This chapter introduces the basic concepts of case management, including those aspects of case management that make it unique compared with other types of business applications. The relationship between case management and enterprise content management, collaboration, and business process management also are explored. Finally, the concept of case management solutions is introduced.

This chapter includes the following sections:

Case management was developed because certain business applications that are performed by knowledge workers require a great deal of flexibility, adaptability, control, and collaboration to achieve successful outcomes. Traditional Enterprise Content Management systems and the structured control of business process management (BPM) are insufficient to meet the requirements of these applications. In certain industries, such as healthcare, insurance, and the legal profession, case management is fairly well-understood. The case management approach, however, can be successfully applied to a broad set of business applications. Doing so gives knowledge workers and businesses the capabilities they need to achieve their business objectives.

Case management is built around the concept of processing a case, which is a collection of information and coordinated activities by knowledge workers or case workers. A case represents an entity that the organization must process and it is sometimes identified by having a subject, similar to the subject of a sentence or a narrative. The subject can be one of the following types:

A case folder is a container that allows workers to store and retrieve information that pertains to the case. It also tracks the tasks that are required to process the case.

A case management solution is the application of case management technology to a particular business problem in a particular domain. You can use case management solutions in the following scenarios:

For any case management solution, there can be many active cases. For example, the customer complaint management solution creates a case for each customer complaint. The term case instance is sometimes used to refer to these individual cases.

Case management solutions are knowledge-intensive. These solutions require case workers to coordinate data, tasks, processes, and services to achieve a positive business outcome. The case workers need a large degree of flexibility and adaptability to process the case. The requirement for flexibility makes these solutions difficult to implement in traditional Enterprise Content Management and BPM systems because most traditional implementations require predictable and repeatable processes. Cases are less predictable than traditional processes because the case worker judgment and experience influence how the case is handled, and therefore, the outcome. However, case management solutions also are repetitive, and therefore, require process support that makes it difficult to implement them by using only an Enterprise Content Management system.

Case workers are not the only individuals who interact with a case. A case participant might be a user who helps process and close a case. A participant also might be a user who performs management operations, such as assessments, audit, and outcome analysis. Management functions can be performed on a single case instance, or across many case instances. Case management solutions provide participants with views into the case that allow them to efficiently complete their assignments. However, not all the participants in a case need the same level of flexibility or access to the case. In most situations, one or a few knowledge workers control the case and other participants are restricted to performing well-defined activities. The participants who interact with a case can be organized by roles. For example, in a credit card dispute case solution, roles might include customer service representative, dispute agent, dispute supervisor, data clerk, and fraud investigator.

Implementing a robust and effective case management solution requires a software platform with a range of capabilities, including content management, process management, business rules, collaboration, and analytics. The solution must integrate seamlessly into the work environment of the case participants. The user interface must provide flexibility and allow a high degree of collaboration among the participants. For example, the interface must allow a user to dynamically add more tasks to a case already in process.

A case management solution must provide case workers with the full context of the case they are working on. This context is referred to as a 360 view of the case. In practice, case workers with enough privileges must have access to all the information pertinent to a case. This information includes history, documents of various media types, and content added by other case workers. In addition, the 360 view includes all the process information for the case. By having all the relevant information available, case workers can make better informed decisions.

Effective visualization of case information (including case history) is important to improve knowledge workers’ productivity. The ability to visualize how the case looked at the moment in which decisions were made, combined with the comments of the workers that took the decision, provides invaluable insights to other workers or supervisors.

Case management looks at repeatable business problems from the perspective of the knowledge workers, and it empowers the knowledge worker to solve those problems. It does so with a flexible solution that bundles the case information, documents, rules, and all the tasks that might be required to solve the business problem.

Case solutions are goal-oriented, but a business goal can be achieved in multiple ways, and not all of them can be predetermined. Therefore, case workers require the flexibility to decide how the goal is achieved. The focus of a case management solution is the goal-oriented nature of the problem being solved. All the detailed aspects of the solution work to achieve that goal. Whether it is a rule, document, task, or a group of data elements, these characteristics all work to help bring the case to its end state.

This focus is where the uniqueness of a case management solution originates. The goal-oriented approach, in case solutions, is different than that of traditional BPM solutions, which focus almost exclusively around process. The focus around a case and its interactions with data, rules, content, and processes is the complexity that differentiates them.

