all units of this scale, the reason for this should be investigated. Are pattern-compatible units performing better or worse than non-pattern units? Should there be an adaptation towards the pattern of the non-pattern structure?

Based on the above interpretation of the property, the proposed operationalization includes the following questions to be investigated during business analysis:

SS-1: Do organisation patterns repeat on different scales of the organisation in the dimension "organisation structure"? If so, does the repeating pattern has advantages compared to other structures and should be implemented on all scales? SS-2, SS-3, and SS-4: Same as SS-1, but for product structure (SS-2), process structure (SS-3), resources structure .

This property also includes that information should no longer be monopolized, but be made generally available. In practice support for this aspect has to be established in the enterprise architecture and implemented by information systems in the enterprise. More obvious solutions would include access to essential information from all organisational functions. Enterprise models include relations from functions to information systems, i.e. we could use these relations as indicators.

Operationalization (continued): SS-5: Is the information system structure included in the model? If so, do all organisation units have access to essential information systems?

Self-organisation

Self-organisation includes that fractals restructure, regenerate and dissolve themselves based on goals in a dynamic process and internal and external contacts. If the model of the enterprise under consideration indicates delegation of decision rights regarding enterprise strategy implementation to organization units, these units should have continuous improvement and adaptation processes in place and it also has to include adaptation. Furthermore, there should be organizational roles responsible for this task.

Operationalization: SO-1: Is delegation of responsibilities in the organization reflected in the model? If so, do continuous improvement and adaptation processes exist? SO-2: Have organizational roles responsible for continuous improvement been established?

In the literature on fractal organisation, so called "process patterns" characterizing fractal organisations are described. An example is the pattern described by [START_REF] Canavesio | Enterprise modeling of a project-oriented fractal company for SMEs networking[END_REF], which identifies monitoring, analyzing, reporting, planning, executing as the main functions in project-oriented fractal companies. Such process patterns for fractal organisations could serve as templates for analysing models in order to detect self-organisation structures.

Operationalization (continued): SO-3: Can all processes from the process pattern be found in the enterprise model under consideration? If so, can additional properties of fractal organisations be identified? SO-4: Can the majority of the sub-processes of the process pattern be found in the model? If so, are the missing processes -if not named in a different way -the starting point for improving the organisation into this direction?

Goal orientation

Goal orientation includes different aspects, like that the goals of individual fractals are free of contradictions from the goals of the overall organization, serve the objective of achieving corporate goals and involve all units concerned. Goal orientation as a property does not need adaptation for use in business analysis, since even non-fractal organisations should follow this principle. However, to determine whether this property is implemented is not a trivial task if only the enterprise models are available.

It would basically require propagation of the goals to different organisational division and the refinement of relevant goals for each organisational unit

Operationalization: GO-1: Are the enterprise's goals included in the enterprise model? If so, are the goals broken down for use in different organisational units? Should this be done in order to reach acceptance, as it is recommended in a balanced scorecard with its subscorecards?

Dynamics and vitality

The operationalization of this property overlaps with SO-1, SO-2, SS-5, and GO1. Additionally fractals with identical goals and input and output variables can have quite different internal structures. If organization units with identical input/outputs and goals exist, is one of the internal structures superior to the others and should it be adapted by the others?

Operationalization: DV-1: Do different processes, activities, or tasks with identical input/output variables exist in the model? If so then if they have different internal structures, is there a superior one performing better?

The above operationalization of self-similarity, goal orientation, self-organisation, and dynamics focuses on the questions to ask in business analysis. Furthermore, we also need to define, how to use these questions in the actual business analysis. As discussed in Section 3, we assume that an enterprise model exists capturing the "as is" situation. Although there are different ways how to use the questions for analysing an enterprise model, we recommend the following procedure and use it in the cases presented in Section 4: The business analysis should be performed by a team consisting of at least one expert in fractal organisation properties familiar with the questions and one enterprise modelling expert familiar with the model under consideration. The analysis should start with an introduction of scope and purpose of the model, the method and notation used, and a walk-through of the actual model, which starts with an overview to the main processes and structures, and includes at least one part of the model in full detail. Afterwards, the questions are analysed as follows:  SS-1 to SS-4: the analysis team jointly browses different perspectives (process, organization, product, resources) of the enterprise model on different levels. Similarities are documented as pattern candidates. After finishing the browsing, all candidates are revisited in order to decide whether they are patterns.  SO-1, SO-2 and GO-1: the analysis team checks the meta-model for entity types or relationships types matching the wanted ones (i.e. role, delegation, goal). For the matching entity types, the instances are browsed to answer the questions.  SO-3 and SO-4: the analysis team browses the instances of the process-related entity-types in the model for instance names matching the names of the subprocesses in the process patterns.  DV-1: same procedure as for SS-1 to SS-4, but limited to those parts of the model containing processes, activities or tasks.

Application of the Adapted Properties in Real-World Cases

This section focuses on evaluating the adapted properties introduced in section 3 regarding the applicability and pertinence by applying them in two cases. One case is taken from the public sector and the other one from industry. Section 4.1 presents and discusses the application of the adapted property in the public authority case; section 4.2 covers the industrial case. An interpretation of the results and comparison of the cases is included in section 5.

Public Authority Case

The Public Authority case model was developed in 2005. Its purpose was to establish a vision of new information systems of a university. Currently the information system has been developed. Its functionality is taken into consideration in the enterprise model analysis. The enterprise model was developed using Enterprise Knowledge Development methodology [START_REF] Bubenko | EKD User Guide. Appendix B to Deliverable 3 of EUfunded project "HyperKnowledge[END_REF]. The model consists of five sub-models reflecting perspectives of Goals, Processes, Actors and Resources, Concepts, and Information Systems Components and Requirements.

The results of analysis of the model are presented according to the four properties of fractal organizations and their operationalization introduced in Section 3.

