Towards an Ontology for Health Complaints Management

André Oliveira

, Filipe Portela

1,2

, José Machado

, António Abelha

, José Maia Neves

, Suzana Vaz

Álvaro Silva

and Manuel Filipe Santos

Algoritmi Research Centre, University of Minho, Guimarães, Braga, Portugal

ESEIG, Porto Polytechnic, Vila do Conde, Porto, Portugal

ERS, Porto, Portugal

Keywords: Ontology, Complaints Management, Healthcare, Information System.

Abstract: The dissatisfaction of healthcare institutions users has increased in Portugal in the recent years. This fact can

be seen through the increase of complaints that the entity responsible in this country has been receiving lately.

More and more technical efforts has been done to understand and analyse this tendency. In this paper the

authors are proposing an ontology about the whole process of complaints management from healthcare

institutions. All the work was developed after analysing the entire process and the data collected by the entity

responsible with this matter in Portugal. The ontology developed can show the main concepts involved in the

process and the relationship between them. As main ontology entities are person, document, measure and

status.

1 INTRODUCTION

Nowadays the entity which is responsible for

complaints management in healthcare area in

Portugal collects a large volume of data every day. A

very large part of the data collected states real

problems being most of them associated to services

provided to the healthcare institutions users. This fact

results in a growing necessity of developing analysis

in this area by discovering an adequate answer to the

complaints in order to solve the problems and

improve the quality and efficiency of services

provided in healthcare units.

This article aims to explore and develop an

ontology focused on the health complaints

management area as a way to specify and organize all

the knowledge involved. In this study a formal

representation of all knowledge by structuring a

framework based in concepts and informational

classes involved in the management process and

through the semantic relationships between them are

proposed.

The development of this study is the first phase of

a project having as goal to develop real-time models

able to make automatically classification and

recommendations in the complaints management

system by exploring date and text mining techniques.

In this way in this phase an ontology about

complaints management that can be integrated in the

project previously referred was developed. This

ontology is capable of making an exactly translation

of the whole management process and at the same

time can be reutilized in similar projects.

The work were performed with the help of the

Portuguese Complaints management institution. The

ontology developed in now being implemented.

In order to fully understand the information in this

article, initially in Section 2 it is an analysis of the

state of the art which will be briefly spoken about the

institution that enabled the proper development of

ontology providing information about all the

complaints. In this section it is explained the process

and the various entities and concepts involved in the

process. This section also describes the ontology and

complaints concepts. Here some information about

where users can submit their complaints as a

constitutional right and why it is so important to

realize studies and analysis about complaints are

provided. To finalize this section the motivations that

lead experts to analyze complaints and the

contributions which they provide to the scientific

community are also discussed.

In the third section of this article a description of

the ontology is performed. This section starts with an

exact designation of the whole process involved in the

174

Oliveira, A., Portela, F., Machado, J., Abelha, A., Neves, J., Vaz, S., Silva, Á. and Santos, M..

Towards an Ontology for Health Complaints Management.

In Proceedings of the 7th International Joint Conference on Knowledge Discovery, Knowledge Engineering and Knowledge Management (IC3K 2015) - Volume 3: KMIS, pages 174-181

ISBN: 978-989-758-158-8

complaints management in healthcare units. As the

section name indicates the ontology is presented

specifically through the respective diagram, relying

on a description of all classes, concepts and properties

involved.

The fourth section is dedicated to discuss the work

and respective results. In this section is discussed the

relevance of the effort employed in this project as a

contribution to the scientific community and the

usefulness of the project in a real context domain.

After the discussion there is a conclusion section

where the last ideas about the work and the next steps

of this project are presented.

2 STATE OF THE ART

2.1 Complaints Management Entity

The entity involved in this project is a Portuguese

entity of public nature having the mission of regulate

all the activity developed by health care provider’s

establishments (Lobo, 2004).

This institution has the skills to cover the national

network of the health care public and private services.

Primarily concerned with the protection of user rights

and basic principles of public service, namely the

universality and equality of service access, safety and

quality of care (Simões, 2004).

In recent years, as part of its functions, this

organization has targeted the exercise of mainly

regulation in two dimensions: economic, to fix prices,

control the production in health establishments, and

on a social dimension, humanizing services and

monitoring the compliance of users rights (Relatório

sobre "A carta dos Direitos dos Utentes", 2011).

