The Outcome Flow ensures that when care, responsibility, or escalation moves between teams or organisations, the episode completes with an explicit outcome — not by assumption, attrition, or silence.
In distributed care, work often appears to finish when responsibility moves elsewhere. But without explicit outcome governance, safety loops never close. Signals linger. Alerts decay. Learning stalls.
Care does not end when information moves. It ends when resolution is known.
Governance responsibilities
The Outcome Flow establishes clear governance responsibilities whenever a clinical episode, escalation, referral, or monitoring period reaches resolution — or fails to do so.
This includes:
- Responsibility for declaring when an episode is complete. Closure is an explicit act, not an inferred state.
- Visibility of outcomes to upstream and downstream services. Those who initiated, supported, or depended on the episode can see how it concluded.
- Traceability between intent, action taken, and result. Outcomes are linked back to the purpose that justified the work.
- Explicit handling of partial resolution, non-resolution, or abandonment. Unfinished care is named as such, not silently absorbed into the system.
- Feedback of outcomes into safety, quality, and learning processes. Resolution informs improvement; silence does not.
Outcome governance ensures that care is judged by resolution, not just activity — and that responsibility truly discharges rather than evaporates.
Common failure modes
When outcome governance is implicit or absent, predictable failure modes emerge:
- Episodes that never formally close. Work stops, but no one declares that it has ended — leaving responsibility unresolved.
- Monitoring signals that decay into background noise. Alerts stop firing, not because risk resolved, but because attention moved elsewhere.
- Referrals that complete administratively, not clinically. A letter is sent. A task is ticked. The clinical question remains unanswered.
- Escalations resolved informally without trace. Decisions are made in conversation or corridor, but never recorded as outcomes.
- Post-incident reviews that cannot establish what actually happened. Activity is visible. Resolution is not.
These failure modes are rarely obvious in real time. They surface later — as repeated harm, duplicated work, defensive practice, or unexplained clinical variance.
Clinical safety implications
Data Coordination Board (DCB) 0129 / 0160 framing
From a clinical safety perspective, the Outcome Flow mitigates systemic hazard classes associated with incomplete, ambiguous, or unclosed episodes of care.
In DCB 0129 / 0160 terms, these hazards include:
- Failure to close safety-critical loops. Risks remain active because no explicit outcome or resolution was recorded.
- Assumed resolution without evidence. Teams believe care has completed when no verifiable end-state exists.
- Inability to learn from outcomes. Safety improvement stalls because outcomes are not visible across pathways.
- Repetition of harm due to missing feedback. The same failures recur because learning never propagates beyond the local episode.
- Inability to reconstruct episode resolution after harm occurs. Safety cases fail because the end state of care was never formally declared.
By making outcomes explicit at runtime, the Outcome Flow enables safety cases to demonstrate not merely that actions occurred, but that care reached a defined, reviewable, and safe conclusion — even when responsibility moved across organisational boundaries.
The Outcome Flow completes the Seven Flows governance cycle. Without it, the system silently accumulates unresolved risk — even when every other Flow is present and functioning correctly.
What this feels like in practice
When outcome governance is present, clinicians notice immediately:
- You know when a piece of work is genuinely complete — not just handed on
- You can see whether an escalation resolved the underlying issue, or merely moved it
- Monitoring periods end deliberately, with an explicit end state — not by silence
- Safety reviews focus on learning from decisions, not reconstructing what happened
- The same unresolved problems stop resurfacing across pathways
This is not performance reporting. It is clinical closure made explicit — so care can safely end, learning can propagate, and responsibility can genuinely discharge.
What this is not
The Outcome Flow is not:
- a reporting framework
- a KPI or outcomes dashboard
- a commissioning metric
- a retrospective audit tool
It does not judge clinicians or services. It ensures that episodes end deliberately, with an explicit end state — and that learning is possible when they do not.
Without explicit outcomes, accountability dissolves. With them, responsibility can safely discharge.
How this Flow interacts with others
Outcome sits downstream of Alert & Responsibility and Service Routing, and closes the loop back to Clinical Intent.
Intent defines why work begins. Routing defines where it goes. Responsibility defines who owns it. Outcome defines whether it resolved.
Without Outcome, responsibility never fully discharges. Work appears to move, but risk remains active.
If the Outcome Flow is missing, the system silently accumulates unresolved risk — even when every other Flow is present and functioning correctly.
Future iterations will add worked examples and assurance artefacts as the framework is applied in practice.