The concept of a goal-driven case solution is to bring focus on what is needed to be done to a case. A case is to be processed, completed, paid, or resolved. The data, rules, and activities that are identified exist to support this end goal. Although the case constructs are defined, each individual case instance has enough variability that a knowledge worker judgment is required to manage the case to its end state.

For example, in a credit card dispute case, the business goal is to resolve the dispute. Although each case instance has the same goal, the outcome of each case can be different. In the credit card dispute example, some disputes end with the merchant returning money to the customer. Other disputes end with the customer maintaining the charge on the credit card, the bank fixing an accounting mistake, and so on.

In this example, each case is completed with a different outcome, but all of them met the same business goal of solving the credit card dispute.

A case management solution is designed to provide the tools to solve a repeatable situation. In a credit card dispute resolution, the situation is customers who are disputing charges to their credit cards. Although all of the processing patterns are similar, each dispute is different enough to present a certain level of unpredictability in the process.

The overall case design might look similar, but the case worker must react to new information in ways that cannot be predetermined. New information can change the outcome of a case in ways that can be determined only by the case worker.

However, not all aspects of a case are unpredictable, and so IBM BPM technology can be used to model the predictable aspects of case solutions. These predictable aspects of the case processing can be encapsulated into process fragments that can be used as part of the toolset that case workers use.

Case management recognizes that a business goal can be achieved in multiple ways, not all of which can be predetermined. The path that follows from the start of a case to the completion of that case can be different for each case instance. Not all activities or steps that are required to complete a case can be known when you design the case solution. For the known activities, the order of execution might be unknown.

The reason IBM BPM and Enterprise Content Management technologies are insufficient for implementing case management is that cases are knowledge-intensive, which requires the judgment of case workers. Therefore, the outcome of the case depends more on human judgment than on the underlying technology. The technology, however, must support the case worker by providing the tools that are needed to advance the case to its resolution. It cannot replace the judgment of the case worker, and should not unnecessarily constrain the actions of the case worker.

Although the outcome of the case depends on case worker judgment, case workers cannot arbitrarily decide the fate of a case. Case workers must justify their decisions and collaborate, as necessary, to reach those decisions. The case management solution must support this knowledge-intensive activity by providing the tools and facilities to help the knowledge workers accomplish their work. At the same time, it must provide the persistence, history, tracking, and monitoring that is needed to justify and audit case worker actions and decisions.

Case and process modeling are separate. Modeling is the definition of the solution. It uses a tool to describe the solution that must be run to the system. The tool is normally called a modeling or design tool, and the model is the human readable output or printout that is produced by the tool. The IBM BPM process modeling is well-understood and formalized by standards, such as the Business Process Modeling Notation (BPMN). Case management has not been studied as long or as deeply. However, there is an effort underway at the Object Management Group (OMG) to define a modeling notation that is called Case Management Modeling and Notation (CMMN). This notation is in beta status. CMMN helps clarify and formalize case management modeling.

From a modeling perspective, case modeling focuses on knowledge worker needs. It allows the person who is modeling the case to define the tools that are needed to complete a case. Those tools can be modeled as tasks, which can be process fragments. The modeling of cases focuses on what must be done to complete a case instead of how it is done. Tasks in a case then describe what must be done. Not defining the how gives the case workers more flexibility to decide the best tasks for a particular case instance.

IBM BPM models focus on the activities that are required to achieve the business goal and the efficient ordering of those activities. Therefore, IBM BPM models describe how the processes are done, in addition to what must be done.

For the case model to achieve a balance between formal and informal processes, the formal processes are broken into process fragments. This concept is the case task, which corresponds to a process fragment, but also might be implemented with other non-BPM technologies.

Tasks break the model of cases into two levels of abstractions. A task represents a higher level of abstraction than process and describes “what” must be done. A task also can describe “why” it must be done. For example, a task to review a customer’s application must be done if a new customer application is received. This concept allows the person modeling the case to model at a higher level of abstraction and avoid describing the details of “how” a task must be done. When you model a case, you are trying to answer the “what” and “why” questions by using tasks. In contrast, when you model a IBM BPM process, the designer answers the “what”, “who”, “when”, and “how” questions.