Self-similarity SS-1: Do organisation patterns repeat on different scales of the organisation in the dimension "organisation structure"? If so, does the repeating pattern has advantages compared to other structures and should it be implemented on all scales?

The pattern at different scales was identified in Actors and Resources sub-model. It was Unit level i, Management of Unit level i, binary relationship between Unit level i and Management of Unit level i. The levels in decreasing order of granularity were University, Faculty, Institute, and Department. A representative of University IT department participating in the model analysis session admitted that clear repetition of the same pattern at all scales would give an opportunity to state clearer and richer information systems requirements.

SS-2: Do structural patterns repeat on different scales of the organisation in the dimension "product structure"?

Product structure was not represented in the model.

SS-3: Do process patterns repeat on different scales of the organisation in the dimension "process structure"? If so, does the repeating pattern has advantages compared to other structures and should it be implemented on all scales?

In the business process model which was developed at a high level of abstraction common patterns where not found except of some similarities with respect to maintenance of different Information systems registers related to each level of organizational structure. Relationships between the registers were not specified.

SS-4: Do structure patterns repeat on different scales of the organisation in the dimension "resource structure"?

Resources (excluding organizational structure) were represented at a high level of detail and did not contain repeating patterns.

SS-5: Is the information system structure included in the model? If so, do all organisation units have access to essential information systems?

Information systems structure was partly represented in Concepts sub-model. Indirect relationships to all organizational units were identified in the model.

Self-organisation SO-1: Is delegation of responsibilities in the organization reflected in the model?

Model showed only which information is received or transferred by which actor. Delegation of responsibilities was not represented.

SO-2: Have organizational roles responsible for continuous improvement been established?

The activity of continuous improvement was identified in the model, but was not assigned to any actor. This can be explained with the fact that in 2005 there was no specific department responsible for continuous improvement. Some years later a University Strategy Department was established which partly deals with issues of continuous improvement. An interesting fact is that this department has its own information system that operates on different principles than other parts of the information system and causes lots of problems for users due to request of inputs that do not fit the work structure. The Strategy Department's system was outsourced from another public institution. The difficulties currently perceived emphasize that it is necessary to represent who and how is responsible for continuous improvement in the enterprise model to avoid problems that can arise if this issue is not considered.

SO-3: Can all processes from the process pattern be found in the enterprise model under consideration?

Planning process was missing.

SO-4: Can the majority of the sub-processes of the process pattern be found in the model?

Processes of the process pattern (except of planning) were represented in the model, however they did not form fractal structure.

Goal orientation

GO-1: Are the enterprise's goals included in the enterprise model? If so, are the goals broken down for use in different organisational units? Should this be done in order to reach acceptance?

The models included a sub-model dedicated to the goals of the university; however, the goals were not broken down for use in different organizational units. Particular goals for units at all levels would be beneficial so as to achieve clearer and richer requirements and reach user acceptance for information systems solutions.

Dynamics and vitality DV-1: Do different processes, activities, or tasks with identical input/output variables in the model? If so, then if they have different internal structures, is there a superior one performing better?

On the highest level of abstraction it was possible to identify such inputs and outputs for processes related to different registers. These processes were not shown in detail and thus it was not possible to analyze their internal structure. In another project related to university information system [START_REF] Stecjuka | Best practices oriented business process operation and design[END_REF] such structures were identified and recommended for implemention at several branches of the fractal organization.

Industrial Case

The industrial model analyzed was developed in the EU-FP6-project MAPPER [START_REF] Johnsen | Model-based Adaptive Product and Process Engineering[END_REF] during 2006 -2008. The model was produced in the automotive supplier use case of MAPPER and focused on the department of advanced engineering and the 'process of innovation', which basically involves several organizational functions in developing new technologies or components for future products of the company. The method used was C3S3P [START_REF] Burke | Organisational Development -A Process of Learning and Changing[END_REF][START_REF] Sandkuhl | The Early Phases of Enterprise Knowledge Modeling: Practices and Experiences from Scaffolding and Scoping[END_REF]. Two model versions were available: the model of the 'as is' situation, also called scoping model, and the model slowing the 'to be' situation, also called solution model.

The models covered the POPS* perspectives [START_REF] Lillehagen | The Foundations of AKM Technology, 10th International Conference on Concurrent Engineering (CE) Conference[END_REF], which include the enterprise's processes (P), the organization structure (O), the product developed (P), the IT system used (S) and other aspects deemed relevant when modeling (*). The analysis of the models from MAPPER is presented in the following and divided according to the four properties and their operationalization introduced in Section 3.

Self-similarity SS-1: Do organisation patterns repeat on different scales of the organisation in the dimension "organisation structure"?

Solution model and scoping model included only the advanced engineering department in full detail. Other organisation structures were not included. Thus, similarity between organisation units could not be detected.

SS-2: Do structural patterns repeat on different scales of the organisation in the dimension "product structure"?

The scoping did not contain any product structure, but it was decided to include the product decomposition structure, requirements, technical characteristics, materials, etc. in the solutions model. Structural similarities between different levels of the product structure were detected, but these similarities were based only on common characteristics of different component types. Further unification of the structures on different levels wouldn't make sense since the different kinds of product components (sensors, harness, wires, etc.) have significantly different structures and features.

SS-3: Do process patterns repeat on different scales of the organisation in the dimension "process structure"? If so, does the repeating pattern has advantages compared to other structures and should it be implemented on all scales?

Regarding the work processes, the scoping model did not contain any similarities between different levels, which were not surprising since the processes were only very roughly defined without details and refinements. In the solution model, similarity exists on two levels. First, all tasks aiming at "establishing" a specification start with "preparing" the task and continue by "developing an initial draft", "establishing test methods" and the "final specification". The second similarity was detected on a refinement level. Wherever a material, a test method or a design approach had to be selected, first the existing ones were checked for suitability, then the decision was made whether to develop a new one in-house or to outsource this.

