1
From data to knowledge: a method for modelling
hospital logistic processes
Laura Măruşter and René J. Jorna
University of Groningen, Faculty of Management and Organization,
PO Box 800, 9700 Groningen, The Netherlands
Abstract— When modelling or redesigning a process, the
Knowledge Management perspective is seldomly used. Using the
knowledge categorization developed by van Heusden&Jorna [1],
we propose a knowledge management perspective to provide a
strategy for modelling and redesigning a business process. As
an illustration of our approach, we use hospital data of multi-
disciplinary patients. This specific group of patients requires the
involvement of different specialties for their medical treatment
that leads to more efforts regarding the coordination of care
for these patients. In order to increase the care efficiency,
knowledge that supports the reorganization of care for multi-
disciplinary patients should be provided. We use the above
mentioned knowledge management perspective for creating new
multi-disciplinary units, in which different specialties coordinate
the treatment of specific groups of patients.
Index Terms— knowledge management, knowledge types, pro-
cess modelling, clustering, process discovery.
I. I NTRODUCTION
Information started to play a central role beginning with the
second half of the twentieth century. It leads nowadays to big
changes in the social and economic life. In healthcare, due
to advances in medical sciences and the introduction of new
technologies, treatments and types of services, managing all
involved processes and related knowledge became a challenge.
If we consider healthcare organizations as complex bodies of
knowledge, they have to respond to these challenges.
Knowledge Management Systems (KMS) have been intro-
duced to capture and stockpile workers’ knowledge and make
it accessible to others via a searchable application [2]. As
mentioned in [3], a KMS should provide relevant knowledge
and support the documentation and exchange of knowledge.
However, it is argued whether KMS provide what is expected.
Knowledge Management Systems are supposed to “get the
right information to the right person at the right time”. They
assume that all relevant knowledge can be stored in computer-
ized databases, software programs, and, institutionalized rules
and practices, which does not happen in reality, however [4].
Due to the application of information technology and the
promotion of changing the structure in certain organizations,
the organization’s business processes need to be redesigned or
reengineered. This approach was coined as “Business Process
Reengineering” [5] and “Business Process Redesign” [6]. As
changes occur in the business environment, the existing pro-
cess is at risk of becoming misaligned and consequently less
effective. Although KM is rarely thought of as a strategy for
Correspondent author: l.maruster@bdk.rug.nl
redesigning business processes, “KM can be used to develop
and enhance business processes on an ongoing basis. ... a
business process can be viewed as the nexus around which
knowledge sharing and creation can thrive, and KM can be
thought of as a strategy of business process redesign” [7]. To
increase the capabilities of enterprises to learn faster through
their processes, strategies have been proposed that construct
KM systems around processes to: (i) increase their knowledge
creating capacity, (ii) enhance their capacity to create value,
and (iii) make them better able to learn [7]. Modelling or re-
designing a business process involves more than restructuring
the workflow; therefore business professionals need to learn
how to describe, analyze, diagnose, and redesign business
processes using robust methodologies and tools.
We propose a KM perspective for modelling and redesign-
ing a business process, by employing the knowledge cate-
gorization defined by Heusden&Jorna [1]. Based on ideas
of Boisot [8] and using the insights of cognitive science,
van Heusden&Jorna (see also Cijsouw&Jorna [9]) developed
a knowledge classification consisting of sensory knowledge,
coded knowledge and theoretical knowledge. Sensory knowl-
edge is based on sensory experience. It is basically concrete,
and therefore depends on the co-presence of (individual) be-
havior and an environment. It is difficult and often impossible
to code this knowledge; it is about concrete experiences, and
it can be shared only with those who are co-present. Coded
knowledge is a representation based on an arbitrary conven-
tional relation between the representation and that which is be-
ing referred to; language is the clearest example of this type of
representations. Coded knowledge contains all types of signs
or symbols either in text form, drawing form, or expressed into
mathematical formulas. A person who is able to explain why
certain pieces of knowledge belong together possesses theo-
retical knowledge concerning this specific knowledge domain.
We argue that people use theoretical knowledge when they
are able to answer why-questions; they are able to formulate
structural relations. Theoretical knowledge is often used to
identify causal relations: the so-called if-then-relations.
