Service Routing Flow

Governance responsibilities

The Service Routing Flow establishes clear governance responsibilities whenever a request, referral, or escalation crosses organisational boundaries.

This includes:

• responsibility for determining the clinically appropriate destination
• visibility of why a service was chosen, not just where the request was sent
• assurance that context travels with the request, not separately
• traceability between routing decision, service capability, clinical intent, and outcome

Service Routing governance ensures that referrals are judged by appropriateness — not convenience, habit, or capacity pressure.

Common failure modes

When service routing is implicit or assumed, predictable failure modes emerge:

• Patients bounce between services. Each service is technically correct to redirect, but no one owns the routing decision across the boundary.
• Context is stripped at boundaries. History arrives, but the clinical question does not.
• Capacity problems masquerade as clinical failure. Services reject work they were never appropriate to receive.
• Escalations default to the loudest or closest service. Urgency overrides suitability.
• Post-incident reviews cannot explain why a service was chosen. The decision logic was never explicit.

These are not referral quality issues. They are failures of routing governance.

Clinical safety implications

Data Coordination Board (DCB) 0129 / 0160 framing

From a clinical safety perspective, the Service Routing Flow mitigates systemic hazard classes associated with misdirected care and loss of clinical context.

In DCB 0129 / 0160 terms, these hazards include:

• Requests routed to services without the capability to respond appropriately. The destination exists but cannot act on the need.
• Delays caused by repeated redirection across organisations. Patients experience harm while services debate ownership.
• Loss of critical decision context during referral transitions. Information travels but meaning does not.
• Escalations handled by teams not equipped to act on them. Urgency is honoured but suitability is not.
• Inability to reconstruct routing decisions after harm occurs. Safety reviews fail because routing logic was never recorded.

By making routing decisions explicit and auditable at runtime, the Service Routing Flow enables safety cases to assess appropriateness of destination, not just timeliness or correctness of action.

Service Routing failures often cascade into Outcome failures — when care is misdirected, outcomes cannot be correctly attributed, and the feedback loop required for system learning breaks down.

These hazards are difficult to evidence retrospectively when routing decisions are implicit, but become assessable when destination choice and rationale are explicit at the point of handover.

What this feels like in practice

When service routing is governed properly, clinicians notice:

• Referrals arrive with a clear clinical question
• You understand why this came to your service
• You spend less time redirecting and more time deciding
• Escalations reach teams that can actually act
• Boundary friction reduces without removing clinical judgement or local discretion

This is not about rigid pathways. It is about making routing decisions visible and defensible.

What this is not

The Service Routing Flow is not:

• a directory service
• a pathway engine
• a capacity management tool
• a referral template

It does not decide what care should be delivered. It ensures that the decision about where care should go is explicit, reasoned, and reviewable.

Safe routing is not about speed. It is about appropriateness under pressure.

How this Flow interacts with others

Service Routing sits downstream of Clinical Intent and upstream of Alert & Responsibility.

Intent explains why a request exists. Routing determines where it should go. Alert & Responsibility ensures who owns it next.

If any of these are missing, handovers remain unsafe even when systems interoperate perfectly.