SS-4: Do structure patterns repeat on different scales of the organisation in the dimension "resource structure"?

The only resources included in the scoping model were the major IT systems used in the enterprise. This was primarily to identify the systems and did not show their internal structure or relationships. The solution model included more structure and refinements of this aspect, but similarity on different scales was not detected.

SS-5: Is the information system structure included in the model? If so, do all organisation units have access to essential information systems?

To improve and promote access to information and knowledge, and sharing of such information was one of the main intentions of the project. Thus, the solution model contains many details of which view of what information is needed for what role in what task. All roles and all organisation units have access to essential information. This property of a fractal organisation is clearly visible in the model.

Self-organisation SO-1: Is delegation of responsibilities in the organization reflected in the model? and SO-2: Have organizational roles responsible for continuous improvement been established?

Mechanisms and structures for continuous improvement and adaptation of the organisation structure were outside the scope of the modelling. The model focused on the core process "Process of Innovation" of one organisation unit "advanced engineering" but did not cover the whole organisation unit or the whole organisation.

SO-3: Can all processes from the process pattern be found in the enterprise model under consideration? and SO-4: Can the majority of the sub-processes of the process pattern be found in the model? Such structures are not part of the model. The model did not cover the whole organisation, nor the whole organisation unit. Whether the process pattern exists in the organisation or not cannot be concluded from the model.

Goal orientation

GO-1: Are the enterprise's goals included in the enterprise model? If so, are the goals broken down for use in different organisational units? Should this be done in order to reach acceptance?

The models included a sub-model dedicated to the goals of the MAPPER project and the goals of the company for the POI. These goals were captured as goal hierarchy, the goals were linked to processes and organizational units related to goal fulfillment.

This goal orientation and the traceability of the goals were implemented in the solution model since a number of specific goals regarding knowledge sharing and innovation were very important for the company and should be addressed. In the scoping model, goals were not included and the specific goals not defined. Thus, the case is a good example for the importance of goal orientation in industry and a confirmation of the relevance of this property of fractal organizations.

Dynamics and vitality

DV-1: Do different processes, activities, or tasks with identical input/output variables exist in the model? If so, then if they have different internal structures, is there a superior one performing better?

On a high aggregation level, many processes exist with identical input and output, since most processes of the POI have the product knowledge as input and the changed product knowledge as output. However, on a lower level, these identical inputs are no longer visible, since only different part of the product knowledge is used.

Discussion

This section is dedicated to discussing the experience acquired in the two cases presented in section 4. The approach used for this discussion is to compare the results of analysing the enterprise models of the two cases with the results of the original business analysis performed in these cases, i.e., the analysis results of the enterprise models developed in these real-world cases are considered as "gold standard" when comparing the results of the analysis with the adapted properties. For both cases, a table will be presented summarizing two aspects of the evaluation:  Applicability: Was it possible to apply the property and its operationalization in practice?  Usefulness: Was the use of the properties and its operationalization of any help in business analysis? Regarding applicability four categories will be distinguished:  it was possible to apply the operationalization and the property was detected  it was possible to apply the operationalization, but the property was not detected  It remains unclear, whether the operationalization can be applied (e.g. if the model does not contain information needed for applying the property)  it was not feasible to apply the operationalization Regarding usefulness, five categories will be distinguished:

 New insights: using the property gave new insights and other opportunities to improve the organization as compared to the result of the original business analysis  Confirmed: using the property resulted in confirmation of the results of the original business analysis, i.e. the same or compatible results were achieved  Contradiction: using the property resulted in recommendations contradicting the results of the original business analysis.  Not relevant: the property was not relevant for the business analysis  Not applicable: the property could not be analyzed, e.g. due to missing data Table 1 shows a summary of the analysis of the public authority case. Property detected (to some extent)

There is a process for continuous improvement but there is no delegation: New insight: modelling the delegation is essential in case of continuous improvement.

SO-3

Not detected Not applicable (property not detected) SO-4

Property detected New insight (related to SO-2; it is essential to represent planning process in an enterprise model GO- 1Property detected (to some extent)

New insight: it is beneficial to propagate goals in organisation structure DV-1

Property detected (to some extent)

Confirmation: in another research of university information system preferable process structures were found.

This summary shows that it was not possible to detect fractal properties SS2, SS4, SO1, and SO3. Some properties, namely, SS3, SO2, GO1, and DV1, were detected to some extent. Nevertheless, the results of analysis of fractal properties showed that utilization of them in enterprise models could provide richer models and more detailed information systems requirements. Table 2 shows a summary of the analysis of the industrial case. This summary shows that it was possible to apply the operationalization of the properties in the industrial case. Only the properties for self-organization could not be utilized since the scope of the model was too narrow as it was limited to one department and one value creation process. Furthermore, most of the other properties were not detected in the model, indicating that the enterprise under investigation does not show many characteristics of a fractal organization.

However, those properties which were detected confirmed the results of the original business analysis, i.e. utilization of self-similarity for the process and product perspective (SS-2 and SS-3) and goal orientation (GO-1) are relevant and valuable for the enterprise under consideration. Self-Similarity in the product perspective also showed a case where it is important to see and respect limitations of self-similarity, since some levels of the product structure have similarities, but these similarities disappear with increasing specialization.

The presented research focused on a most common canonical list of the properties of fractal systems, namely, self-similarity at different levels of scale, self organization, goal-orientation, and dynamics and vitality [START_REF] Ryu | Fractal approach to managing intelligent enterprises. Creating Knowledge Based Organisations[END_REF]. In [START_REF] Fryer | What are fractal systems: A brief description of complex adaptive and emerging systems[END_REF] there are other properties of fractal systems listed, such as emergence, co-evolution, sub-optimality, requisite variety, connectivity, and simple rules. Operationalization of these properties may generate some new questions besides the ones described in Section 3. However, further research is needed to see to what extent the analysis of these additional properties is possible and useful in the context of enterprise modelling.