The reason why we prefer this knowledge categorization
against the well known tacit-explicit knowledge categoriza-
tion, is because the later one has an inherent problem. The
term “tacit knowledge” is ambiguous, because it encompasses
sensory knowledge and theoretical knowledge. In Polanyi’s
examples [10], it sometimes means the behavior of novices,
nearly having any code or theory, and sometimes the behavior
of experts, who have a lot of theoretical knowledge. However,

the tacitness of this knowledge concerns “compilation” and
not concrete experience.
Knowledge management support approaches, like
Knowledge-Based Systems (KBS), emphasize knowledge
capture, organization and formalization, by making expert
sensory knowledge explicit [11]. However, in the KBS
approach, the creation of new knowledge is limited to the
integration of knowledge from multiple experts and sources.
The advantage of the approach proposed in this paper
resides especially in the ability to provide complete new
knowledge about the business process, that domain experts
only partially possess. We will call our approach the S-C-T
strategy for process modelling, where “S” stands for Sensory
knowledge, “C” stands for Coded knowledge and “T” stands
for Theoretical knowledge. In this paper we illustrate the
proposed strategy by investigating the logistic process of
treating patients in one Dutch hospital.
Our S-C-T strategy comprises three main KM activities.
1) knowledge creation. Raw data are first converted into
coded knowledge, then coded knowledge is used to pro-
vide theoretical knowledge about the business process.
The newly created coded and theoretical knowledge
provide insights into the business process.
2) knowledge use. The new theoretical knowledge can be
used for analyzing, diagnosing and reorganizing the
business process.
3) knowledge transfer. Because of its codification, the new
theoretical knowledge can be easily transferred to other
people, or from one part of the organization to another
one.
The paper is organized as follows: in Section II we describe
three forms for knowledge conversion and the creation of
new knowledge about the treatment process in a hospital. In
Section III we illustrate how newly created knowledge can be
used. Our approach on the distribution of knowledge about
the hospital process is discussed Section IV. We conclude our
paper and provide directions for further research in Section V.
II. K NOWLEDGE CREATION
Patients who require the involvement of different specialties
are hardly a new phenomenon in health care. The number of
this patients is increasing because of the increasing special-
ization of doctors within the hospital and an aging population.
Studies in the Netherlands show that approximately 65% of
the patients visiting a hospital are multi-disciplinary [12].
Consequently, certain special arrangements have emerged for
these patients. For instance, some hospitals have special cen-
ters in which different specialties work together on backbone
problems. However, the specialties compounding these centers
are based on the specialist’s perceptions. In other words, they
may have a certain sensory knowledge about what specialties
should form a center, which eventually could be also supported
by some quantitative information (e.g. frequencies of visits),
but knowledge expressed in models or rules is missing. In
this paper we provide a method that allow medical specialists
to use explicit models as base for creating multi-disciplinary
units, in which different specialties coordinate the treatment
of specific groups of patients.
2
TABLE I
E XAMPLE OF VISITED SPECIALTIES IN FOUR MONTHS (JANUARY,
F EBRUARY, M ARCH AND A PRIL ) FOR PATIENT A AND B AND THE
CORRESPONDENT MEAN AND VARIANCE
Patient A Patient B
January I-I-D I-I-I
February I-I-I C-I
March - I-I
April I-D-C I-I-D-I-I
Mean (1/3, 0, 2/3)=0.3 (0,1/2,0,2/5)=0.2
Variance (1/3, 0, 2/3) = 0.11 (0,1/2,0,2/5) = 0.06
Patients with peripheral arterial vascular (PAV) diseases
(peripheral refers to the entire vascular system except for the
heart and brains) are a good example of multi-disciplinary
patients. One medical complaint can have many different
causes, one cause can have different manifestations and there is
complexity in cause and effect between pathologies. One of the
consequences of the complexity of expressing these patients
in medical terms is that the homogeneity of the underlying
treatment processes of these patients is low.
A logistic view on health service organizations comprises
the design, planning, implementation and control of coordi-
nation mechanisms between patient flows and diagnostic and
therapeutic activities. Patients with PAV diseases are grouped
on the basis of medical homogeneity, but unfortunately this
does not result in logistically homogenous groups. In [13]
we investigated whether groups of PAV patients, that are
homogeneous from the logistic point of view, can be build
in reality.
