Trust assurance · board view
What is still unfinished?
Open loops
Workflows without a confirmed completion condition
Unowned actions
Work visible to everyone and owned by nobody
Unacknowledged concerns
Patient signals nobody has picked up
Handover gaps
Context that did not survive a change of team
Referrals not confirmed
Sent is not the same as seen, accepted or done
Patient communication outstanding
The team acted; the patient has not been told
Where are loops breaking?
Act·The next responsible action is stated, timed and visible to the team until it is done or handed on deliberately.
Simulated assurance view. Drill-down detail follows below.
Trust assurance
See where care workflows, communication and continuity are breaking down — while there is still an opportunity to act.
Simulated maternity unit · Last updated 14:42
18
Open safety / workflow actions
Simulated prototype data
4
Unowned actions
Simulated prototype data
2
Unacknowledged patient concerns
Simulated prototype data
3
Overdue reviews
Simulated prototype data
2
Patients who do not understand next step
Simulated prototype data
1
Handover gaps
Simulated prototype data
5
Open post-discharge actions
Simulated prototype data
3
Concerns responded to but not resolved
Simulated prototype data
Pathscription failure patterns — where are loops breaking?
Simulated week · prototype data- HEAR8 gapsPatient signals not entering workflow
- KNOW14 gapsContext not reviewed at transitions
- OWN22 gapsActions without ownership
- ACT31 gapsActions overdue
- TELL17 gapsPatient/team communication incomplete
- CHECK26 gapsFollow-up/resolution not confirmed
Most common
ACT
Fastest improving
OWN
Recurring issue
Postnatal CHECK gaps
Leadership can drill into each category. All figures are simulated prototype data and are not validated performance measures.
HEAR
- · concerns captured
- · patient-reported concerns acknowledged
- · waiting items recorded
KNOW
- · context available at transition
- · context reviewed by incoming team
- · duplicated history-taking reported
OWN
- · time to ownership
- · unowned actions
- · ownership transferred at handover
ACT
- · time to action
- · overdue actions
- · workflow completion
TELL
- · patient informed
- · next step explained
- · communication after plan change
CHECK
- · concern resolution confirmed
- · referral next step confirmed
- · reassessment completed
- · patient understanding confirmed
Where do we need to act?
- View actions
1.Repeated unowned actions
4 open items currently have no owner.
Most affected workflow: Postnatal follow-up
Trend: ↑ from simulated previous shift
- View Heard & held
2.Patient voice
2 women currently report they do not understand what happens next.
1 has not yet been acknowledged.
Trend: Flat on simulated previous shift
- View handover gap
3.Handover continuity
1 patient's important care context has not yet been acknowledged by the incoming team.
Trend: ↓ from simulated previous shift
- View open loops
4.Follow-up completion
3 referrals / follow-up actions have been initiated but the next step is not confirmed.
Trend: ↑ from simulated previous shift
Assurance domains
High-level domains inspired by current NHS maternity assurance priorities. These do not automatically satisfy any scheme requirement.
Workforce & capacity
High workload — simulated
- · Open action volume
- · Unowned work
- · Handover burden
Open issues: 4 unowned · 3 overdue
Trend: ↑ open actions this simulated shift
Training & team readiness
Conceptual — future evidence
- · Recurring areas of process difficulty
- · Workflow completion patterns
Open issues: Not yet modelled in prototype
Trend: —
Learning from care
6 recurring gap types
- · Recurring workflow gaps
- · Audit history
- · Near-miss workflow patterns
Open issues: 1 pattern flagged for management review
Trend: ↑ unowned postnatal follow-up
Service-user voice & equity
81% of concerns confirmed closed
- · Heard & held responses
- · Understanding checks
- · Waiting reports
Open issues: 9 communication loops still open
Trend: ↑ acknowledgement 88% → 94%
Care-pathway completion
86% workflow completion
- · Configured pathway steps
- · Ownership
- · Escalation
- · Follow-up
Open issues: 18 open · 7 actioned but loop open
Trend: ↑ actioned referrals still open 4 → 7
Governance & leadership
1 open management action
- · Trends
- · Recurring gaps
- · Drill-down
- · Traceable audit events
Open issues: 5 high-attention items
Trend: Stable (simulated)
Workforce & capacity
Workforce & capacity
Current unit workload: High — simulated
18
Open actions
4
Unowned
3
Overdue
2
Patients awaiting senior review
3
Patients with open concerns
5
Actions due within next simulated 30 minutes
Operational capacity signals
- High workload with multiple unowned actions — potential capacity conflict
- Two senior reviews competing for attention — potential capacity conflict
- Incoming shift has 7 open actions to inherit
- Three patient concerns remain unresolved
Capacity signals describe workflow load only. Pathscription does not assess staffing adequacy and makes no judgement about whether staffing is safe.