Conclusions and Future Work

The aim of the paper was to investigate whether the properties of fractal organizations can be applied in business analysis and whether this results in useful outcomes and new insights. Based on an adaptation and operationalization of properties of fractal organizations, two real-world cases were analyzed using the adapted properties. The first case showed many properties of fractal organizations and led to new insights regarding further improvement potential of the organization. In the second case, the results were not as positive as in the first case, but still showed the applicability of the properties and importance of properties, like goal orientation and self-similarity.

Although the use of fractal organization properties in business analysis showed some promising results, the potential would probably be bigger if we started to use them already when capturing the "as is" situation in an enterprise. This could help to avoid certain shortcomings in analysis models, like missing delegation relations between roles or improvement processes, but the methods for enterprise modeling might have to be adapted. An example is the property of self-similarity of the processes in the industrial case: during development of the solution model in this case, the processes were designed separately from each other and only after several iterations of refinement and validation a similarity between them developed. This refinement process probably would have been shorter with the advantages of selfsimilarity in mind. One of the main issues in this context is the method support. Enterprise modeling methods like EKD or C3S3P do not include activities supporting the implementation of certain organization paradigms, like fractal organizations, and probably should not do so, since this would limit the applicability and the situational adaptability of the methods. However, for business analysis and process design activities, it might be beneficial to raise awareness on the analysis side for advantages of fractal organization forms and to offer additional method support, like a method component for fractal organization based process design.

The main limitation of the work is the small number of cases considered in the evaluation and the limited number of fractal organisation properties applied. Basically we can conclude that it is possible to apply our operationalization and that this was contributing to business analysis in these two cases, but we should not even try to generalize these results. Since the results from these first two cases are promising, future work will have to focus on identifying characteristics of cases or organisations, where the use of fractal organisation properties in business analysis can be recommended. More cases are required in order to reach conclusions on this question. Furthermore, the operationalization has to be subject to a more thorough quality check including (a) do we need to include more properties or a different interpretation of fractal organisation properties? and (b) can the operationalization be made more precise, complete and easier to apply? This aspect requires involvement of more practitioners.

Table 1 .

 1 Summary of public authority case

	Property	Applicable?	Usefulness
	SS-1	Property detected	New insights (how to organize work at lower levels of
			institutional granularity)
	SS-2	Property not detected	Not applicable (property not detected, however the
			product perspective could be useful and give new
			insights with respect to information systems
			requirements)
	SS-3	Property detected (to	New insights (more detailed analysis of these
		some extent)	properties could help to identify particular
			requirements at different levels of fractal organization)
	SS-4	Property not detected	Not applicable (property not detected)
	SS-5	Property detected	New insights (direct instead of indirect relationships
			could give better chances for interface requirements
			definition)
	SO-1	Not detected	Not applicable (aspect missing in the model except of
			information flows to and from actors)
	SO-2

Table 2 :

 2 Summary of industrial case

	Property	Applicable?	Usefulness
	SS-1	Property not detected	Not applicable (property not detected)
	SS-2	Property detected	Confirmation and contradiction: some part of the
			structures should repeat, but unification of product
			structures wouldn't make sense.
	SS-3	Property detected	Confirmation: processes with similar structure
	SS-4	Property not detected	Not applicable (property not detected)
	SS-5	Property detected	Not applicable (property not detected)
	to	unclear	Not applicable (aspect missing in the model)
	SO-4
	GO-1	Property detected	Confirmation: goals have to be propagated in
			organisation structure
	DA-1	Property detected	Not applicable (aspect missing in the model)

Acknowledgment

We acknowledge Ilze Birzniece, Ligita Businska, Janis Drobisevskis, and Peteris Rudzajs for analysis of the of public authority enterprise model. We acknowledge the work in the MAPPER project for developing the industrial model.


Adid Ali Fareedi

Vladimir Tarasov
email: vladimir.tarasov@jth.hj.se

Modelling of the Ward Round Process in a Healthcare Unit

Keywords: Enterprise modelling, conceptual modelling, ontologies, healthcare process, ward round

Information systems (IS) are nowadays extensively used to support all kinds of activities in healthcare organisations. Enterprise modelling can help to make the use of IS in healthcare more effective by providing process and domain models reflecting a particular healthcare unit. This paper proposes a model of the ward round process in a healthcare unit. The proposed model identifies the roles of medical professionals, tasks that can be performed according to the personnel's competences, and activities that are carried out as part of the tasks to achieve goals of the ward round process. A formal approach has been used to implement the modelling results in the form of an ontology. Such formal ontologies can support improvement and development of IS in healthcare. We learned that modelling workshops are important for development of models that can be formalized in a machine-readable form.

Introduction

Information systems (IS) are nowadays part of almost every activity or process in healthcare organisations. IS are intended to support the medical personnel and make their work more efficient. Yet, the use of IS in healthcare needs to be improved [START_REF] Littlejohns | Evaluating computerised health information systems: Hard lessons still to be learnt[END_REF]. Current IS do not always meet the needs of healthcare professionals and patients. To achieve better use of IS, we need to understand work processes, which are to be supported by IS, the needs of the people who are going to use IS, and the details of the healthcare domain. Enterprise modelling provides means to model the current situation and to describe work processes, tasks, roles, and resources. Thus, enterprise modelling can help to make the use of IS in healthcare more effective by providing models reflecting a particular healthcare unit. Conceptual modelling is an important part of enterprise modelling [START_REF] Loucopoulos | Enterprise knowledge management and conceptual modelling[END_REF]. The advantage of conceptual modelling is that the resulting model can be formalised as an ontology in a machine-readable form, that can be directly used to improve existing IS or build new ones. Ontological modelling methods have been used to support development of healthcare IS in may cases (e.g. [START_REF] Dang | An ontological knowledge framework for adaptive medical workflow[END_REF][START_REF] Raghupathi | An archetype pattern driven approach to ontology development in health care information systems[END_REF][START_REF] Ganendran | An ontology-driven multi-agent approach for healthcare[END_REF]).

