Where clinical safety actually fails — and what infrastructure would make it safer. Exploring the structural gaps in healthcare handoffs, accountability, and care transitions.
After thirty years building infrastructure in regulated sectors — finance, government, defence — I've seen how accountability failures cause harm. Healthcare has the same patterns, but the consequences aren't regulatory fines. They're people getting hurt. This series examines where responsibility actually dissolves, why our systems can't see it, and what infrastructure would make care transitions genuinely safe. Not better training. Not more checklists. Structural solutions for structural problems.
Follow the analysis from diagnosis to design
The failures that cause the most harm rarely look like failures at the time. They occur in the gaps between decisions, during transitions when accountability becomes ambiguous. Everyone acts reasonably. Everyone is wrong.
Most people think of handoffs as moments. A discharge happens. A referral gets sent. Done. That's not how it works. Handoffs are risk surfaces with area, exposure time, and boundary conditions that current systems don't model.
There's a question that surfaces in almost every serious incident review: who was actually responsible at that point? Responsibility is inferred from context, assumed based on role, and socially negotiated — until something goes wrong.
Healthcare has plenty of data. What it lacks is durable evidence — evidence that can survive time, organisational change, and scrutiny without being reinterpreted through hindsight. The gap between what we record and what we can prove is where patient safety quietly erodes.
Julian Bradder
Founder, Inference Clinical
julian@inferenceclinical.com
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