Pathscription can help teams explore whether unfinished work accumulates during periods of operational pressure.
Service-user voice & equity
Service-user voice
92%
Women reporting they feel heard
Simulated prototype data
94%
Concerns acknowledged
Simulated prototype data
81%
Concerns fully closed
Simulated prototype data
89%
Patients reporting they understand next step
Simulated prototype data
3
Patients who reported repeating important history
Simulated prototype data
2
Open preference concerns
Simulated prototype data
8
Waiting items raised by patients
Simulated prototype data
2
Waiting items still open
Simulated prototype data
Being recorded is not the same as being heard.
9 concerns have not yet reached confirmed resolution.
- 6 reports
Communication
“I don't understand what happens next.”
- 5 reports
Waiting
“Someone said they would come back.”
- 3 reports
Preferences
“I don't feel my birth preferences have been understood.”
- 2 reports
Repeating history
“I have had to explain this before.”
- 4 reports
Fear / distress
“I am frightened.”
Themes group explicit fictional patient statements only. No sentiment is inferred beyond what a woman has said in words.
Future Pathscription research could examine whether workflow completion differs between patient groups.
| Measure | Group A | Group B | Group C |
|---|---|---|---|
| Time to acknowledgement | — | — | — |
| Time to ownership | — | — | — |
| Time to communication completion | — | — | — |
| Patient-reported understanding | — | — | — |
| Open concern rate | — | — | — |
Conceptual only. Values are deliberately left unpopulated: this prototype does not generate or imply disparities between patient groups. Real-world equity analysis would require appropriate governance, data-quality review and careful clinical/statistical interpretation.
Care-pathway completion
Are agreed care actions actually being completed?
126
Actions created
108
Completed
18
Open
4
Unowned
7
Actioned but loop still open
- Referral sent but confirmation outstanding3
- Patient reviewed but questions unanswered2
- Intervention recorded but reassessment outstanding2
Actioned does not always mean complete
Psychological support referral
- Referral sent✓
- Patient informed✓
- Receiving service confirmed—
- Appointment / next step—
- Follow-up owner—
Loop status: Open
Pathscription tracks the workflow beyond the first action.
Simulated maternity pathway A
8
Required workflow steps
7
Completed
1
Outstanding
Outstanding item: Senior review documentation
Owner: Dr Alex Morgan · Status: Due
Pathways shown are fictional demonstrations. Real pathways would require trust configuration and clinical governance.
Learning from care
Learning from workflow failure
Top recurring workflow gaps — simulated
- 1.No owner assignedPostnatal follow-up18 occurrences ↑
- 2.Patient waiting for promised actionWard round communication12 occurrences →
- 3.Incoming team had not acknowledged contextShift handover8 occurrences ↓
- 4.Referral initiated but next step unconfirmedPsychological support referral7 occurrences ↑
- 5.Patient did not understand planCare-plan discussion6 occurrences →
- 6.Plan changed before communication loop completedBirth preferences4 occurrences ↓
An important action or concern that risked being lost or delayed but was identified and resolved before the workflow closed.
Workflow near miss is a prototype concept about workflow completion. It is not a formally defined clinical near-miss event and must not be reported as one.