The purpose of this paper is to propose a model of the ward round process at Ryhov hospital in Jönköping. The model is implemented as a formal ontology.

Existing IS have not been able to provide full support to medical professionals in all different contexts of the healthcare processes at Ryhov hospital. Development of a formal model of the ward round process is needed to help to customize current IS to improve information flow, i.e. to provide the required information to an individual according to his/her role and competence in a specific context of the ward round at the Ryhov Hospital. The main contribution of the work is that it presents a detailed representation of the ward round that can be used for development or improvement of healthcare IS. Such IS can provide better support for the healthcare professionals to improve the quality of the patient's treatment. The ontology-based implementation of the model can be also directly utilised in IS to improve information flow in a healthcare organisation.

The paper is structured as follows. Section 2 briefly describes modelling in healthcare, explains the Ward Round process and presents the case. The method used for carrying out this study is presented in section 3. Section 4 details the developed model of the Ward Round process from the model design to the implementation. Section 5 discusses the lessons learned during the model development. The summary of the results and future work are presented in section 6.

Background

This section provides short overview of different modelling approaches applied in the healthcare area as well as briefly describes the ward round and its importance in the medical institutions. The section ends with an introduction of the modelling case.

Modelling in Healthcare

Enterprise modelling (EM) plays an important role in the healthcare sector because it promises to improve the use of healthcare information systems (IS). EM can be used to analyse patterns of healthcare activities, ensure fulfilment of the end-user's needs and requirements, build a systematic view of patient-centred processes, and help healthcare institutions to improve internal knowledge and understanding. EM also contributes to supporting IS that are intended to help healthcare professionals to manage patient treatment activities and document all the events of the care processes [START_REF] Staccini | Modelling health care processes for eliciting user requirements: A way to link a quality paradigm and clinical information system design[END_REF]. Enterprise modelling approach has been used for supporting a set of structured, goal/problem-driven models for capturing, structuring and representing organizational knowledge, and designing different perspectives of process modelling: functional, informational, organizational and behavioural [START_REF] Shahzad | A goal-oriented approach for business process improvement using process warehouse data[END_REF][START_REF] Persson | How to disseminate professional knowledge in healthcare: The case of skaraborg hospital[END_REF][START_REF] Petersen | Patient care across health care institutions: An enterprise modelling approach[END_REF].

New business demands imposed on enterprises and organisations require EM methods that are more formal, i.e. conceptual modelling methods [START_REF] Loucopoulos | Enterprise knowledge management and conceptual modelling[END_REF]. Ontological modelling is the key tool in formal conceptual modelling since "an ontology is an explicit specification of a conceptualization" [START_REF] Gruber | A translation approach to portable ontology specifications[END_REF]. Ontology development is a method to formalize conceptual models in machine-readable form that can be utilized for improvement of existing healthcare IS or development of new IS.

Nowadays, the importance of ontological modelling has been acknowledged due to its usage in the healthcare sector. Ontological modelling helps to acquire knowledge in the machine-understandable form, which results in making IS more intelligent. This approach has been used in the healthcare area for modelling of the patient's treatment process and for improvement of the quality of healthcare services [START_REF] Dang | An ontological knowledge framework for adaptive medical workflow[END_REF]. To achieve the latter, efficient healthcare workflow management systems are needed that support data exchange between different processes and provide relevant information timely, effectively and according to the demand of individuals. An ontological knowledge framework presented in [START_REF] Dang | An ontological knowledge framework for adaptive medical workflow[END_REF] covers the hospital processes from patient records to hospital resources and administrative tasks. An adaptive workflow system constructs a process and resource model, which include different levels to represent the patient treatment processes: patient's admission, treatment planning, and discharge.

Different approaches are utilized for ontological modelling in the healthcare sector nowadays. The archetype pattern approach is employed to develop an ontology for a healthcare IS and to provide shared understanding of the healthcare processes [START_REF] Raghupathi | An archetype pattern driven approach to ontology development in health care information systems[END_REF]. The ontology-driven multi-agent approach provides a framework to help the medical professionals to interact and collaborate effectively [START_REF] Ganendran | An ontology-driven multi-agent approach for healthcare[END_REF]. The competence management approach is used to develop competence of healthcare personnel based on goals in order to enhance competence at the enterprise level. The case study of Municipal Hospital of Karlsruhe details this competence management approach [START_REF] Kunzmann | Ontology-based competence management for healthcare training planning: A case study[END_REF].

The Ward Round Process

The ward round is the process intended for making decisions concerning the patient's treatment process by medical professionals and resource personnel [START_REF] O'hare | Anatomy of the ward round[END_REF]. It provides opportunity for multidisciplinary teams to carry out different activities: patient's examination, treatment and discharge from the hospital [START_REF] Arasaratnam | Medical ward rounds[END_REF]. Ward rounds support patient treatment planning, prognosis formulation and analysis of social, psychological, rehabilitation and placement issues [START_REF] O'hare | Anatomy of the ward round[END_REF]. Learning opportunities are supported by ward round as well [START_REF] Stanley | Structuring ward rounds for learning: Can opportunities be created?[END_REF]. Ward round is categorized into traditional and modern ones. The traditional ward round is authoritatively led by senior hospital personnel who have responsibility for making decisions in the patient treatment process. On the contrary, the modern ward round relies on expertise of both senior and junior colleagues and aims at achieving consensus in order to improve the quality of healthcare from the patient perspective [START_REF] O'hare | Anatomy of the ward round[END_REF][START_REF] Abid | Ontology-based model for the "ward-round" process in healthcare (OMWRP)[END_REF].

