# STEWARD — Hospital & Clinic Administrator Complete AI OS

## Setup, benefits, dashboard, workflows and governed-agent guide

**Complete Edition:** foundation + dashboard + 24 SuperPowers + 24 workflows + 30 templates + 18 schemas + 10 disabled agents + 160 release checks.  
**Lane:** `hospital_clinic_administration` • **Home:** `My STEWARD` • **Version:** 1.0 • **Reviewed:** 2026-07-15

> **Allow time.** Installation may require several Hermes turns because it verifies isolation, builds the foundation, stages the SuperPowers, tests recovery and produces evidence. It does not continue in the background. Keep the conversation open and use the exact resume command if interrupted.

## What STEWARD is

STEWARD is a private, human-governed operating system for the work and life of hospital and clinic administrators. It helps turn fragmented strategy, operations, resources, workforce, quality, risk and AI initiatives into clear questions, decision packets, owned workflows and closed loops. It supports hospitals, clinics, health systems, service lines, multi-site practices, community settings and dual-hat clinician-administrators without assuming that any title grants universal authority.

It prepares and organizes. It is not an EHR, HRIS, scheduling or claims platform, finance ledger, contract or procurement system, incident-reporting system, security console, legal/compliance service, accreditation authority, emergency command center or autonomous executive.

**Product-name note:** STEWARD is a working product name, not a clearance opinion. Before public commercialization, obtain appropriate trademark, entity-name and domain review.

## What the administrator gains

- **A clearer command view:** one My STEWARD dashboard with four launch buttons and no more than seven attention items.
- **Better decisions:** explicit options, assumptions, evidence, equity, reversibility, owners and receipts.
- **Operational focus:** safe aggregate access, flow, demand, capacity and improvement tools—without patient tracking or live command.
- **Resource stewardship:** transparent budget, workforce, vendor and sustainability scenarios without transactions or commitments.
- **Trustworthy assurance work:** source-aware quality, policy, accreditation, privacy and cyber preparation without false certification.
- **Human-centered leadership:** psychological safety, change, accessibility, community voice, delegation, succession and protected-life planning.
- **AI governance with brakes:** use-case intake, agent charters, independent testing, least privilege, human handoffs, kill, rollback and retirement.

## Separate means separate

STEWARD uses its own lane, namespace, home, schemas, permissions and agents. It does not inherit a nurse, physician, resident, respiratory, educator or generic employee profile. If the administrator also holds a clinical or other role, they choose one active hat per workflow. Whole-life content is available only in a personally controlled isolated store and is disabled in an institution-managed workspace unless separation is technically proven.

## The governing sequence

1. **CHART** verifies context, human authority, authorization, risk/records and trace/termination.
2. **ALIGN** maps aim, leadership, interdependencies, gates and the next human-owned state.
3. **ORBIT** governs an agent from objective through independent test to human transfer or termination.
4. **Human decision and official system** remain the source of authority, acknowledgment and record.

## My STEWARD Core Four

1. **Orient Mandate & Priorities**
2. **See Operations & Risk**
3. **Align People, Resources & Change**
4. **Decide, Escalate & Close**

The fifth launcher starts empty. Permanent controls include Privacy, Sources, Active Hat, Decision Rights, Human Queue, Pause All, Kill, Safe Reset, Correct, Export, Delete, Rollback, Remove and Full Uninstall.

## Twenty-four optional SuperPowers

| ID | Pillar | SuperPower |
|---|---|---|
| `PWR-01` | S | Strategic North Star & Operating Mandate |
| `PWR-02` | S | Executive Decision, Options & Scenario Studio |
| `PWR-03` | S | Portfolio, Initiative & Benefit-Realization Navigator |
| `PWR-04` | S | Board, Committee & Stakeholder Governance Navigator |
| `PWR-05` | T | Access, Demand & Capacity Intelligence Studio |
| `PWR-06` | T | Flow, Throughput, Handoffs & Bottleneck Lab |
| `PWR-07` | T | Daily Management, Huddle & Escalation Decision Board |
| `PWR-08` | T | Hospital, Clinic, Service & Site Operating-Model Designer |
| `PWR-09` | E | Budget, Forecast, Variance & Resource-Stewardship Studio |
| `PWR-10` | E | Revenue Cycle, Payer & Contract Learning Navigator |
| `PWR-11` | E | Procurement, Vendor, Asset & Sustainability Due-Diligence Studio |
| `PWR-12` | W | Workforce Capacity, Workload & Skill-Mix Evidence Navigator |
| `PWR-13` | W | Culture, Psychological Safety, Conflict & Listening Navigator |
| `PWR-14` | W | Change, Plain-Language Communication & Adoption Architect |
| `PWR-15` | W | Leadership, Delegation, Succession & Whole-Life Compass |
| `PWR-16` | A | Quality, Safety, Accreditation & Regulatory-Readiness Navigator |
| `PWR-17` | A | Policy, Control, Compliance & Audit-Evidence Studio |
| `PWR-18` | A | Equity, Accessibility, Patient/Family & Community Experience Lens |
| `PWR-19` | R | Emergency Preparedness, Business Continuity & Downtime Rehearsal |
| `PWR-20` | R | Cybersecurity, Privacy & Third-Party Risk Navigator |
| `PWR-21` | R | Incident, Issue, Corrective-Action & Learning System |
| `PWR-22` | D | Data, Digital & AI Use-Case Portfolio Governor |
| `PWR-23` | D | AI Agent Charter, Tool, Permission & Human-Handoff Designer |
| `PWR-24` | D | Agent Evaluation, Monitoring, Incident, Kill, Rollback & Retirement Controller |