Given some criteria for selecting patients that can be con-
sidered PAV patients, records for 3603 patients have been
collected from Elisabeth Hospital from Tilburg, The Nether-
lands. The collected data refer to personal characteristics (e.g.
age, gender), policlinic visits, clinical admissions, urgency or
planned admission, visits to radiology and functional investi-
gations (for details, see [13]). Using these data, we show in
this section how new knowledge about the logistic process can
be created, employing three types of knowledge conversion.
A. Knowledge conversion
We obtain the knowledge needed by performing three types
of knowledge conversions:
i. raw data into coded knowledge,
ii. sequence data into coded knowledge,
iii. coded knowledge into theoretical knowledge.
1) Converting raw data into coded knowledge: Based on
existing logistic literature, the concept of complexity of the
underlying process has been operationalized by distinguishing
six aggregated logistic variables. Each of these variables has
been investigated as a potential (partial) measurement of care
process complexity. In other words, we express the concept of
logistic complexity in terms of codified knowledge.
The six aggregated logistic variables are presented below.
We used the following abbreviations: “I” represents Internal
medicine, “C” represents Cardiology and “D” represents Der-
matology.

(i) C dif visit: the total count (number) of involved spe-
cialties within the medical case. The assumption is that
the more specialties are involved, the more complex the
medical case is. Suppose that a medical case contains
a sequence of visited specialties as follows: I-I-C-I-D-I.
Thus, the logistic variable C dif visit = 3.
(ii) C shif t: the number of shifts within the medical case,
counted by the total number of visits to specialties within
the medical case. The assumption is that the more a
patient has to go from one specialty to another, counted
by the total number of visits, the more complex the
medical case. As an illustration, let us consider the
following example. Consider that patient A has a medi-
cal case that involves the following sequence of visited
specialties: I-I-C-I-D-I; C shif t will be computed as
the number of shifts divided with the total number of
visits, within the medical case, i.e. C shif t A = 4/6 =
0.6. Consider now that patient B has a medical case
where the specialties are in the sequence I-I-C-I-I-I-
I-D-I-I-I-I-I. Thus, C shif t B = 4/13=0.3. Patient A
is more complex than patient B, although both A and
B “changed” specialties four times. Thus, the more a
patient has to go from one specialty to another, counted
by the total number of visits within the medical case,
the more complex the medical case.
(iii) N visit mc: number of visits within the medical case
per time-scale. The assumption is that the more visits
per time-scale, the more complex the medical case. For
example, consider that patient A visited three specialties
in four weeks, whereas patient B visited three specialties
in twelve weeks. Subsequently, N visit mcA = 3/4 =
0.7 and N visit mcB = 3/12 = 0.2, consequently patient
A is more complex than patient B.
(iv) N shif t mc: number of shifts within the medical case
per time-scale, counted by the total number of visits
to specialties. The assumption is that the more shifts
per time-scale, the more complex the medical case. For
example, let be a patient A with a medical case that
involves the following sequence of visited specialties in
four weeks: I-I-C-I-D-I. Patient B visited the follow-
ing specialties in twelve weeks: I-I-C-I-I-I-I-D-I-I-I-I-I.
Hence, N shif t mcA = 0.6/4 = 0.15, N shif t mcB
= 0.3/12=0.025 and consequently, patient A is more
complex than patient B.
(v) M shif t mth: mean of number of shifts (counted by
the total number of visits to specialties) per month.
Within a medical case, for each month the number of
shifts (by the total number of visits to specialties) is
calculated, next the mean is computed. The higher the
mean, the higher the complexity of the medical case.
Suppose that patients A and B have the sequences of vis-
ited specialties in the months January, February, March
and April as shown in Table I. Because M shif t mthA
= 0.3 and M shif t mthB = 0.2, patient A is more
complex than patient B.
(vi) V ar shif t mth: variance of number of shifts (counted
by the total number of visits to specialties) per month.
Within a medical case, for each month the number
3
of shifts (counted by the total number of visits to
specialties) is calculated, next the variance is computed.
The higher the variance, the higher the complexity of
the medical case. As we can see from Table I, patient
A is more complex than patient B.
B. Converting sequence data into coded knowledge
1) Process discovery: To have a better understanding of
the treatment process for PAV multi-disciplinary patients, we
have to develop the process model for the logistic process.