The Ryhov Hospital Case

The work described in this paper was partly carried out within the project "Bridging the Gaps". It is a research project aimed at improving healthcare and driven by The Jönköping Academy for Improvement of Health and Welfare. 1The healthcare processes modelled in Sect. 4 represent the ward round at Ryhov Hospital in Jönköping, Sweden.

During the ward round, healthcare professionals with different competences, roles and skills gather at the appointed time to assess the patient's status, collect information for making diagnosis as well as plan the patient's treatment process. The head nurse consults the EBBA information system to get data about availability of vacant beds to enhance the treatment pace of normal patients, emergency patients, patients sent from other healthcare units, and patients admitted through the certain ward. Every morning the medical staff receive information regarding a particular patient in the form of medical reports from different information channels like Cambio Cosmic (electronic medical record system), EBBA (patient-admittance status system), and a database connected to the pathology laboratory. These systems are integrated and share information in real-time manner to support intelligent decision making during the ward round in a healthcare unit. The details about the case can be found in [START_REF] Abid | Ontology-based model for the "ward-round" process in healthcare (OMWRP)[END_REF].

Method

Modelling of the ward round case (see Sect. 2.3) has been partly carried out as a collaborative activity with participants of different backgrounds such as modelling, medical, and IT ones. As soon as the goal was to create a healthcare process model as a formal ontology, the other part of the modelling was only performed by the modelling experts because it required very specialized expertise. The formal ontology was the intention since it could be used to support development and improvement of healthcare IS. During the modelling activity we followed a number of steps [START_REF] Abid | Ontology-based model for the "ward-round" process in healthcare (OMWRP)[END_REF]:

-Arrange a modelling workshop with domain and modelling experts, -Acquire knowledge about the ward round during the modelling workshop, -Prepare the case data based on the modelling workshop, -Support the case with the study of related literature, -Analyse the results of the domain modelling and literature review, -Determine appropriate tasks, processes, activities, and roles comprising the ward round, -Describe steps needed to perform the tasks, -Select a suitable methodology for implementation of the model as a formal ontology and perform the implementation, -Verify and evaluate the constructed model through domain experts' assessment and description logic queries.

The modelling workshops have been used as one of the main techniques in this study. We have conducted two workshops. The first one was intended to acquire relevant knowledge from the domain experts for creation of the model of the ward round at Ryhov hospital in Jönköping. In this workshop, we have engaged multidisciplinary professionals such as modelling experts, medical practitioners and IT experts with their experiences, observations and different expertise to develop a model of the ward round. Before presenting the results in the second modelling workshop, we developed a formal model that can be useful for the improvement of healthcare IS. During the second workshop we presented the results of the modelling to the domain experts to ensure the quality of the model. We also discussed design issues like individual roles and key responsibilities in the ward round, and different resources that were used in ward rounds.

Model of the Ward Round Process

This section presents design and briefs implementation of the model of the ward round and explains different activities which are necessary to perform the ward round process. The details of the model are described in [START_REF] Abid | Ontology-based model for the "ward-round" process in healthcare (OMWRP)[END_REF]. Before considering the ward round for a patient's treatment, it is important to evaluate the patient's condition at the time of admission. The criteria for the admission procedure are also described in [START_REF] Abid | Ontology-based model for the "ward-round" process in healthcare (OMWRP)[END_REF].

Design of the Model

The design of the model, which resulted from the first modelling workshop, is depicted in Fig. 1. It shows the structure of the ward round at Ryhov hospital in Jönköping. The ward round is the centre of activities where different hospital professionals gather for treatment of the patient. The overall ward round process is divided into three sub-processes, which consequently support each other. These sub-processes are the pre-ward round process, the ward round process and postward round process.

The ward round process includes different tasks that are carried out to treat the patient's illness. Hospital professionals have different roles in the process and the ward round has different goals to achieve quality in the patient's treatment process. These goals lead to different tasks, which include activities in the patient's treatment process. Different resources are utilized for the completion of each task. Resources can be patient treatment documents, medical equipment, IS, competence resources and database systems.

Ward Round Process

In ward round process modelling, we have divided medical professionals into three designated teams: designated team 1, designated team 2 and designated team 3. These teams consist of multidisciplinary professionals who are responsible for initiation of the sub-processes: the pre-ward round process, ward round process, and post-ward round process. The teams perform different tasks and activities and use resources to achieve the set goals. Designated team 1 includes a junior practitioner, head nurse, additional nurse, occupational therapist, and laboratory personnel that are responsible for update of the patient's medical record in the pre-ward round process. Designated team 2 consists of a consultant, senior and junior practitioners, nurse, and occupational therapist to perform the ward round process for planning of the patient's treatment. Designated team 3 is also comprised of senior and junior practitioners, an occupational therapist and medical student for group discussion and evaluation of the current analysis of the patient's illness in the post-ward round process.

We have chosen designated team 2 for a more detailed description. This team initiates the ward round process with the goal of timely result receipt, the task of patient treatment planning, and the activity of identifying medical problems in the patient's treatment in the ward round session. Designated team 2 utilizes the resources EBBA and Cosmic to achieve quality of patient treatment in the ward round process. The process of modelling included identification of goals, tasks, activities, roles, and resources, which are listed in the following subsections.

Goals.

The following goals are important to achieve quality of the patient treatment planning process in the ward round:

-To analyse the actual causes of the patient's illness, -To support quality management of planning in the ward round, -To prepare a pool of additional questions related to the patient's previous life or medical, psychiatric, sexual, family and social aspects, -To achieve effective decision making in immediate or long-term treatment planning to tackle the patient's illness.

Tasks. The tasks of planning of the patient's treatment.