2.2 Complaints

According to the current legislation in Portugal, all

health care institutions users have the constitutional

right to pursue and formally complain about the

services provided, when they are not adequately

treated (Relatório sobre "A carta dos Direitos dos

Utentes", 2011). This system also can be used to

make a louvor. The complaints has not only the goal

to present the negative aspects but also can be used to

expose the most positive aspects.

All citizens as users of health care facilities have

the constitutional right to complain (negative or

positive) about the service or the way of they had been

treated. Effectively this right gives a clear and

perceptible response in health matter. It is one of the

majors concerns of the regulator entity. It is very

important to have a proper processing of all

complaints and expositions of displeasure by the

users. The main goal is allowing a better assessment

of the weak points of the national health system and

identify areas requiring further intervention.

In 2009, the regulator entity received a total of

7848 complaints related to health services, and most

of them were related to waiting times and quality of

administrative assistance and health care. Thus, the

claims are a good indicator of the response that the

people expects receive in health care facilities. The

complaints handling process, should reflect the needs

and expectation of users as well shall be in

accordance with the objectives of organizations

(Firmino, 2011). A correct management of

complaints clearly affects the sense of justice and

satisfaction of users, strengthening the bonds of

loyalty of users to the institution concerned. An

effective and efficient management of complaints

could result in organizational success on a highly

competitive market of direct competition, as is

observable in the health sector.

2.3 Ontologies

In recent years an increase use of ontologies was

observed, migrating from artificial intelligence (AI)

laboratories for the personal computers of experts in

the field (Gruber, 1993; Noy and McGuinness, 2001).

The concept of ontology has a Greek origin and it

was originally formulated by Aristotle being

described in philosophical Oxford dictionary as “[…]

term derived from the Greek word meaning “to be”,

but used since the seventeenth century to denote the

branch of metaphysics that means of what exists”

(Almeida and Bax, 2003; Blackburn and Marcondes,

1997; Guarino, Oberle, and Staab, 2009). Since then

the concept has generated a lot of controversy and

several authors have set out differing views on the

concept depending of the context in which it occurs.

Today ontology is treated as the “science of

being” and this definition also may lead to different

interpretations (Pisanelli, 2004). The Webster’s

dictionary defines ontology in two perspectives:

• The branch of metaphysics related to nature and

the relations of being;

• A particular theory of nature of be and all his types

of existence (Pisanelli, 2004);

In 20

century, the area of artificial intelligence

decided adopt the theme and plot their own

perspective and it is interpreted as a “specification of

a conceptualization” in the context of sharing

knowledge through data (Gruber, 1993; Pisanelli,

2004; Yao, Orne, and Etzkorn, 2005). It is possible to

Towards an Ontology for Health Complaints Management

175

verify that ontologies are constantly used in the field

of computer science, and in some ways they are seen

as a very particular and special type of informational

object or computational artefact (Guarino et al.,

2009). In that view, an ontology can be defined as a

formal and explicit specification of a shared

conceptualization, where formal specification refers

to something that computers are capable to read and

to explicit the concepts, ideas, terms, properties,

relationships, functions, constraints and axioms

explicitly defined. Conceptualization is an abstract

model of some phenomenon of the real world and for

sharing it we can understand an idea of consensual

knowledge (Borst, 1997; Morais and Ambrósio,

2007).

This is a technique characterized by defining a

common vocabulary for researchers who need to

share their knowledge and their discoveries in a

certain scientific field. Here it is included a definition

of a context interpretable by computers able to

characterize the core concepts of a field of study and

the relationships between them (Noy and

McGuinness, 2001).

Several authors claim that the reason for the

development of ontologies is directly related to the

sharing and reuse of knowledge by sharing the

understanding of the information structure used and

worked among software and people. However

ontologies also facilitates communication by

enabling humans and machines to make assumptions

about an explicit domain.

In practical terms ontologies define a language,

like a set of terms and concepts that will be used to

formulate queries or research information. The

ontology in this view could define the combination of

rules between terms and their relationships. These

relations are established by experts after intensive

study of the project area. Ontology users carry out

informational queries through specified concepts and

terms (Almeida and Bax, 2003; Morais and

Ambrósio, 2007; Obitko, Snásel, and Smid, 2004).