A process model is a description using a formal language of
an actual or proposed process that represents the process ele-
ments or process tasks. Modelling an existing process is often
providing a prescriptive model, that contains what “should” be
done, rather than describing the actual process. Subsequently,
models tend to be subjective. A modelling method closer to
reality consists in using data representing the actual events that
took place. The desired outcome is to have process models that
are not biased by subjective perceptions or normative behavior.
Reversing the process and to collecting data at runtime to
support process design and analysis is a way to reach this
goal. The information collected at runtime, usually recorded
in a process log, is used to derive a model explaining the
events recorded. We call this activity process discovery (also
referred as process or workflow mining). A comprehensive
survey relating the workflow mining is presented in [14].
2) Petri nets: The classical Petri net is a directed graph with
two node types called places and transitions[15]. The nodes
are connected via directed arcs. Connections between two
nodes of the same type are not allowed. Places are represented
by circles and transitions by rectangles (or by vertical bars).
Figure 1 shows a Petri net consisting of 10 places and 12
transitions. Transition a has one input place and one output
place, transition f has one input place and two output places,
transition k has two input places and one output place. The
black dot in the input place of a represents a token, which
denotes the initial marking. The transitions, places and arcs
represent the structural dimension of a Petri net, while the
movement of the token from place to place represents the
behavioral or dynamic dimension of a Petri net. For more
details about classical Petri net see [16].
To illustrate the idea of process discovery, consider the
process log from Table II. This log abstracts from time, date,
and event type, and limits the information to the order in
which tasks are being executed. In this example, there are
seven cases that have been processed; twelve different tasks
occur in these cases. We can notice the following: for each
case, the execution starts with task a and ends with task l, if c
is executed, then e is executed. Also, sometimes we see task
h and i after g and h before g.
Using the information shown in Table II, we can discover
the Petri net process model shown in Figure 1. In this simple
example, the construction of the Petri net was straightforward.
However, in the case of real-world processes where much more
tasks are involved and with a high level of parallelism, the
problem of discovering the underlying process becomes very
complex.

3 h
f k
2 g
a 1
i d
b 4
c 6
Fig. 1. An example of Petri net
TABLE II
A PROCESS LOG EXAMPLE CORRESPONDING TO THE P ETRI NET FROM
F IGURE 1
Case number Executed tasks
Case 1 afghikl
Case 2 abcejl
Case 3 afhgikl
Case 4 afgihkl
Case 5 abcejl
Case 6 abdjl
Case 7 abcejl
3) Coded knowledge expressed as relations between tasks:
The method for constructing a Petri net process model from a
log file is based on finding the relations that can exist between
tasks. We refer to three type of relations, e.g. causal, exclusive
and parallel. For example, using the process log from Table II
corresponding to the Petri net from Figure 1, we identify:
1) a causal relation between tasks c and e: task e is always
directly following task c, but c never follows e;
2) an exclusive relation between tasks b and f : task b never
directly follows task f and f never directly follows task
b;
3) a parallel relation between tasks h and i: task h is
directly following task i and i is directly following h.
C. Converting coded knowledge into theoretical knowledge
Theoretical knowledge provides abstract knowledge ex-
pressed as causal and structural relations. This kind of knowl-
edge is necessary when taking important decision as re-
organizing and restructuring hospitals. People need first to
know and understand the process and second to be able to
transmit to other people this knowledge. By clustering the
aggregated measures described in Section II-A, logistic patient
groups result. These logistic groups are the base for developing
theoretical knowledge expressed as rules and Petri net process
models.
1) Theoretical knowledge expressed as rules for the de-
velopment of logistic patient groups: The six aggregated
measures described in Section II-A have been clustered using a
hierarchical clustering algorithm available in Clementine soft-
ware [17]. Two valid clusters are induced and we interpreted
them by using Quinlan’s induction algorithm C4.5rules [18].
Inspecting the induced rules, two clusters are identified: one
cluster with 7 rules that includes “moderately complex” PAV
patients, and another cluster described by 12 rules that covers
the “complex” examples. Examples of the induced rules are
4
8
5 i 7
10 l
o
9 j
e
given in Table III. For each rule we have performance informa-
tion, expressed as coverage and reliability. Coverage represents
the number of instances that matches the rule’s conditions,
and reliability represents the percentage of instances correctly
predicted by the rule.
