Sample Decision Record
What gets preserved, forever.
Below is an anonymized record from one of our design-partner health systems. Every assumption, stakeholder voice, and review event is part of the permanent decision archive.
Med-Surg patient handoff workflow — pause for readiness gates
Problem
In Medical-Surgical and Telemetry units across both campuses (340 beds, ~120 nursing staff per shift), nurse managers spend 4+ hours per week manually reconciling patient handoff documentation across three disconnected systems, leading to delayed care transitions and an 18% error rate in shift-change orders. Estimated cost: $1.8M annually in avoidable length-of-stay.
Justification
All four leaders agree this is critical, but two readiness gaps must close before we commit resources: (1) the training plan cannot start until the union scheduling window opens next quarter, and (2) night-shift handoff mapping is incomplete. Recommendation is to use the next 6 weeks to finish observation studies and negotiate a training timeline, then reconvene for a go/no-go.
Explicit assumptions(append-only after lock)
- A1Epic Handoff module can be activated without re-licensing or vendor re-engagement.
- A2Union will agree to a training window in Q3 once the scheduling cycle opens.
- A3Night-shift workflow is structurally similar enough to day shift that observation findings will generalize.
- A4No new sentinel events will occur during the 6-week observation period.