Increasingly, the branch of ontologies has been

proving its merit in the scientific community asserting

itself as an effective way for modelling data

collections within the user’s context. They can be

seen as a powerful and useful tool for presenting

overviews of a particular theme of study related to a

specific scientific area, formulating a rapid and

appropriate means for navigation and search of data

and information. In order to summarize the model of

concepts and relationships provided by ontologies, a

high level of abstraction is used. They provide to

humans a rich semantic level with the formality level

required to develop a processing and mechanical

reasoning through computers (Golemati, Katifori,

Vassilakis, Lepouras, and Halatsis, 2007).

The development of an ontology requires the use

of a specific vocabulary in order to describe a reality

as well as a collection of logical axioms to give

semantics to the intended meaning by the words of a

vocabulary. On the development of an ontology we

always need to use the following objects (Martins,

2002; Pickler, 2007):

• Entities, that describes concepts and are

responsible to give the logical representation;

• Attributes, that are responsible for describing the

properties of the entities involved;

• Relationships, that are responsible for describing

the connections existents between objects of a

model;

On the development of an ontology, Aldo

Gangemi (Gangemi and Presutti, 2009) defends the

existence of two kinds of ontologies, being the first

designed Coverage-oriented ontologies covering the

terminology, metadata or folksonomies respecting to

a specific domain and being the second kind designed

as Task-oriented ontologies. This type is able to

structure a knowledge base that can be used to answer

competency questions.

In the study of a specific scientific area must be

defined a perspective to use in a way to capture

knowledge or to identify the principles concepts that

will be used in the ontology and the relationships

between them. For that purpose there are three

approaches that can be used and integrated into the

knowledge capture activity being them the Top-

Down approach, the Bottom-Up approach and the last

the Middle-Out approach.

Currently more and more ontologies have been

developed for many different areas. One of the areas

where ontologies have been more prominent is

medicine, where it is focused on the representation

and organization of medical terminologies. Several

applications based on ontologies and their

perspectives have been developed in the health care

sector, and their benefits have been proved at the level

of development of information systems dedicated to

health. These systems are systematically more

powerful than before and they are more capable of

interoperability. At the level of medical patient data

the application of ontologies helped to improve the

transmission, reutilization and sharing process of

information, and also provided contributions in

statistics for many different purposes in healthcare

sector (Pisanelli, 2004).

Nowadays there are ontologies dedicated to the

specific area of costumer management and for

managing the relation with them having as a

KMIS 2015 - 7th International Conference on Knowledge Management and Information Sharing

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fundamental factor their level of satisfaction. Several

ontologies are actually focused on detection of health

problems and diseases for doctors, but there is not yet

a single ontology that can be capable of deal directly

with the area of complaints management in health

care units.

This type of complaints has a complete different

characteristic. The complaints are obtained from

simple commercial establishments of direct

transaction and distribution of products to the final

consumer. One of the main distinguishing

characteristics of complaints obtained from health

care providers units is the fact that in a simple

complaint the protestant can claim about several

aspects related to the attendance, to the service and

the infrastructure, as the waiting time and could be

also of medical aspects involving several different

areas of study.

3 ONTOLOGY DESCRIPTION

3.1 Problem Contextualization

As above stated, this ontology focuses its intervention

on the field of complaints management in healthcare

units. It was developed relying on the information

collected from the Portuguese institution responsible

for the regulation of complaints (Relatório sobre "A

carta dos Direitos dos Utentes", 2011).

Therefore and taking into account the concepts

and rules assimilated from many different articles and

studies focused in the field of ontologies, it was

extremely necessary during the development process

take into account two main perspectives: the first

perspective is related to the embodiment of this work

in developing an analysis system for complaints, from

the perspective of who provides data for the

informational ontology chain (protestant, complaints

respondent and the regulatory institution) and the

prospect of future utilization of this ontology by

experts from the scientific community on similar

projects.

The users of a health care services unit have

constitutional right to make a complaint (positive or

negative) of the service that was rendered them

always they feel the need to do so. For this valid

reason in all establishments (public or private) there

are always a requirement to submit the book of

complaints and it is mandatory to provide it to

customers freely whenever this book is requested.

The book in question is dedicated solely to receive

complaints, and has a unique structure being exactly

equal for all establishments in the Portuguese health

network. In this way when a client begin to formulate

a complaint on this book, this can be seen as the first

stage of the entire complaints management process.

