Co-Design of an Integrated Diagrammatic Systems Modelling Language (iDSML) to Facilitate Effective communication and problem solving in Healthcare Systems. (The ‘DIAGRAMS’ study).


The aim of this research was to design an integrated diagrammatic systems modelling language for describing healthcare systems. This was to facilitate communication and problem-solving in healthcare systems.

In order to achieve this the following objectives were addressed:

  1. A review of the academic literature and current practice for approaches to and theories for developing diagrammatic visual languages.
  2. Identifation of categories in the healthcare domain appropriate for representation in a diagrammatic language.
  3. Collections or elements of graphical objects appropriate for representing the defined categories based on theory and empirical observations were defined.
  4. Combinations of graphical objects to form the syntax of the diagrammatic language were defined.
  5. Case-studies to test efficacy of a new language based on defined measures of assessment.
  6. Development of a modelling process toolkit for using the language.
  7. Disseminatination of results in appropriate healthcare journals and conferences.

The basic assumption in the research was that healthcare practitioners and managers require a better approach to diagrammatically describing healthcare systems and processes. This led to the question;

Will a better diagrammatic modelling language help improve the design, quality and safety of healthcare delivery?


The research was Mixed Method Research. The design adopted a two-phase methodology employing a semiological framework (see figure 1) with a strong focus on design by the use of the inclusive design process at key stages.

Phase one

This comprised of three elements:

  1. A focused review of literature on approaches to systems modelling and representation and related theories
  2. The categorisation of the healthcare domain through the collection and analysis of healthcare process maps and focus groups with stakeholders.
  3. The development of the graphic objects (graphemes) and the “semantics” of the language.
  4. The formulation/development of the “syntactics” of the language using psychological experimentation.

Phase two

This focused on language validation and involved the application of the outcome of phase one (the developed language) in three NHS services and in-depth case-study interviews with the stakeholders. The services were:

  1. A community Learning Disabilities Service – North East Essex
  2. A group of five mental health services – East of England
  3. An Accident and Emergency Department – Addenbrookes
  4. Theatre processes in Addenbrookes

Key findings and outputs:


Komashie A, Mousavi A, Clarkson PJ, and Young, T. An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory IEEE Journal of Translational Engineering in Health and Medicine 2015 doi: 10.1109/JTEHM.2015.2400436. (PDF)

For a ‘BITE’ sized summary of the research, please see:

Bite Number 9 : Designing the “anatomy” of healthcare delivery systems: A focus on complexities in mental health –  May 2016

For further information on this project, contact Dr Alex Komashie at ak670@hermes.cam.ac.uk


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