For instance, if we look in Table III at Rule #1 for
the “moderately complex” cluster, there are 1943 examples
covered by the IF-part of this rule, and 99.9% of them actually
belong to the “moderately complex” cluster.
2) Theoretical knowledge expressed as Petri nets models:
In order to discover the underlying process of patients from
“moderately complex” and “complex” clusters, we have to
construct the corresponding process logs. We consider as
process activities the sequence of visits to different specialisms
(i.e. surgery, internal medicine etc.), functional investigations
and radiology departments 1 . A case for this process is the
medical case, i.e. a medical complaint relating a peripheral
arterial vascular problem. We build with the aid of medical
specialists a set of heuristic rules for splitting the patient’s
history into separate medical cases. A patient can have more
medical cases. The end result is a database with 4395 records
as medical cases of the 3603 considered patients. We build two
process logs for medical cases from “moderately complex”
and “complex” clusters and we applied the process discovery
method described in [19] to these logs. In Figure 2 (a) and
(b) the process models are presented for medical cases from
“moderately complex” and “complex”clusters, respectively.
D. New knowledge about multi-disciplinary patients
The obtained clusters provide us with insights into the
logistic process of multi-disciplinary patients.
1) Patient logistic groups: As general characteristics, pa-
tients from the “moderately complex” cluster have visited up
to three different specialists and show lower values for the shift
characteristics, while patients from the cluster “complex” have
visited more than three different specialists and the values for
shift features are higher (see also the rules from Table III).
There is also a remaining cluster that contains few cases that
cannot be grouped in none of the other two clusters, which
have been excluded from our analysis.
The reliability of these rules is very high, and supports
our interpretation that patients from cluster-1 are “moderately
1 In this case study we used the following codes for specialisms: CHR -
surgery, CRD - cardiology, INT - internal medicine, NRL - neurology, NEUR
- neurosurgery, OGH - ophthalmology, LNG - pulmonology, ADI - dialysis,
FNKT (FNKC) - functional investigations. RONT (ROEH, RMRI, RKDP,
ROZA) stands for activities performed at the radiology department.
 5

TABLE III
S OME EXAMPLES OF THE RULES THAT CHARACTERIZE CLUSTER -1 (“ MODERATE COMPLEX ” PATIENTS ) AND CLUSTER -3 (“ COMPLEX ” PATIENTS )

Rule number Rule description Coverage Reliability (%)

Rules for cluster-1 “moderately complex”
Rule#1 IF C dif spm ≤ 3 and C shif t ≤ 0.296 and N visit mc ≤ 0.506 and 1943 99.9
M shif t mth ≤ 0.101 and V ar shif t mth ≤ 0.042
THEN cluster-1
Rule#5 IF C dif spm ≤ 3 and C shif t ≤ 0.296 and N visit mc ≤ 0.506 and 1948 99.6
M shif t mth ≤ 0.224 and V ar shif t mth ≤ 0.039
THEN cluster-1
Rule#7 IF M shif t mth ≤ 0.074 2509 89.0
THEN cluster-1
Rules for cluster-3 “complex”
Rule#1 IF C dif spm > 3 and V ar shif t mth > 0.044 1017 99.9
THEN cluster-3
Rule#3 IF C dif spm > 3 and C shif t > 0.394 and V ar shif t mth > 0.01 905 99.9
THEN cluster-3
Rule#12 IF M shif t mth > 0.074 1886 91.5
THEN cluster-3

complex” and those from cluster-3 are “ complex”. Namely,
for “moderately complex” cluster, 6 out of 7 rules have the
reliability over 98.9%, only Rule#7 has a lower reliability of
89%. In the case of the “complex” cluster, 11 out of 12 rules
have the reliability over 97.9%, Rule#12 having a smaller
reliability of 91.5%. Inspecting these “low” reliability rules,
they are in line with our interpretation; Rule#7 for cluster-
1 states that patients from this cluster have M shif t mth,
namely the mean of number of shifts per month (counted by
the total number of visits to specialties) less than 0.074, while
Rule#12 says right the opposite (M shif t mth > 0.074),
which clearly delimits between “moderately complex” and
“complex” patients. These rules cover also many cases (Rule#7
covers 2089 instances and Rules#12 covers 1886 instances,
from a total of 4395 instances), thus the conclusion is that
such “low” reliability rules are also useful and they support
our interpretation of the two clusters.