Activities. The activities that help to carry out the above mentioned task are:

-To consider a differential diagnosis in the patient's treatment planning in the ward round process [START_REF] Cherry | Management plans[END_REF], -To formulate a differential diagnosis, which involves review of the patient's history and clinical examination of the findings in the patient's treatment planning [START_REF] Cherry | Management plans[END_REF], -To identify medical problems connected with the patient's illness and to construct a management plan to tackle the disease [START_REF] Cherry | Management plans[END_REF], -To ask additional questions to clarify different aspects of the patient's history regarding medicine, effects of medicine, sensitive aspects of psychiatric and sexual nature, and evaluate risk factors related to consequences of the illness, family history and social history [START_REF] Cherry | Management plans[END_REF], -To decide on the patient's treatment plan according to the patient's illnesseither an immediate plan or long-term one [START_REF] Cherry | Management plans[END_REF].

Roles. The following roles are extracted from the case during the modelling of the ward round process:

-A consultant is responsible for identification of all possible causes after the review the patient's history during patient treatment planning, -A consultant is also responsible for identification of medical problems related to the patient's illness during patient treatment planning, -A senior practitioner formulates a differential diagnosis after the review of the patient's history and examination of the clinical findings, -A junior practitioners assists a senior one in collection of the examination findings, -A nurse provides medical reports related to the patient or the patient's portfolio, -A junior practitioners is also responsible for asking the patient additional questions to support the quality of patient treatment planning, -A senior practitioner decides on the treatment plan according to the patient's illness-either an immediate plan or long-term plan.

Resources. To perform the activities of the task of patient treatment planning, several resources are utilized during the ward round in Ryhov hospital at Jönköping:

-The information systems Cosmic and EBBA are used for acquiring information related to the patient in the process of patient treatment planning, -The laboratory database system is used to send reports on the patient medical tests to nurses for patient treatment planning, -Patient medical reports are used for the assessment of the patient treatment process.

A Process View of the Ward Round

We have employed EKD modelling technique (see [START_REF] Bubenko | D3: Appendix B. EKD User Guide[END_REF]) to design the ward round model shown in Fig. 1. This sections describes key processes, external processes and information sets, which are depicted in Fig. 2. They constitute the process view of the ward round model. An external process is a collection of activities that are located outside the scope of the organizational activity area and communicate with processes or activities of the problem domain area [START_REF] Bubenko | D3: Appendix B. EKD User Guide[END_REF]. An information set is a set of information, which is sent from one process to another one to facilitate information flow between the processes [START_REF] Bubenko | D3: Appendix B. EKD User Guide[END_REF]. The following processes represent the working flow of the ward round: 6. Long term planning of patient treatment. Long term treatment is described for a normal patient in the ward round. 7. Create a patient-centred agenda. This process determines particular disease treatment. 8. Perform immediate medical treatment. Immediate treatment is provided to the patient in the ward round. 9. Prioritize urgency of examination. It establishes what data are most necessary to conduct the ward round. 10. Educate and train the patient. One needs to know the patient's point of view and explain reasons for disease treatment in the ward round. 11. Create a patient agenda and interaction. This process establishes good interaction with the patient in the ward round. 12. Establish psychological intervention. A psychological intervention session needs to be established during the ward round.

Implementation of the Model

This section briefly explains the implementation of the ward round model (detailed description can be found in [START_REF] Abid | Ontology-based model for the "ward-round" process in healthcare (OMWRP)[END_REF]). A formal approach has been used which resulted in an ontology. We have used the Web Ontology Language (OWL)2 and the Protégé ontology editor3 to develop the ontology-based implementation. The constructed ontology contains 146 classes, 76 object properties, 1 data property, and 122 individuals. Fig. 3 depicts an overview of the ontology that contains different entities involved in the ward round and relations between them.

The medical staff members are involved in different processes (pre-ward round, ward round, and post-ward round) according to their competences and assigned roles. The assignment of the roles of a consultant or senior practitioner determines which process is initiated. The selection of a process is followed by the medical agenda [START_REF] Price | ABC of psychological medicine: Beginning treatment[END_REF] in the patient treatment procedure. Different processes in the ward round model utilize diverse resources for receiving related information from the information channels according to the rules set by a healthcare unit. These processes have particular goals. Every goal leads to a number of tasks that include activities. "Component selection criteria" is a component that supports the selection of the right person to perform his/her responsibilities according to the assigned roles. The selection is carried out based on the person's competences and skills.

To illustrate the use of the constructed ontology for modelling of a real situation from the ward round, we give an example scenario describing the role of a junior practitioner and show its ontological representation in Fig. 4.

Scenario.

The junior practitioner role is assigned to Person A who works at Ryhov Hospital in Jönköping and belongs to designated team 2. Person A participates in the ward round process and performs different tasks Fig. 3. Overview of the ontology-based implementation of the ward round model like patient treatment planning. Person A carries out several activities such as to complete the physical examination to determine medical problems for patient treatment planning. Person A's main responsibilities are to visit a particular ward daily and check the patient's status from the Cosmic information system to inform the senior staff. Person A has several competences: cultural, occupational and general ones (they are not shown for breviety).

Evaluation of the Model

The goal of the evaluation was to achieve quality of the work and get assurance that the model represents the ward round in the correct way. The evaluation of the model was done in two ways [START_REF] Abid | Ontology-based model for the "ward-round" process in healthcare (OMWRP)[END_REF]:

1. Using description logic (DL) queries. We have used the DL Query Tab in Protégé 4 to verify competency questions. They help to confirm that the ontology has enough information to answer these questions, which are related to the domain (the ward round). Table 1 shows an example of one competency question with a DL query and Fig. 5 presents the results of executing the DL query in the Protégé editor. 2. 2 nd modelling workshop. During this workshop, we have presented holistic view of the model design that illustrates how medical professionals with different roles and competences initiate different processes and perform different activities to achieve the ward round goals. We have also exemplified the model of the Ryhov hospital case with a simple scenario that shows representation of a practical situation. These formal modelling results reflect detailed representation of the ward round, which can be used in healthcare IS to improve information flow in the ward round context. Thus, during the 2 nd modelling workshop we have presented the final modelling results to the domain experts to verify the model, get feedback and suggestions for future improvement.