Every power installs **Available Inactive**. Preview does not activate it. One-run activation requires a current CHART pass, exact data/outputs, named human owner, approval receipt and defined safe exit. At finish it returns inactive.

## Before setup

Have the following ready, or leave it visibly Unknown: your exact title; legal entity and ownership/governance model; hospital/clinic/network/service/site; operating level; active hat; jurisdiction; written delegated decision rights and thresholds; named clinical, HR, finance, compliance, privacy, security, legal, procurement, quality and executive routes; accessibility/language preferences; and whether personal life tools have a genuinely separate personal workspace.

Do not gather or paste sensitive records for installation.

## Give Hermes this one file

Use `Hospital-and-Clinic-Administrator-Complete-AI-OS-with-STEWARD-SuperPowers-Hermes-Program.md`. Start a new or verified-isolated administrator workspace, attach the file, and say: `Install this complete STEWARD program exactly as written. Begin with read-only preflight.` Review one Activation Card before approving any change.

Do not use the ZIP as the installation input; it is the complete archive for inspection, backup and implementation teams.

## Installation phases

1. **Read-only preflight:** Hermes checks collisions, isolation, current state and controls.
2. **Activation Card:** Hermes asks the minimum safe questions and shows one combined plan.
3. **Foundation → S1:** Hermes creates the isolated lane, core, 18 schemas and dashboard shell, then executes 40 foundation criteria (A–D plus I).
4. **Overlay and remaining tests → S2:** Hermes stages 24 inactive powers, workflows, templates and 10 disabled agents; binds—never recreates—the schemas; then executes 120 overlay/integration criteria.
5. **Post-S2 assurance and Activation Report:** Hermes reconciles the 160-result ledger, recovery evidence and unsupported blockers before reporting release state.

## If interrupted

Nothing is running in the background. Paste the Exact Resume command from the installer or your latest receipt. Hermes must revalidate state and continue only from the saved checkpoint; it must not silently restart or assume completion.

## First safe use

Paste this after a clean Activation Report:

> Open My STEWARD in Private Administrator OS. Use only my minimum professional identity/authority metadata, public information, administrator-owned nonsensitive information or clearly synthetic examples. Show my exact title, entity/site, active hat, authority source/expiry, CHART status, Core Four, seven attention slots, source freshness, all 24 power states, all 10 agent states and permanent Privacy, Pause All, Kill, Correct, Export, Delete, Rollback and Uninstall controls. Do not request PHI, patient data, other-person employee/applicant/practitioner data, sensitive operator employment records, incident/claim/contract/vendor/security/nonpublic-financial content. Do not connect, schedule, send, share, publish, buy, pay, submit, decide, activate or automate. Help me preview one low-risk workflow, create one expiring draft, then accept, revise or delete it and confirm no background work remains.

## Safe first agent

Paste this only after ordinary first use works:

> Open ORBIT and preview AGT-01 Source & Requirement Verifier using public sources and a clearly synthetic question. Keep install state PERM-P0 Disabled. Show objective, owner, non-goals, proposed maximum PERM-P1, allowed/prohibited data, sources, no-tool/no-write boundary, normal/failure/missing-source/prompt-injection/bias/security tests, human review, cost/time cap, expiry, kill, rollback, purge and retirement. Do not activate or persist. Wait for my exact one-run approval.

