Make every clinical handover safe, fast, and auditable.
Governance and interoperability that follow the patient across organisational boundaries. Not a platform. Not a workflow tool. The substrate that makes accountable handover possible.
Handover is where healthcare fails.
Every time a patient moves between settings, teams, or systems, the governance that should accompany them does not. Identity is re-established. Consent is assumed. Provenance is lost.
Identity is re-established
Patient identity confirmed at registration becomes uncertain by the time they reach the ward. Systems do not share identity assurance.
"Which John Smith? The one from A&E or the surgical referral?"
Context does not travel
Clinical reasoning captured in one system is invisible to the next. Decisions are made without the full picture.
"The GP letter mentioned something about allergies, but it is not in our system."
Responsibility is assumed
When a patient transfers, who is responsible? The answer is often unclear until something goes wrong.
"I thought the ward had picked up the referral. They thought we were still managing."
The Seven Flows
Seven governance flows define the conditions under which clinical data and responsibility may move safely across systems. These are not workflows. They are invariants.
Identity
Identity must be verifiable across organisational boundaries before responsibility can safely transfer.
Trusted identification of patients, practitioners, and organisations. Without verified identity, every downstream action inherits uncertainty.
What it governs
Patient matching across systems. Practitioner authentication. Organisational trust relationships. Device and system identity.
Why it exists
Misidentification is the root cause of wrong-patient errors, duplicate records, and attribution failures in clinical audit.
What it guarantees
Every action can be attributed. Every record can be matched. Every actor is accountable.
What breaks without it
Medication administered to wrong patient. Results filed to wrong record. Responsibility becomes unattributable.
If identity fails, no downstream control can restore attribution.
Consent
Consent must be explicit, current, and portable for data or action to remain legitimate as context changes.
Dynamic, granular consent that travels with the data. Not a one-time checkbox, but a continuous evaluation of permission.
What it governs
Data sharing permissions. Research participation. Third-party access. Cross-border transfers.
Why it exists
Static consent captured at registration cannot anticipate every future use. Consent must be evaluated at the point of action.
What it guarantees
Data is only used within the bounds of patient permission. Consent decisions are auditable.
What breaks without it
Data shared without permission. Legal exposure. Erosion of patient trust in digital health.
If consent fails, every subsequent data use is legally indefensible.
Provenance
Clinical data must carry its origin, method, and integrity state for decisions based on it to be defensible.
Complete lineage of every piece of clinical data. Where it came from, how it was transformed, who touched it.
What it governs
Data origin tracking. Transformation history. Copy and derivative management. Source verification.
Why it exists
Clinical decisions depend on data trustworthiness. Without provenance, reliability cannot be assessed.
What it guarantees
Every data point can be traced to source. Transformations are documented. Trust can be verified.
What breaks without it
Decisions made on unreliable data. Audit failures. Inability to investigate adverse events.
If provenance fails, no downstream control can restore trust.
Clinical Intent
Clinical intent must be explicit and preserved across systems to distinguish deliberate care from incidental activity.
Explicit recording of why clinical actions are taken. The reasoning that connects data to decisions.
What it governs
Clinical reasoning capture. Decision documentation. Referral justification. Treatment rationale.
Why it exists
Actions without documented intent cannot be audited, learned from, or defended.
What it guarantees
Every clinical action has recorded reasoning. Decisions can be reviewed and improved.
What breaks without it
Audit gaps. Inability to improve clinical pathways. Medicolegal exposure.
If intent fails, clinical actions become indistinguishable from administrative noise.
Alert & Responsibility
Alerts must have an explicitly assigned owner for responsibility to exist; unowned alerts are latent risk.
Explicit transfer of clinical responsibility between practitioners. No ambiguity about who is accountable.
What it governs
Responsibility handoffs. Alert acknowledgment. Escalation chains. Coverage arrangements.
Why it exists
Verbal handoffs fail. Responsibility gaps kill. Every transition needs explicit acceptance.
What it guarantees
Clear chain of responsibility at all times. Alerts reach the right person. Handoffs are acknowledged.
What breaks without it
Patients fall between cracks. Critical alerts missed. Responsibility disputes after incidents.
If responsibility fails, harm occurs without anyone accountable for preventing it.
Service Routing
Clinical activity must be routed to services that are authorised, appropriate, and accountable at the point of execution.
Clinical criteria determine where patients go. Routing based on need, not availability or convenience.
What it governs
Referral routing. Service matching. Pathway selection. Specialist allocation.
Why it exists
Capacity-driven routing ignores clinical need. The right patient must reach the right service.
What it guarantees
Routing decisions based on clinical criteria. Appropriate service matching. Auditable allocation.
What breaks without it
Wrong specialty referrals. Delayed care. Patients bounced between services.
If routing fails, care reaches the wrong hands regardless of how well other flows perform.
Outcome
Outcomes must be observable and attributable for learning, assurance, and accountability to function.
Systematic capture of what happened. Closing the loop so every intervention can be evaluated.
Why it exists
Without outcome data, healthcare cannot improve. Every intervention needs measured results. Every flow before this one exists to make outcomes possible.
What it enables
- Interventions can be evaluated.
- Effectiveness can be measured.
- Learning can occur.
- Value can be demonstrated.
Outcome is where governance becomes visible to the outside world.
What breaks without it
No basis for improvement. Ineffective treatments persist. Value cannot be demonstrated. Assurance becomes assertion.
If outcome fails, no preceding flow can demonstrate that value was delivered.
From implicit to governed care
Implicit Care
- Identity assumed from context
- Consent captured once at registration
- Data copied without lineage
- Access permitted without stated purpose
- Responsibility transferred verbally
- Routing driven by capacity
- Outcomes recorded inconsistently
Governed Care
- Identity verified at each transition
- Consent evaluated dynamically
- Provenance maintained through transformation
- Intent recorded and auditable
- Responsibility transferred explicitly
- Routing governed by clinical criteria
- Outcomes captured and fed back
Same governance substrate, different operating models
Private insurers and providers face the same governance gaps as NHS organisations. Patient journeys cross multiple providers. Claims require clinical evidence. Post-procedure recovery happens at home.
- Cross-provider governance for insurer networks
- Claims-aligned clinical evidence trails
- Remote monitoring with explicit responsibility chains
Start where you are
Governance infrastructure is adopted incrementally. No rip-and-replace. Start with one flow. Prove value. Extend.
Discovery
Map your current handover points against the Seven Flows. Identify where governance is implicit, absent, or failing.
First Flow
Implement governance for your highest-priority flow. Prove the model works in your environment.
Extend
Add flows based on demonstrated value. Each new flow builds on the substrate established by the first.
Embed
Governance becomes infrastructure. Teams operate within governed flows without conscious effort.
Incremental value
Every stage delivers observable benefit. No multi-year programmes before first value.
Evidence-led expansion
Extend scope based on demonstrated outcomes, not projected ROI.
Behaviour over technology
Infrastructure enables. Culture sustains. We work on both.
Ready to make handover accountable?
Start with a discovery call. We will map your current governance state and identify where the Seven Flows can help.
Book a discovery call