The user of a health care unit who produces a

complaint in the book, is referred to this stage as the

Protestant and initiate the stage by the formulation of

the informative fields concerning with personal

information identifying the person who claims by

name, civil identification number, address and

telephone number. Then and still filling the

complaint, there is a supply of information relating to

the person or institution who suffers the complaint

and the Respondent. Finalizing the formulation he

writes information relying with the claim itself i.e.

writing the subject of the complaint choosing a

category or type to designate the document and

finally the writing of the text which the reason of

dissatisfaction / satisfaction of the Protestant that lead

to the formulation of the claim itself is explained. In

conclusion of this first stage it remains to say that

filling the complaints book is not the only way for the

Protestant presenting and sharing his claims about a

service, this action also can be done by writing the

complaint directly on the web portal (formulary is

equal to the book) of the institution that regulates

health care complaints in Portugal.

Posteriorly all the complaints are collected and

they are sent for analysis by the responsible

institution. The analysis process is conducted by a

detached agent of the institution, which oversees and

reviews all the information of the complaint He

determines whether it is well categorized. Then he

processes it into the institution system using the

Protestant and the Respondent personal information

and writing an informative synthesis of all complaint

subject.

After the complaints processing stage be

completed there is an analysis phase which the central

issue of the document is the complaint study. In this

phase a corrective measure to solve the problem

identified is created. It is communicated and shared to

the respondent of the complaint in order to solve the

problem.

If the measure outlined by the institution is well

applied by the Respondent the problem is solved and

the case is finalized. Then the complaint in matter is

officially archived. When the measure drawn is not

capable to solve the identified problem or do not

return the expected result, there is a communication

between the regulatory institution and the Respondent

of the complaint to study the reasons of why the

problem was not primarily solved or why the measure

was not adequate initially to the problem.

Towards an Ontology for Health Complaints Management

177

Figure 1: Taxonomy and Diagram of Major classes of complaints ontology.

Remains to be said that as soon as it starts the

processing and analysis phase of complaints is

assigned to every single one complaint a state related

with the conclusions of the preliminary analysis of the

document attributed by the detached supervisor agent

by the institution.

In figure 1 can be observed all the major classes

involved in the process of complaints management in

health care establishments and its relationships

previously described in this section of the article.

3.2 The Ontology

The ontology is basically a transcription of all

knowledge acquired in a particular field of interest,

i.e. it is a data model that aggregates several concepts,

terms and the properties which defines and determine

the exploration theme and specifies the various

existing relationships between them.

For the development of this ontology a Top-Down

approach was followed. First the most general and

abstract concepts were defined. Subsequently the

degree of specialization was increased.

This ontology reflects all knowledge acquired

over the area of complaints management in health

care establishments, and so on the main concept of the

whole study is the complaint. As can be seen in the

figure 2 this is the principal class of the ontology and

all other classes created are effectively subclasses of

this superclass complaints.

After this, we can see the existence of two level of

classes, the first is structured by the class document,

the class measures, the class status and finally the

class person. In the second level of classes the reader

can denote an increase of the degree of specialization

of the ontology related to the presentation of more and

more specialized classes restricting even more the

number of individuals involved in the problem.

This ontology diagram (figure 2) is composed by

classes, object properties and data type properties in

order to represent exactly the flux of data and the

principal terms identified in the process of complaints

management in health care institutions.

As previously referred ontology is the complaints

superclass. This superclass should have four

subclasses namely the class Document, the class

Person, the class Measures and the class Status.

The class Document was created with the

objective to reflect the first stage of the process of

complaints management. In other words this is the

phase where a person makes formally a complaint and

the properties that make up this class are related to the

categorization of the document, the description of the

complaint and the subject involved.

In the process of creation of a complaint the

Protestant has to decide the way that he is going to

present his claim and he has two ways: paper or

electronically. It was the reason to create two

subclasses of document, the class PaperComplaint

and the class OnlineComplaint.

The class Person was created by the fact that in

this ontology there are three classes that feature both

human resources in the process chain and

simultaneously they have similar data properties. In

this way the class person has as informational data

properties the name and the address of the person

involved in the process of complaints management.

On the second level of this class the ontology has

the class AgentSupervisor who is the person detached

by regulator institution for the analysis developed

about a complaint. This class has as properties the

activity developed by the agent and information about

his position inside the company.

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178

Figure 2: Complaints ontology diagram.

Another subclass of person is the class

Respondent, concerning with the person or entity

which the complaint is formed and focuses.

The last subclass of person is the class Protestant.

This class refers to the person whose felt dissatisfied

with the service provided or wants to thank to

someone or some care. This class has informational

properties of data as the telephone number of the

protestant or his nationality.