## Permission levels

| Level | Meaning |
|---|---|
| PERM-P0 | Disabled; no execution |
| PERM-P1 | Private nonsensitive/public/synthetic draft; no tools or actions |
| PERM-P2 | One exact approved owner-controlled source; read-only draft |
| PERM-P3 | Institution-approved read or sandbox for one exact purpose/partition |
| PERM-P4 | One-run staged nonbinding administrative draft to one approved non-authoritative destination; human release required |
| PERM-P5 | Prohibited high-impact, production, self-expanding or hidden action |

## Thirty cards and templates

| ID | Template |
|---|---|
| `TPL-01` | Administrator True North & Protected-Life Promise |
| `TPL-02` | Administrator Identity, Entity, Site, Hat & Delegated-Authority Card |
| `TPL-03` | Source, Requirement, Policy & Freshness Ledger |
| `TPL-04` | CHART Authority and Action Gate Receipt |
| `TPL-05` | Strategy-on-a-Page & Ninety-Day Alignment Card |
| `TPL-06` | ALIGN Executive Decision, Options & Assumptions Brief |
| `TPL-07` | Portfolio, Dependency, Capacity & Benefit Gate |
| `TPL-08` | Board or Committee Brief, Conflict Prompts & Action Register |
| `TPL-09` | Access, Demand, Capacity & Equity Brief |
| `TPL-10` | Flow, Bottleneck, Handoff & PDSA Map |
| `TPL-11` | Daily Huddle, Seven Signals & Escalation Board |
| `TPL-12` | Hospital, Clinic, Service or Multi-Site Operating-Model Canvas |
| `TPL-13` | Budget, Forecast, Variance & Sensitivity Scenario |
| `TPL-14` | Aggregate Revenue-Cycle, Denial & Contract-Question Brief |
| `TPL-15` | Procurement, Vendor, Business Case & Exit-Risk Matrix |
| `TPL-16` | Asset, Space, Supply & Sustainability Stewardship Map |
| `TPL-17` | Workforce Capacity, Workload & Skill-Mix Evidence Brief |
| `TPL-18` | Psychological Safety, Listening Themes & Response Commitments |
| `TPL-19` | Change Impact, Communication, Learning & Adoption Plan |
| `TPL-20` | Leadership, Delegation, Succession & Growth Map |
| `TPL-21` | Quality, Safety, Accreditation & Regulatory Readiness Crosswalk |
| `TPL-22` | Policy, Control, Audit Evidence & Exception Matrix |
| `TPL-23` | Equity, Accessibility, Patient/Family & Community Impact Review |
| `TPL-24` | Synthetic Emergency, Continuity & Downtime Exercise Plan |
| `TPL-25` | Privacy, Cybersecurity, Data-Flow & Third-Party Risk Intake |
| `TPL-26` | Incident, Issue, Corrective-Action & Official-System Boundary Card |
| `TPL-27` | Digital & AI Use-Case Intake, Stage Gate & Retirement Plan |
| `TPL-28` | ORBIT Agent Charter, Permission & Human-Handoff Envelope |
| `TPL-29` | Agent Test, Run, Human Decision, Incident & Retirement Receipt |
| `TPL-30` | Seven-Day Launch & Ninety-Day STEWARD Development Plan |

## Non-negotiable boundaries

- Private mode accepts only the operator's minimum professional identity/authority metadata; it accepts no patient data, other-person employee/applicant/practitioner data, sensitive operator employment records, incident data, claims, contracts, vendor-confidential, security-sensitive or nonpublic financial content.
- The base Complete Edition stays aggregate- and process-level even in an institution-approved workspace; patient-, event-, claim- and individual-workforce modules require a separate governed product and release suite.
- Real de-identification requires an institution-approved method; user self-redaction is not enough.
- No clinical action or patient communication; no employment, credentialing or staffing decision; no financial transaction, claim or coverage decision; no contract/procurement commitment; no legal/compliance/accreditation determination; no identity/security/production change; no emergency command.
- A draft is never an official record. A message or AI status is never human acknowledgment.
- Not for emergencies or real-time monitoring. Pause and use official procedures.
- No hidden scoring, surveillance, protected-class inference, small-group exposure or retaliation prediction.

## Recovery and control

`STATUS STEWARD INSTALL` reports phase and no-background state. `PAUSE ALL STEWARD` blocks activity. `SAFE RESET STEWARD` returns powers inactive and agents disabled. `ROLL BACK STEWARD TO <S0|S1|S2>` restores verified configuration. `REMOVE STEWARD POWER <PWR-xx>`, `REMOVE STEWARD OVERLAY` and `FULL UNINSTALL STEWARD` preview dependencies, preserve only owner-approved exports and prove orphan cleanup.