Lessons Learned

The main objective of the modelling workshops was to develop a model that can be formalised as an ontology in a machine-readable form to support improvement and development of IS in healthcare. We learned that using modelling workshops The steps, which we described in Sect. 3, are well suited to develop any model in the healthcare sector in the systematic way. However, we have observed that participation of only multidisciplinary professionals with different expertise like modelling or use of IT in healthcare during the modelling workshops is not enough. We should also invite healthcare professionals to obtain better knowledge of intrinsic details from the healthcare domain. This may help to develop better ontological models in healthcare.

It is also important to include healthcare professionals in the modelling workshops from the beginning because it is quite helpful for modellers to learn and get experience from different domain professionals and to train to work with participants with mixed culture and background. This work pattern helps the modellers to present the modelling results to the domain experts because they already familiar with the experts. It also creates synergy effects among the par-ticipants and improves the quality of the work. According to our experience, we can conclude that modelling workshops are a good opportunity specifically for new-comers in modelling. Novice modellers can quickly learn how to perceive the domain and choose a suitable methodology for modelling from the other multidisciplinary participants.

We have arranged two modelling workshops in our research work but we think that it is not sufficient. During the 1 st workshop, we familiarised ourselves with the participants and got "know-how" about the domain. In the 2 nd workshop, we presented the results in the form of models to the domain experts to get feedback. We suggest to conduct more workshops with healthcare professionals for improvement and assessment of the model.

We have presented our results to the domain experts during the modelling workshops in diagrammatic form that provided overview of the ward round model in the holistic way. This approach facilitates broad understanding of how the objects in the domain are connected with each other and what the information flow is. We have also used tabular form to present our results to the domain experts. The tabular form allowed them to get additional details about the elements in the ontology-based model. We have learned that both forms are useful for presentation of modelling results.

Different modelling tools have been considered, especially data and software modelling tools. However, finally we chose specialized tools for ontology-based model construction. We think that ontology editors like Protégé 4 4 and Top Braid Composer5 are appropriate for model construction. During the development we have found that these tools are good because they allow for both expressiveness in models and evaluation of the modelling results.

Conclusions

This paper proposed a model representing the ward round process at Ryhov hospital in Jönköping. The model contains individual roles to be taken on by medical professionals while carrying out tasks to achieve effective patient treatment in the ward round process. During this process multidisciplinary professionals form different teams to perform tasks to achieve goals of the ward round. The model also shows different processes at different stages of the ward round. The hospital personnel have roles according to their competences required to perform activities in these processes.

The work was carried out based on two modelling workshops and literature study. We have implemented the constructed model in the form of a formal ontology. The ontological implementation has been developed using the Web Ontology Language (OWL) 6 and the Protégé 7 ontology editor. For the evaluation of the results, we have utilized two ways: description logic (DL) queries and a 2 nd modelling workshop to verify the constructed model. This work suggests that formal modelling techniques are important for the healthcare sector. The constructed ontology-based implementation of the model can be used to represent information needs of the healthcare professionals in the ward round patient treatment process in a healthcare unit. The formal ontology can be utilised directly in IS, which allows for the use of semantic techniques to improve information flow in the ward round process. For example, the ontology can be employed to improve the Cambio Cosmic IS, which is used at Ryhov hospital, in order to provide the doctors and nurses with the needed patient records, lab test results and so on according to their way of working during the ward round.

During the work we have learned that more modelling workshops are needed to create models that represent the domain in a more detailed and accurate way. Healthcare professionals are encouraged to be included in the modelling workshops from the very beginning. Diagrammatic and tabular forms are appropriate to communicate results of formal modelling methods to the healthcare professionals.

Our first priority for future work is to further validate the constructed model by testing it in IS in order to provide better healthcare services. We will also continue development of formal conceptual models in healthcare that can support improvement of information flow and development of better healthcare IS. The same modelling technique can be used for construction of ontological models in other areas like inter-professional interaction during the ward round process and doctor-patient communication, unmet patient needs after the ward round session, patient and student perspectives of teaching optimization, role and place of relatives, consultant vs. junior doctor rounds, quality of notes and patient communication, and alternatives to the bed-to-bed round [START_REF] O'hare | Anatomy of the ward round[END_REF]. These areas were out of the scope of this paper but they can be used for further research in healthcare modelling.

Fig. 1 .

 1 Fig. 1. Overview of the model

Fig. 2 . 2 . 3 . 4 . 5 .

 22345 Fig. 2. The process perspective in the ward round model

Fig. 4 .

 4 Fig. 4. The junior practitioner role represented with the constructed ontology

Fig. 5 .

 5 Fig. 5. The results of executing the DL query in the DL query tab in Protégé

Table 1 .

 1 An example of a competency question and a DL query

	Competency question	DL query	Query results
	Who are the members	Role and	Medical Individuals:
	involved in ward round	initiateProcess	OccupationalTherapist,
	team?	value	AdditionalNurse, SeniorPractitioner,
		WardroundProcess1	HeadNurse, JuniorPractitioner

http://www.jonkopingacademy.se

http://www.w3.org/TR/owl2-overview

http://protege.stanford.edu

http://protege.stanford.edu

http://www.topquadrant.com/products/TB_Composer.html

http://www.w3.org/TR/owl2-overview

http://protege.stanford.edu

Acknowledgements. The authors would like to thank Dr Klas Gäre and MSc Eva Lindholm for their active participation in the modelling workshops and valuable contribution to the discussion of the model. Some parts of the presented research were carried out within the project "Bridging the Gaps" supported by the Vinvård research program, which is financed by VINNOVA and the Vårdal Foundation in coordination with the Swedish Association of Local Authorities and Regions.