What LSPPT Means
LSPPT stands for Legal, Safety, People, Process, Technology — the five disciplines required to govern any clinical pathway that crosses an organisational boundary.
LSPPT is not a checklist. It is a structural requirement. Governance that addresses fewer than five disciplines leaves gaps — and those gaps do not stay small. They accumulate into systemic risk: liability without safety cases, safety cases without accountable people, accountable people without defined processes, processes without supporting technology. Each missing discipline weakens the others.
The framework emerged from observing what happens when clinical pathways cross boundaries between NHS trusts, between primary and secondary care, between NHS and private providers. At every boundary, the same five disciplines must be addressed. When any one is absent, the boundary becomes a site of unmanaged risk.
Two Zones, Five Disciplines
The five disciplines are not equal in kind. They divide into two zones: constitutional and operational.
Legal and Safety are constitutional — they constrain what is permissible. They set the boundaries of legitimate action. People, Process, and Technology are operational — they determine how permitted activities are executed. They deliver within the constraints that the constitutional disciplines define.
Legal
Statutes, contracts, liability allocation, data protection requirements
Safety
DCB standards, hazard management, clinical risk assessment and mitigation
People
Roles, competencies, accountability chains
Process
Workflows, handover protocols, escalation pathways
Technology
Systems, interoperability, monitoring infrastructure
Constitutional disciplines constrain operational disciplines. Technology cannot override legal requirements. Process cannot bypass safety obligations. The hierarchy is not optional.
Each Discipline, Briefly
Legal
Statutory obligations, contractual frameworks, liability allocation, data protection requirements. The legal discipline establishes who bears responsibility and under what terms clinical activity may cross a boundary.
Who is legally responsible when a patient crosses a boundary?
Safety
DCB 0129/0160 compliance, hazard identification, clinical risk management, safety case maintenance. The safety discipline identifies what can go wrong at the boundary and ensures mitigations are in place.
What clinical risks emerge at the boundary, and how are they mitigated?
People
Role definitions, competency requirements, accountability chains, training obligations. The people discipline ensures that individuals on both sides of the boundary know what they are responsible for and are equipped to deliver.
Who is accountable for what, and are they equipped to deliver?
Process
Handover protocols, escalation pathways, audit procedures, governance reviews. The process discipline defines how work flows across the boundary and what happens when it fails.
How does work flow across the boundary, and what happens when it fails?
Technology
System interoperability, data standards, monitoring infrastructure, integration governance. The technology discipline ensures that systems on both sides can exchange data reliably and that the exchange is auditable.
Can systems exchange data reliably, and can we prove it?
Choreography, Not Just Process
LSPPT describes choreography — coordinated movement across autonomous organisations — not just process within one.
The distinction matters. Process assumes a single authority that controls the sequence of steps, allocates resources, and resolves exceptions. Choreography acknowledges that each organisation maintains sovereignty over its internal operations. No single authority dictates how both sides work. Governance across boundaries must respect this sovereignty while ensuring safe handover. LSPPT provides the structure for that coordination without requiring either organisation to cede control.
Five Questions for Any Boundary
For any clinical pathway that crosses an organisational boundary, these five questions reveal the state of governance:
- Legal: Is there a contractual framework that allocates liability for clinical outcomes at this boundary?
- Safety: Has a clinical safety assessment been conducted that specifically covers the boundary crossing?
- People: Are roles and accountability chains defined for the handover point, not just within each organisation?
- Process: Is there a documented and tested handover protocol that both organisations follow?
- Technology: Can the systems on both sides exchange the required clinical data reliably and with audit trail?
If any answer is no, the boundary has unmitigated risk.
Explore Each Discipline
Each LSPPT discipline has a dedicated pillar article that examines its role in boundary governance in detail.
These pages describe boundary governance as choreography: coordinated disciplines that must work together across organisational boundaries.
Legal Pillar
Statutes, contracts, and liability allocation at the boundary
Clinical Safety Pillar
Hazard management and clinical risk at the crossing point
People Pillar
Roles, competencies, and accountability across organisations
Process Pillar
Handover protocols and escalation pathways
Technology Pillar
Interoperability, data standards, and integration governance
The Five Disciplines
Read the full Architecting Neighbourhood Health series
Score Your Boundaries
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