The implementation of the task details corresponds to the lower level of abstraction. Implementation might involve modeling a process fragment where you answer the what, who, when, and how questions. However, it also can be implemented by other technologies or applications.

Figure 1-1 shows the IBM Case Manager case task page with a model of a case that contains seven tasks. Tasks are not connected with lines as they are in traditional IBM BPM systems because there is no execution order between them. The tasks are designed as tools for the case worker.

Most case solutions require knowledge workers and routine workers. Routine workers are sometime called heads-down workers, and are assigned repetitive work that requires little judgment. Routine workers are suited for data entry applications, such as scanning correspondence, and certain types of IBM BPM applications.

In processing cases, organizations must manage the use of routine workers and knowledge workers assignments. Most organizations manage the two pools of workers separately, and separate routine workers roles and knowledge workers roles. The concept of role allows organizations to fulfill those assignments by moving workers between the roles, or having workers who are assigned to multiple roles. Roles allow managers and supervisors to quickly and easily move resources where they are needed.

Case management solutions have a primary focus on the data around the case and what is needed to complete it. In a IBM BPM solution, the focus is on the process and what is needed to complete it. The confusion at times comes when the case uses a defined process. The use of these defined processes (which can use IBM BPM) is needed within the case solution, but is not the focus of the solution. The processes are short lived and achieve a specific purpose, such as obtaining specific information, processing a rule, gaining approval, asking for input, or updating other systems with decision.

Case management and business process management solutions have the following key differences:

Case management solutions are considered partially repeatable, which means that much of the processing is repeatable, but not entirely. The business goal is always the focus, but the path to accomplish it is non-deterministic. The tasks might or might not be performed, which is different from traditional IBM BPM. Case management recognizes that many solutions cannot be fully described in a IBM BPM system because of one or more of the following factors:

There are several technologies that provide process functionality. These technologies go from formal, structured processes at one end of a spectrum to informal processes at the other. Formal processes were called production workflow in the 1980s, and today are implemented by IBM BPM systems. These solutions also are referred to as process-centric.

A formal process encodes the business goals the process is designed to accomplish, which gives the IBM BPM system full control over the business goal. Formal processes might not have any human intervention. If they do, the participants on the process do not need to know the business goal. If the participants run their assigned activities, the IBM BPM system ensures that the business goals are achieved.

The IBM BPM system is in complete control, which allows vendors to provide a full suite of functions to model, track, monitor, and manage the processes. The process can contain business rules that change the execution path of the process, but the path that is taken is always modeled.

At the other extreme of the spectrum, informal processes were called ad hoc workflows in the 1990s. They evolved into collaborating technologies, including email and instant messaging. The informal process is not modeled and cannot be easily tracked by the system. The participants in the process must agree on and understand the business goal and have enough information about how to achieve it. There is no process to follow, and the system does not know when the goal is achieved or when the process is started. These types of processes and technologies are useful for non-repetitive and one-of-a-kind assignments that do not need to be tracked or audited.

Case management tries to achieve a balance between formal and informal processes by formalizing parts of the process. These parts are called process fragments or tasks. In addition, the system is aware of when the case starts and when it finishes so it can track and monitor the cases. In a case management system, the case workers are in control of how cases are processed. However, they do not need to know all of the details about how to achieve the goal, and the system can detect when it is achieved. The process fragments and tasks are available as tools for the case worker to use.

Figure 1-2 shows aspects of the process spectrum and positions case management against formal and informal processes. It does not cover all aspects of case management, but it includes some of the aspects that are common with business process management.

One aspect that is not shown in this figure is management and control. Within a case management system, this is an overarching aspect of a solution. For example, as shown in Figure 1-2, the line is drawn between “Process History important for auditing” and “Documents and recordings are critical to justify decisions” separating the nature of formal and informal processes. In contrast, case management has an overarching view on both sides of the spectrum concerning the case.

During the processing of a case, multiple documents can be produced and used by the various participants who interact to solve the case. Documents are a key part of any case management solution because knowledge workers depend on documents to complete their tasks. Case workers are no different, and so, while resolving a case, multiple documents can be created and used. These documents can be emails, text documents, spreadsheets, voice recordings, images, video clips, presentations, and others. All this information must be stored and organized as part of the case. This process requires cases to have a flexible and familiar containment mechanism, similar to a folder structure in a file system.