2) Process models for the patient logistic groups: In order
to simplify the discussion of the obtained Petri net models,
we considered the most frequent activities, i.e., we selected
those events whose frequency divided by the frequency of
all events exceed the threshold of 0.01. In Figure 2 (a) we
show the discovered Petri net model using only medical cases
from the cluster “moderately complex” and in Figure 2 (b) the
discovered Petri net model using only medical cases from the
cluster “complex”.
We observe that in case of “moderately complex” med-
ical cases, on every possible path, at most three different
specialisms are visited, e.g. “CHR, INT” or “CRD, NEUR,
NRL” (the visits for functional investigations and to the
radiology departments are not counted as specialisms). Note
the existence of a place in case of CHR, CRD, INT and NRL
departments (remember that in the Petri net formalism, places
are represented by circles and transitions by rectangles), that
has the same transition as input and output. Although CHR,
CRD, INT and NRL are dead transitions (they need at least two
tokens to fire, but in the place with the same transition as input
and output it is not possible to be any token) and subsequently
these transitions cannot fire, our method indicates a possible
self loop. Such loops are very likely to occur, because these
specialisms are repeatedly visited.
In case of “complex” medical cases (Figure 2 (b)), three
or more specialisms are involved in each possible paths, i.e.
“CHR,CRD,INT”, or “ADI,CHR,INT,LNG”, etc. Note that
more specialisms are involved in the treatment process of these
“complex” medical cases, e.g., LNG, OGH and ADI are added.
To emphasize the visited departments that patients from the
cluster “moderately complex” (Figure 2(a)) have in common
with the patients from cluster “complex” (Figure 2 (b)), we
colored in grey the common Petri net nodes.
As summary, the knowledge we discovered corresponds to
the following points:
1) by grouping logistic variables, we obtained new theoret-
ical knowledge in terms of clusters, about patients that
differ from the logistic point of view.
2) by characterizing the logistic clusters, we obtained new
theoretical knowledge expressed as rules that distin-
guishes patients belonging to different clusters, along the
six logistic dimensions. Moreover, this characterization
provide knowledge about the relative importance of the
involved logistic dimensions. The rules indicate, for
instance, that N shif t mc may have a low importance:
it is never used in any of the rules in the rule set.
3) by discovering Petri net process models, we obtained
new theoretical knowledge at an abstract level. The
Petri net process model provided both structural and
behavioral insights about the process (e.g. the order
in which the departments are visited). Moreover, the
discovered Petri net process models for the “moderately
complex” and “complex” clusters confirmed the cluster
characterization (see the examples shown in Table III).
Namely, patients from the “moderately complex” cluster
have visited up to three different specialists, while
patients from cluster “complex” have visited more than
three different specialists (see Figure 2).
III. K NOWLEDGE USE
In this section we illustrate the use of the newly obtained
knowledge. For a better coordination of patients within hospi-

b
CHR CRD
FNKC
FNKT
NEUR
INT NRL RKDP
RMRI
ROEH
RONT
ROZA
e e
(a)
Fig. 2. The discovered process for cluster “moderately complex” (a) and “complex” (b) medical cases. The node labels have the following meanings: CHR
- surgery, CRD - cardiology, INT - internal medicine, NRL - neurology, NEUR - neurosurgery, FNKT (FNKC) - functional investigations. RONT (ROEH,
RMRI, RKDP, ROZA) - radiology
tals, there is the need to create new multi-disciplinary units, in
which different specialties coordinate the treatment of specific
groups of patients. According to our results, it seems that for
patients with peripheral arterial vascular diseases, two multi-
disciplinary units can be created. In case of “moderately com-
plex” cases, a unit consisting in CHR, CRD, INT, NRL and
NEUR would suffice. The “complex” cases would additionally
need in their treatment speciality like OGH, LNG and ADI.
We note that both clusters share almost the same functional
investigation and radiology departments.
Another requirement is the existence of adequate criteria to
select new patients for treatment in a multi-disciplinary unit.