Unowned postnatal follow-up actions have appeared on 4 consecutive simulated shifts.
11
Occurrences
42 min
Average simulated time without owner
Postnatal follow-up
Affected workflow
Suggested management action: Review workflow
Pathscription may surface patterns for human review. It does not change clinical care or redesign clinical policy.
Governance & leadership
86%
Workflow completion
5
Open high-attention items
81%
Patient voice loops closed
94%
Handover continuity
4
Open actions without owner
78%
Post-discharge loops closed
91%
Context reviewed at transition
Executive summary
Most simulated maternity workflows are completing as expected.
Current areas requiring management attention:
- • unowned postnatal actions
- • delayed acknowledgement of patient concerns
- • incomplete communication following care-plan changes
- • follow-up referrals without confirmed next steps
No clinical conclusions should be drawn from this prototype data.
What changed?
Improved
- Patient concern acknowledgement 88% → 94%
- Context reviewed before team transition 86% → 91%
Needs attention
- Open postnatal follow-up 3 → 5
- Actioned referrals still open 4 → 7
Simulated historical data only.
Open unowned actions: 4
Answered with Heard & Held data
94% of simulated concerns acknowledged · 81% confirmed closed by the woman herself.
Open source view →
Evidence
Auditable evidence
Patient concerns acknowledged: 94%
Open actions without owner: 4
Context reviewed at transition: 91%
Metrics are generated from workflow events recorded as care happens — not from manually entered retrospective reports.
Assurance without another spreadsheet
Pathscription is designed to create assurance data as care workflows happen. The aim is not to ask maternity teams to complete another retrospective audit. The same events used to coordinate care can produce operational and governance evidence.
Conceptual mapping to current maternity safety and assurance priorities.
Potentially relevant to
Workforce & capacity
Possible Pathscription evidence
- · workload signals
- · open action volume
- · unowned work
- · handover burden
- · workflow completion
Potentially relevant to
Service-user voice & equity
Possible Pathscription evidence
- · concerns
- · Heard & Held responses
- · patient understanding
- · preference concerns
- · waiting reports
- · continuity of context
Potentially relevant to
Learning from reviews
Possible Pathscription evidence
- · recurring workflow gaps
- · audit history
- · response timelines
- · near-miss workflow patterns
Potentially relevant to
Care pathway assurance
Possible Pathscription evidence
- · configured workflow completion
- · outstanding required actions
- · ownership
- · escalation
- · follow-up
Potentially relevant to
Board oversight
Possible Pathscription evidence
- · trends
- · open risks
- · recurring gaps
- · drill-down
- · traceable audit events
Potentially relevant to
Training / team readiness
Possible Pathscription evidence
- · recurring areas of process difficulty
- · workflow completion patterns
Formal assessment against NHS Resolution requirements would require review with participating trusts and relevant governance teams. Pathscription makes no compliance claim and has no NHS or regulatory approval.
Value & evaluation
Potential value drivers
Clinician time
Reduced chasing, duplication, manual coordination and repeated information gathering.
Workflow failure
Potential reduction in avoidable missed actions, delayed follow-up and communication failures.
Complaints
Better documentation and closed-loop communication may reduce some avoidable causes of dissatisfaction and complaints.
Patient harm
Earlier identification of unfinished workflows may reduce the opportunity for some preventable failures to progress.
Claims exposure
If real-world evidence shows fewer avoidable safety failures, this could potentially reduce negligence exposure.
Claims & harm
Maternity-related clinical negligence represents substantial cost to the NHS. Pathscription's hypothesis is that reducing avoidable workflow, communication and continuity failures may contribute to reduced harm and claims exposure. This must be tested through prospective clinical and health-economic evaluation.
100,000
Workflows
100,000
Minutes potentially released
1,667
Staff hours
£66,667
Illustrative staff-time value
Simulated / illustrative research metric. This is not a validated NHS saving, a forecast, or a business case. Real value would require prospective measurement.