However, a typical file system is not flexible enough to store case information. For example, a document might be used simultaneously in multiple cases, and therefore must be in each case folder. A change to the document must be reflected in all the cases. It also is important that metadata, version, and security are maintained so the complete history of the case is kept current and traceable.

These requirements are achieved in case management solutions by using an Enterprise Content Management system to implement a case folder to collect the information that is related to the case. A case folder (and all its contents) is maintained after the case is complete for legal and compliance reasons. The retained case also can be used in future cases or for analysis across cases. A well-designed case management solution must include the design of the content management aspects, such as folder organization and document types, including metadata.

The amount of information or documents that is required to complete a case can be different for separate instances of the same case solution. Certain cases require more documentation or investigation than others, which means that cases can have different amounts of information. This complexity translates into case information complexity, which requires high levels of organization. Case documents and information are normally organized in a hierarchical containment structure that is similar to a traditional folder structure called a case folder. For example, a customer dispute case might have a folder structure as shown in Figure 1-3 on page 16. The folder structure is populated with the documents and files that are required to solve the case.

A case can contain multiple documents of various types. To manage these documents, you must associate metadata with them. You also need content and metadata search capabilities. Finding information in a case is different from finding information in a database because that information might be inside documents that are stored in the case file. Case workers must easily find the information that they need to work on the case, even if it is buried inside documents. Enterprise Content Management systems make it easier to work with this complexity of information.

The need to find case information is not important only for case workers who handle a single case instance. It also is important for participants, such as managers or analysts who deal with aggregations of case instances. These participants must extract patterns from case information. For example, they might want to determine the frequency that a particular pattern occurs in a collection of cases. In the credit card complaint solution, a manager might want to find the percentage of complaints that are filed for a particular product or a particular merchant. This information might be present only in the documents or emails that are contained in the cases.

By using an Enterprise Content Management system to store case management content, including information and documents, you can maintain fine-grain access control over the information. It is common for cases to deal with sensitive information, so these documents must be protected from unauthorized access. In certain scenarios, even those working on the case should have limited access to the case information.

Case information is long-lived and can be subject to the lifecycle of content objects in an Enterprise Content Management system. In particular, when the processing of a case is completed, all of the case information remains and is still available for users with the correct security privileges. Therefore, cases can be reopened for processing or auditing, if required.

Case information, including history and documents, can have regulatory compliance retention requirements. Cases often are implemented as a case folder (see Figure 1-3 on page 16) to collect all information and documents that are related to a particular case instance. The case folder is retained after case completion. Retaining case folders allows future cases to use the existing case information, and facilitates compliance with legal and regulatory requirements.

 

For example, certain documents might need to be retained for five years, whereas others must be retained for 10 years. The case management system must enforce these regulatory compliance policies and satisfy audit requirements. Even when regulatory compliance is not required, the retention of case information is important for auditing purposes.

Case workers not only need information about the case to make decisions, but must collaborate with other participants in the case. Most of this collaboration is through the documents and information that is contained in the case folder. These items include case notes, extra documents that are added to the case, and decisions that are made. Other collaboration can occur through case worker communication. Case workers must communicate with others who are working the same case through case notes, instant messages, email, and phone conversations. Technology supporting a case management solution must provide these types of collaboration technologies. It also needs the capability to maintain the collaborations as part of the case folder for case resolution and audit purposes.

Case management recognizes that not all the tasks, steps, or activities of a solution can be predefined. Therefore, case worker judgment and collaboration are used to resolve the case. In certain case solutions, negotiation and collaboration between case workers can be more important than imposing a fixed set of activities in a particular order. However, too much negotiation and collaboration can slow down the resolution of a case. Therefore, a balance must be achieved. In many situations, experienced case workers can achieve the correct balance. In other situations, business rules and analytics in the form of decision support can be used to help strike the correct balance.

A case management solution provides the software environment for case workers to collaborate on the completion of cases. The solution can be modeled and deployed by using a case management system. The solution is implemented by using multiple technologies that include Enterprise Content Management, collaboration, business rules, IBM BPM, and others. A case management system is used to bring all of those technologies into a coherent framework.