Predictive rules can be developed, based on a-priori informa-
tion (age, gender and diagnosis) that assign a patient to the
most suitable logistic cluster, e.g. “complex” or “moderately
complex” (for details, see [13]). We may find a rule specifying
that if a patient has diagnosis ‘renal failure’, it is likely to
be a complex patient. This fact should be consistent with
our discovered models. Indeed, if we inspect the discovered
model from Figure 2, for “complex” medical cases, we note
the existence of ADI (dialysis department). Thus, when a
new patient comes to be treated in a multi-disciplinary unit,
knowing that he/she has renal failure (and consequently, he/she
needs to visit the ADI -dialysis- department), it is likely to be
a “complex” patient. Assigning the patient to this cluster, it
is also possible to know more about the patient’s future route
and to estimate what departments are likely to be visited and
in what order.
The discovered process models presented in Figure 2 leave
the impression that both processes contain tasks that occur
in parallel. This is likely to be the case. When treating
6
ADI
CHR
CRD
FNKC
FNKT
INT
LNG
NEUR
NRL
OGH
RKDP
ROEH
RONT
ROZA
(b)
multi-disciplinary patients, many possible combinations of
specialisms appear in the log, due to a complex and difficult
diagnosis process. Subsequently, it would be very difficult
to distinguish between groups of patients, without clustering
patients in different groups. This would come to lots of spent
resources, even when it is not necessary (e.g. for the multi-
disciplinary patients that are in the “moderately complex”
cluster).
IV. K NOWLEDGE TRANSFER AND CONVERSION
There are various forms of knowledge transfer, related
to the content of knowledge and to the S-C-T-distinction.
Concerning the content of knowledge, it is possible to combine
our proposed strategy providing support for people to analyze,
model and reorganize the hospital logistic processes with the
new knowledge that can be distilled from electronic patient
records and from so called diagnosis treatment combinations.
In the recently introduced electronic patient records (EPR)
illnesses, treatments, pharmaceutics and the medical histories
of patients can be used to further improve the logistic hospital
processes. This implies the transfer of knowledge content from
patient’s information to the logistic processes. This is transfer
from an individual patient level to the higher aggregation of the
logistic processes. Another possibility of the transfer of knowl-
edge content concerns the recently started experiments in the
Netherlands with diagnosis treatment combinations (DTC). In
DTC’s information about the diagnoses and the treatments of
patient are integrated in such a way that hospitals can predict
within ranges how long a patient given a certain illness will
remain in the hospital. This is important for the ease of the

patient as well as for a better use of hospital resources. Con-
cerning the transfer of types of knowledge the following two
issues are important. The first is that concerning EPR’s as well
as DTC’s much sensory knowledge - or behavioral activities
of doctors and nurses - concerning the medical domain has
to be converted into coded knowledge. EPR’s and DTC’s
are designed from theoretical knowledge about the medical
domain. The integration of sensory and theoretical knowledge
via codes continues, however with increasing resistance of the
medical profession. The basic remark is “you can’t mold all
of our medical behavior (sensory) into these structures (coded
and theoretical)”. The second kind of conversion concerns the
distillation of sensory, coded and theoretical knowledge from
EPR’s and DTC’s, which are about the medical domain, into
sensory and theoretical knowledge of the logistic processes.
The already mentioned clustering within the logistic processes
and the methodology we explained can be of help, but the
transfer of sensory and theoretical knowledge from the one
content domain to another completely different content domain
is very difficult. Using sensory knowledge in terms of best
practices and proven practices will furthermore strengthen
the improvement of the logistic processes. On one hand, the
knowledge that triggers important decisions should be very
transparent, understandable and easy to be checked by all
involved parties, because reorganizing an institution implies
difficult decisions and high costs. Therefore, through our
approach we tried to provide robust theoretical knowledge
of a highly abstract kind of the logistic hospital process. On
the other hand, the newly developed coded and theoretical
knowledge, transferred to people may even lead to a new
development in behavior, that is to say that the sensory knowl-
edge of people changes. In this context, we may speak about
the unforseen effects of the newly discovered knowledge.