The next class presented is the Measure class

(figure 3). It is directly linked to the solution proposed

for resolving the problem found in complaint

provided by the regulator company. This class has

subclasses designed and related with the principle and

more commons measures.

Figure 3: Design of the Class Measures.

In this order of ideas the subclasses Measures is

composed by Internal Process Creation, Disciplinary

Process, Preventive Measures Implementation,

Corrective Measures Implementation and Ignore.

The properties of Measures class are related to the

adequacy of corrective measures outlined by the

agent who supervised the complaint and if it had the

desired effect or not and what state of the measure is.

In this particular case it is possible to observe that the

measures class is defined with the property analysis

date being this property of date time format. It is the

date that the measure was analysed.

Measure status as the name indicates refers to the

state that actually it is the measure, i.e. if the drawn

measure was effectively applied, if it was approved or

if it was rejected.

The following property is designed as measures

results. It is concerned with the result that the measure

have obtained after their application. This class also

have properties as application date relaying to the day

of application of measure.

Finally the last property measure is description

where it is detailed the resolution to the problem

identified in the complaint.

The last class is status (figure 4). This is a class

dedicated to the analysis of the complaint state. It is

characterized by four subclasses which all represents

a particular state that the complaint can have being

them the subclass Review, Filed, Redirect and

Ignored.

The main property of the class Status is called

StatusDate referring the date on which the regulator

agent classified the complaint status being this

property of type date time.

Towards an Ontology for Health Complaints Management

179

4 DISCUSSION

This ontology was designed in real context being all

the information necessary for developing it work

collected on the field. Therefore it reflects the main

concepts of the area of complaints management in

health care institution.

The development of this ontology fulfils all the

work goals. It provides an understanding of the whole

process of management and regulation of health

complaints and its interpretation is easily

understandable for experts in the field of ontologies.

It can be read by common people and for machine

interpretation fulfilling the purpose related to the

reuse of knowledge.

By the way this work was made with the help of

the entity responsible for the complaints management

in Portugal the ontology was designed in order to be

global and to represent what exactly happens during

the process. This ontology can be easily adopted by

any country and can be used for example by any

service / department provided by a hospital. Taking

as example the Centro Hospitalar do Porto, this

ontology can be adopted to make complaints in

maternity care (Abelha, et al., 2015), emergency

(Portela, et al., 2010) intensive care units (Portela F. ,

Vilas-Boas, Santos, and Rua, 2012) (Portela, et al.,

2014)(Portela et al., 2014), dermatology (Duarte,

Portela, Abelha, Machado, and Santos, 2011) and

others) and for many reasons: patient discharge

(Portela, et al., 2014), readmissions (Braga, Portela,

& Santos, 2014), nosocomial infections (Silva, et al.,

2015), triage (Cabral, et al., 2011), among others.

Figure 4: Design of the Class Status.

5 CONCLUSION AND FUTURE

WORK

This article presents an ontology applied to the field

of management complaints in health care units based

in real facts. For the development of this work it was

needed an intensive search and analysis of the

development of ontologies which was combined with

a study of the complaints management process with

the entity that regulate this issue in Portugal. For this

reason this paper demonstrates a very interesting

contribution to the scientific community because all

the work has real data daily collected.

In the developed ontology, a conceptual layout of

the entire knowledge in the complaints management

process was designed. It is easily to observe that the

most important concepts in this activity are structured

trough classes also being evidenced the relationship

between them. This conceptual layout demonstrates

an easy understanding of the existing information

flow in the area for both experts and researchers in the

field of ontologies as for ordinary people.

One of the main advantages that focused the

development of all work is the ability to use and reuse

the implicit knowledge in ontologies on similar

projects. The absolute objective that motivate the

development of work and the effort dedicated to the

project it is the use of information and the possibility

of using the information provided by ontology in data

and text mining project in order to study the

possibility of developing a system able to

automatically classifies and recommend a

categorization for the management of complaints.

In this sense the developed ontology is being

implemented in real context and its impact will be

studied. The integration of the ontology will be

studied an evaluated by ensuring their viability and

their contributions to both scientific community as

well as to the entity that regulates complaints from

health care establishments, which helped the project

from the start.

ACKNOWLEDGEMENTS

This work has been supported by FCT - Fundação

para a Ciência e Tecnologia within the Project Scope

UID/CEC/00319/2013. We would like to thank to

ERS by kindly providing the data.

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