- Patient did not feel heard2
- Patient did not understand plan2
- Repeated waiting5
- Promise not fulfilled3
- Plan-change communication incomplete4
- Repeated retelling of trauma2
- Unresolved concern at discharge1
Communication loops still open: 9
These signals could be researched as potential precursors to poor patient experience and complaints. Pathscription does not predict individual complaints.
Maternity safety
National focus on improving consistency and reducing avoidable harm.
Patient voice
Greater emphasis on listening to women and families and responding to concerns.
Workforce pressure
Busy clinical environments increase cognitive and coordination burden.
Digital maturity
NHS maternity records are becoming increasingly digital and interoperable.
Assurance
Trusts need meaningful evidence of safety, experience and governance without excessive administrative burden.
Value to the woman
- · Heard
- · Held
- · Informed
- · Remembered
- · Able to see what happens next
Value to the team
- · Less chasing
- · Clear ownership
- · Better handover
- · Lower cognitive load
- · Unfinished work visible
Value to the trust
- · Real-time assurance
- · Patient-voice evidence
- · Workflow trends
- · Governance visibility
- · Potential productivity benefit
- · Potential reduction in avoidable failure costs
How would we prove it?
Productivity
- · Time spent coordinating selected workflows
- · System switching
- · Duplicated information gathering
- · Staff time spent chasing actions
Workflow
- · Actions with an owner
- · Acknowledgement time
- · Completion time
- · Open loops at handover
- · Unowned work
- · Referrals fully completed
Patient experience
- · Felt heard
- · Understood what happens next
- · Repeated important history
- · Felt involved in decisions
- · Somebody came back when promised
Safety process
- · Overdue agreed actions
- · Unresolved concerns
- · Incomplete handovers
- · Incomplete reassessments
- · Context gaps
Economic
- · Staff-time value
- · Complaint volume / themes
- · Incident-related workflow patterns
- · Health-economic modelling
These measures would require formal study design and appropriate clinical, information-governance and research oversight.
Before Pathscription
- Open actions at handover14
- Actions with no owner6
- Patient concerns fully closed68%
- Context reviewed at transition61%
- Patients understanding next step74%
With Pathscription — simulated
- Open actions at handover6
- Actions with no owner2
- Patient concerns fully closed89%
- Context reviewed at transition94%
- Patients understanding next step91%
Illustrative prototype only. These are not observed results.
Management action
Governance does not stop at a dashboard
Issue
Repeated unowned postnatal actions
Management action
Review current ownership workflow
Owner: Head of Midwifery — simulatedDue: FridayStatus: OpenFollow-up: Not yet reviewedIssue
Delayed acknowledgement of patient concerns overnight
Management action
Agree overnight acknowledgement expectation with coordinators
Owner: Maternity Safety Lead — simulatedDue: Next simulated weekStatus: OpenFollow-up: Not yet reviewed
Trust-level closed loop
The same closed-loop principle can apply from bedside workflow to Board-level improvement.
Prototype action — generates an on-screen mock report only.
Pathscription doesn't only show leaders what happened. It shows what is still unfinished.
Traditional assurance is often retrospective. Pathscription explores whether workflow assurance can happen alongside care — making unresolved actions, concerns, handover gaps and communication failures visible while teams can still respond.
- 1A woman says: “I don't feel heard.”
- 2Pathscription records it
- 3Somebody owns it
- 4The team responds
- 5The woman confirms whether it is resolved
- 6The workflow is audited
- 7Pathscription can see whether this keeps happening
- 8Leaders can see the pattern
- 9A management action can be owned and followed
- 10The impact can be measured
From patient concern to Board assurance.
Nothing missed.
Nothing unheard.
Tell us once.
Close the loop.
Prototype — not for clinical use. All patients, metrics, timings, patterns, pathways and financial figures are simulated / illustrative research metrics. Pathscription has no NHS approval, no regulatory approval and no compliance certification, does not prove compliance with any assurance scheme, and makes no claim to prevent negligence, litigation or patient harm. No financial saving shown here is validated.