The Alert & Responsibility Flow ensures that when a signal, alert, or escalation is generated, ownership of the next action is explicit, acknowledged, and auditable.
Alerts do not create safety on their own. Safety emerges only when someone knows they are responsible, and that responsibility is visible to others. In this framework, an alert is treated as a handover of responsibility — not merely a notification.
In distributed care, responsibility does not automatically follow information. If it is not explicitly transferred, it fragments — and harm emerges quietly.
Governance responsibilities
The Alert & Responsibility Flow establishes clear governance responsibilities whenever an alert, escalation, or safety-relevant signal crosses organisational or team boundaries.
This includes:
- explicit assignment of responsibility for the next action
- acknowledgement that responsibility has been received
- visibility of responsibility transitions between teams or services
- traceability from alert → owner → action → outcome
Alert governance ensures that responsibility is owned, not inferred — and that clinical escalation governance does not dissolve into shared inboxes, queues, or assumptions.
This Flow relies on Identity (who), Clinical Intent (why), and Service Routing (where) — but it is the point at which governance becomes operational.
Common failure modes
When alert ownership is implicit or assumed, predictable failure modes emerge:
- Alerts visible to many, owned by no one. Information is broadcast but responsibility is not assigned.
- Responsibility assumed to sit "upstream" or "downstream". Each team believes another is accountable.
- Escalations routed to generic services rather than named owners. Queues absorb alerts without individual accountability.
- Actions delayed because teams believe someone else is acting. Diffusion of responsibility causes inaction.
- Post-incident reviews cannot establish who was responsible at the time. Ownership was never explicit.
These failure modes rarely involve malicious neglect. They arise from governance gaps, not individual behaviour.
Alerts fire. Responsibility fragments. Harm emerges quietly.
Clinical safety implications
Data Coordination Board (DCB) 0129 / 0160 framing
From a clinical safety perspective, the Alert & Responsibility Flow mitigates systemic hazard classes associated with unowned or misdirected escalation. These map to DCB 0129 hazard classes relating to loss of responsibility at transitions of care.
In DCB 0129 / 0160 terms, these hazards include:
- Alerts not acted upon due to unclear ownership. The signal exists but no one is accountable for the response.
- Delayed escalation caused by assumed responsibility. Each party waits for another to act.
- Multiple teams believing another service is accountable. Responsibility is everywhere and nowhere.
- Inability to reconstruct responsibility at the time of harm. Safety reviews fail because ownership was never recorded.
By making handover accountability explicit and auditable at runtime, the Alert & Responsibility Flow enables safety cases to demonstrate clear ownership, timely action, and accountable escalation across organisational boundaries.
Alert & Responsibility failures often cascade into Service Routing failures — when ownership is unclear, escalations cannot be correctly directed, and downstream services receive requests without knowing who is accountable for the outcome.
What this feels like in practice
When alert ownership is explicit, clinicians notice immediately:
- You know when an alert is yours to act on
- You know when responsibility has transferred — and when it has not
- Escalations land with named services or clinicians
- Handover anxiety reduces
- Safety reviews focus on decisions, not blame
This is not about creating more alerts. It is about ensuring alerts mean something operationally.
What this is not
The Alert & Responsibility Flow is not:
- an alerting system
- a triage engine
- a call-centre model
- a blame mechanism
It does not increase clinical workload.
It ensures that when work exists, ownership is clear.
Future iterations will add worked examples and assurance artefacts as the framework is applied in practice.