V. C ONCLUSIONS AND FURTHER RESEARCH
In this paper we proposed the S-C-T strategy for mod-
eling and redesigning a business process, by employing the
knowledge categorization defined by Heusden&Jorna [1]. Our
strategy focuses on three essential KM activities: knowledge
creation, knowledge use and knowledge transfer. We illus-
trated our approach by considering the treatment process of
peripheral arterial vascular (PAV) patients. This is an example
of multi-disciplinary patients who require the involvement of
different specialties for their medical treatment. Consequently,
this leads to more efforts regarding the coordination of care
for these patients. The problem is to provide knowledge for
reorganizing the care for multi-disciplinary patients in order to
increase the care efficiency, that is to eliminate the redundant
and overlapping diagnostic procedures. The proposed solution
is the creation of new multidisciplinary units, in which dif-
ferent specialties coordinate the treatment of specific groups
of patients. The first component of this solution is to identify
salient patients groups in need of multi-disciplinary care. In
our particular case of multidisciplinary patients, we clustered
aggregated data and we found that peripheral vascular patients
can be shared in two distinct clusters, “complex” and “moder-
ately complex” patients, that can be embodied as a new piece
7
of knowledge. The second component of our solution is to find
those relevant specialties that will constitute the ingredients of
the multi-disciplinary units. In such multidisciplinary units,
the care for multi-disciplinary patients is not constrained
within single units. For identifying the specialties that form
the multi-disciplinary units, we built process models for the
treatment of “complex” and “moderately complex” patients,
by employing sequence data. We came to the process models
by a process discovery method on the process logs containing
the sequence of patient’s visits to different specialisms (i.e.
surgery, internal medicine etc.), functional investigations and
radiology departments. By constructing the process models
for “complex” and “moderately complex” patients, we do not
focus only on identifying the involved specialties, but we are
interested also on the order in which different departments
are visited. The new piece of knowledge expressed in Petri
nets process models can be effectively used for constructing
multi-disciplinary units.
The theoretical knowledge expressed in rules and Petri net
models, provides relevant insights into the logistic process and
may support the reorganization of the care process of PAV
patients. Our approach is meant to be more patient-oriented,
in the sense of reducing redundant and overlapping diagnostic
activities, which will consequently decrease the time spent in
the hospital and shorten the waiting lists.
We consider several directions for future research. First,
a-priori knowledge as age, gender, risk factors and relevant
secondary diagnosis are known the first time a patient enters
the hospital. Based on this information, a first prediction
could be made and patients could receive the proper treatment
faster. The recently started developments concerning electronic
patient records (EPR) and diagnosis treatment combinations
(DTC) will give more possibilities to improve the logistic
processes. Information within these data structures can be
used to inform the patient better about the medical issues and
about sequence of treatment that fits the individual level of the
patient and the aggregate level of the hospital the best. This
means that when more information becomes available through
time (as more steps in the process become known), a secondary
more precise prediction can be made. Then, as a second step,
this enriched set of a-priori information can be used to predict
the future path into the Petri net model. For example, patient
characteristics as smoker/no smoker may cause more often
visits to the lung specialist. Second, the obtained Petri net
process models can be analyzed whether they comply with
some correctness criteria, such as proper completion (e.g. no
work is left behind after the process has ended), no deadlocks
and infinite loops, etc. Being aware of such problems may
provide reasons to reorganize the process. Third, we intend
to carry out action research, in order to assess the efficiency
and effectiveness of the proposed approach. Fourth, the new
way of combining sensory, coded and theoretical knowledge
on the one hand and the medical and the logistic domain on
the other might renew the interest of knowledge technology to
complement the old rule based reasoning approach in AI with
the case based reasoning approach [20]. This may be seen as
speculation, but one worthwhile giving. It can be argued that
EPR and DTC are cases instead of only coherent rule sets.
 8

ACKNOWLEDGMENT Laura Măruşter is post-doc at the Faculty of Man-

agement and Organization at the State University
The authors would like to thank Arjen van Witteloostuijn of Groningen (RuG), The Netherlands. She has a
(Faculty of Economics, University of Groningen), for his background in Computer Science. She received her
useful and relevant comments and remarks regarding this B.S. and M.S. degrees from University of the West
Timişoara, Romania, and the Ph.D. degree from
paper. Eindhoven University of Technology, The Nether-
lands. Her research interests include knowledge
management, induction of machine learning and sta-
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