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tion with Paradigm, thus contributing to verification
even further.
4 CONTRIBUTIONS
We contribute to the quality of medical teams by flex-
ibly integrating medical support systems into nonin-
vasive intervention activities.
Medical pathways for noninvasive interventions
exist today and we extend their organizational skele-
ton with more detailed, but flexible descriptions, as
provided by the Paradigm-McPal approach for self-
adaptive coordination. Thereby we follow the itera-
tive set-up of an ethnographic study, to improve our
understanding of applying highly agile coordination
embedded in clinical pathways. We conduct a de-
tailed study of medical work and use recorded rou-
tines to gather data about and acquire insight into
structuring medical knowledge work. Our findings
will be used to refine the coordination approach to-
wards highly agile medical team work, to be carried
out in conformity to relevant clinical pathways and
supported by well-integrated ICT systems.
In addition, this is related to coordination of
knowledge work in general, so it will lead to new
insight into knowledge work. We consider medi-
cal workflows and clinical pathways as a good em-
pirical case and starting point to address highly dy-
namic knowledge work modeling. By establishing
a bridge-head for understanding and supporting flex-
ibility within medical team work, we see great op-
portunities for generalizing such insight towards non-
medical fields.
ACKNOWLEDGEMENTS
This research has been kindly supported by the
EDAFMIS project in the framework of ITEA2.
REFERENCES
Andova, S., Groenewegen, L. P. J., and de Vink, E. P.
(2010). Dynamic consistency in process algebra:
From Paradigm to ACP. Science of Computer Pro-
gramming. 45pp, to appear.
Andova, S., Groenewegen, L. P. J., Stafleu, J., and de Vink,
E. P. (2009). Formalizing adaptation on-the-fly. Elec-
tron. Notes Theor. Comput. Sci., 255:23–44.
Barley, S. R. and Kunda, G. (2001). Bringing work back in.
ORGANIZATION SCIENCE, 12(1):76–95.
Campbell, H., Hotchkiss, R., Bradshaw, N., and Porteous,
M. (1998). Integrated care pathways. British Medical
Journal, 316(7125):133–137.
DOH (1997). The New NHS: Modern, Dependable. HMSO,
London.
Garlan, D. and Schmerl, B. (2002). Model-based adaptation
for self-healing systems. In WOSS ’02: Proceedings
of the first workshop on Self-healing systems, pages
27–32, New York, NY, USA. ACM.
Giaglis, G. M. (2001). A taxonomy of business process
modeling and information systems modeling tech-
niques. International Journal of Flexible Manufac-
turing Systems, 13(2):209–228.
Hunter, B. and Segrott, J. (2008). Re-mapping client jour-
neys and professional identities: a review of the liter-
ature on clinical pathways. International Journal of
Nursing Studies, 45(4):608–25.
Kramer, J. and Magee, J. (2007). Self-managed systems:
an architectural challenge. In FOSE ’07: 2007 Fu-
ture of Software Engineering, pages 259–268, Wash-
ington, DC, USA. IEEE Computer Society.
Lapointe, L. and Rivard, S. (2005). A multilevel model of
resistance to information technology implementation.
MIS Quarterly, 29(3):461–492.
Morrison, R., Balasubramaniam, D., Kirby, G., Mickan,
K., Warboys, B., Greenwood, R., Robertson, I., and
Snowdon, B. (2007). A framework for supporting dy-
namic systems co-evolution. Automated Software En-
gineering, 14:261–292.
Pinder, R., Petchey, R., Shaw, S., and Carter, Y. (2005).
What’s in a care pathway? Towards a cultural car-
tography of the new NHS. Sociology of Health and
Illness, 27(6):759–779.
Taylor, F. W. (1911). The Principles of Scientific Manage-
ment. Harper and Brothers, New York.
Vanhaecht, K., Bollmann, M., Bower, K., Gallagher,
C., Gardini, A., Guezo, J., Jansen, U., Massoud,
R., Moody, K., Sermeus, W., Zelm, R. V., Whit-
tle, C., Yazbeck, A., Zander, K., and Panella, M.
(2006). Prevalence and use of clinical pathways in
23 countries-an international survey by the european
pathway association. Journal of Integrated Care Path-
ways, 10:28–34.
Zander, K. (1991). What’s new in managed care and case
management. The New Definition, 6:1–2.
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