Dynamic case management using decision modeling | Part 1

by Jordy Voesten

27/09/2016

The knowledge worker

In this two-part blog I’ll show you why and how decision modeling can empower dynamic case management.

Ever since Peter Drucker coined the term “Knowledge worker” back in 1969, the number of knowledge workers in our society has rapidly increased and the number of manual laborers has rapidly diminished. While manual labor could be vastly improved by automating processes, this was not always the case for knowledge work. In most knowledge work, the person doing the work needs some degree of freedom in order to achieve desired results. This opened up an opportunity for a different and less automated form of process management: case management.

Case management contains a degree of freedom required for successfully doing knowledge work. The case workers decide on the course of action based on the current context of the case. But in order to guarantee the quality of the work, some form of automation is also desirable.

Dynamic case management

Enter Dynamic Case Management – or advanced case management as it is also sometimes called. The key with dynamic case management is finding the right mix between autonomy and automation: where does the case worker decide - based on their knowledge - and where does the computer make the choice? Too much freedom for the case worker makes a business vulnerable for quality and service level fluctuations and too much rigid automation bogs the knowledge worker down. Decision Management can help you define exactly where one ends and the other begins (and simulate changing the boundaries).

The process a case goes through when handled is defined by its states. I’ll clarify this with an example from an insurance company.

When an insurance company receives a claim from one of its customers, a case is opened. This is the first state of the case: opened. After that the case can cycle through a number of states before it reaches its final closed state. In between that state can change to determine coverage, determine liability, determine claim amount, claim payed, claim denied, etc. If and when a case goes to another state is determined by its context. This context is the current view of the information that makes up the case: the current state, the claim details, the customer’s insurance policy, etc.

Decision Modeling

Instead of defining a fixed path for a case to follow, decision modeling is then applied at two levels: decisions that determine certain key business aspects in a case (for instance who is liable for the damage) and decisions that determine the case flow. Examples of the latter are deciding what the next state of the case should be, who should be the case worker for this case (caseload balancing), or which escalation level should be triggered for a case.

Defining case management using these type of decision models gives a business enormous flexibility in adapting the way cases are handled, without requiring IT change.

This alone is worth the effort of looking at decision modeling as an interesting solution, but I promised you something more. In the next part of this blog, I will dive deeper into the details of these models and show you how you can define the line between automation and freedom for the case worker.