Although the case is the focus of a case management solution, the solution might be composed of multiple types of cases. For example, a customer complaint solution might have multiple types of complaints, depending on the product or service the customer is complaining about. Each type of complaint can be slightly different and can be managed by a different type of case worker. Therefore, a solution often is composed of one or more types of cases.

Case management software solutions are appropriate for situations in which the work that must be accomplished is goal-oriented, knowledge-intensive, and highly collaborative. These types of solutions are based on documents, such as emails, faxes, pictures, and videos. These documents are required for the knowledge workers to make decisions that are based on their judgment. Case management provides the tools and collaboration environment for the knowledge workers to complete their cases.

Case management solutions also are appropriate for work that involves complex decision making by knowledge workers that is based on the information and documents that are associated with case instances. Typical applications include exception handling, complaint or dispute management, contract management, lending applications, benefits enrollment, invoice processing, change request, and incident reaction. These types of solutions require the integration of capabilities from multiple technologies that include content management, IBM BPM, collaboration tools, social software, business rules, and analytics. The case paradigm is applicable in multiple industries and environments that include insurance, banking, healthcare, government, and utilities.

A case consists of a collection of information that is used to achieve a business goal. The first step in designing a case management solution is the identification of this information. This information is in addition to the folders, documents, and tasks. The case data defines what is needed for the case to be processed. This data can come from a number of sources, forms, documents, external systems, and user input. After it is collected, this data is maintained throughout the lifecycle of the case to allow the knowledge worker to process the case through completion. In addition, it should include data that is relevant for reporting and processing (tasks).

A clear understanding of the data and its source is needed to design the solution. Understanding when and where to obtain the data, and how and where to update it is important. The data processing might be by a business task, a data entry window for the case worker to complete, or by external systems. In all cases, you want to keep the case data in the case folder for processing and archival purposes.

The natural way to organize case information is to use a case folder in an Enterprise Content Management system. The case folder can contain a folder structure with subfolders that contain documents, history, and other information that is used to process the case. In general, the case folder contains all the information that is used to process and manage the case.

The case folder provides the context for the case workers to do their work. The information that is contained in the case folder can be categorized into the following types:

This collection of diverse and rich information is important to maintain in a central place for case consistency and integrity. That central container is the case folder. Having the case folder in an Enterprise Content Management system provides the governance, lifecycle management, searching capability, archival integrity, and security that is required. Case information is long-lived; therefore, after the case is completed, the case folder and its information can be maintained in the Enterprise Content Management system for future reference.

Cases must react to what is happening in the case folder so new tasks can be run. New tasks might be needed when documents are added to the case, case properties are modified or based on case actions. Case workers in the correct role and with enough security privileges can view the state of the case tasks. These case workers also can disable, run, and add new tasks to the case.

Figure 1-4 shows the basic functions of the case folder.

In a case management solution, tasks are tools the case workers use to process a case. The case worker or workers in charge of a case must decide which tasks must be run to complete the case. Depending on the modeling of the case solution, tasks might be started by the system or classified as required or optional. A case worker with enough privileges can start, disable, or add tasks, depending on the requirements of the current case instance. Figure 1-5 on page 21 shows the interface that a case worker can use to interact with the tasks in a case solution that is implemented with IBM Case Manager.

 

Well-known tasks can be defined as part of the modeling of the case solution. (Figure 1-1 on page 9 shows an example of such a model.) However, not all of the tasks are understood at modeling time. The case workers can add tasks when they are working a case. In case modeling, tasks introduce a higher level of abstraction than the process fragments. During the processing of an actual case, tasks introduce a higher level of control. Case workers with the correct privileges can see and control the tasks by using an interface similar to the one that is shown in Figure 1-5. Other case participants see work to be done in their role or personal in-baskets and might not have access to the high-level tasks. Tasks are not assigned to people; however, personnel assignments can be done in the process fragments implementing the tasks.

Tasks can be nested and composed of other tasks. Tasks that contain other tasks are called container tasks. These tasks allow business analysts to organize case solutions into sets of tasks that might be required at different phases of the case.

Neither Enterprise Content Management systems or BPM systems use tasks as implemented by case management systems. Therefore, flexible case solutions that use the task concept can be implemented only by using a case management system.