## Source watch

The registry below is a starting point, not legal advice or a complete applicability analysis. Hermes records exact document versions, effective dates, status and local overrides.

- [HHS OCR — HIPAA Minimum Necessary Requirement](https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/minimum-necessary-requirement/index.html) — Privacy design context; local privacy/legal owners determine applicability.
- [HHS OCR — HIPAA De-identification Guidance](https://www.hhs.gov/hipaa/for-professionals/special-topics/de-identification/index.html) — Approved de-identification methods; user self-redaction is not accepted in Private mode.
- [HHS OCR — HIPAA and Cloud Computing Guidance](https://www.hhs.gov/hipaa/for-professionals/special-topics/health-information-technology/cloud-computing/index.html) — Cloud risk analysis, authorization and business-associate context.
- [HHS OCR — HIPAA Security Rule Guidance](https://www.hhs.gov/hipaa/for-professionals/security/guidance/index.html) — Current Security Rule guidance and risk-management context; do not treat proposals as current mandates.
- [HHS OCR — HIPAA Security Rule Notice of Proposed Rulemaking](https://www.hhs.gov/hipaa/for-professionals/security/hipaa-security-rule-nprm/index.html) — Proposal watch only; the current Security Rule remains in effect until a final rule becomes effective.
- [CMS — Conditions for Coverage and Conditions of Participation](https://www.cms.gov/medicare/health-safety-standards/conditions-coverage-participation) — Federal participation source hub; verify exact provider type, rule and effective date.
- [eCFR / CMS — 42 CFR Part 482 — Conditions of Participation for Hospitals](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482) — Current electronic federal hospital requirements; eCFR is authoritative but unofficial and applicability requires qualified review.
- [eCFR / CMS — 42 CFR Part 485 — Conditions of Participation: Specialized Providers](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-485) — Current electronic requirements including relevant specialized-provider and Critical Access Hospital provisions; verify exact subpart.
- [eCFR / CMS — 42 CFR Part 491 — Certification of Certain Health Facilities](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-491) — Current electronic RHC/FQHC certification requirements; verify exact facility type and section.
- [HRSA — Health Center Program Compliance Manual](https://bphc.hrsa.gov/compliance/compliance-manual) — Health Center Program compliance reference; confirm current chapter, applicability and related guidance.
- [CMS — Measures Management System](https://mmshub.cms.gov/) — Measure lifecycle and specification context; exact measure versions remain authoritative.
- [CMS — Interoperability and Prior Authorization Final Rule CMS-0057-F](https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-prior-authorization-final-rule-cms-0057-f) — Actor- and program-specific readiness context; verify dates, exclusions and current implementation guidance.
- [ASTP/ONC — HTI-1 Final Rule](https://www.healthit.gov/topic/laws-regulation-and-policy/health-data-technology-and-interoperability-certification-program-updates-algorithm-transparency-and-information-sharing-hti-1-final-rule) — Certified-health-IT transparency context; applicability requires qualified review.
- [ASTP/ONC eCFR — 45 CFR 170.315(b)(11) — Decision Support Interventions](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-D/part-170/subpart-C/section-170.315) — Actor-specific certified-health-IT criterion and procurement-question context; not blanket approval of every AI tool.
- [ASTP/ONC eCFR — 45 CFR Part 171 — Information Blocking](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-D/part-171) — Actor-specific EHI access, exchange and use context; legal applicability and exceptions stay human-owned.
- [HHS OCR eCFR — 45 CFR 92.210 — Patient Care Decision Support Tools](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-92/subpart-C/section-92.210) — Section 1557 decision-support-tool inventory and discrimination-risk context for covered entities; verify current litigation and applicability.
- [HHS OIG — General Compliance Program Guidance](https://oig.hhs.gov/compliance/general-compliance-program-guidance/) — Voluntary compliance-program reference; not legal advice or certification.
- [HHS — Healthcare and Public Health Cybersecurity Performance Goals](https://hhscyber.hhs.gov/cybersecurity-performance-goals.html) — Voluntary healthcare cybersecurity practices and prioritization context.
- [NIST — AI Risk Management Framework](https://www.nist.gov/itl/ai-risk-management-framework) — Voluntary AI governance reference; track versions and companion profiles.
- [NIST — AI RMF Generative AI Profile](https://www.nist.gov/publications/artificial-intelligence-risk-management-framework-generative-artificial-intelligence) — Generative-AI risk reference; not a certification.
- [NIST — Cybersecurity Framework 2.0](https://www.nist.gov/cyberframework) — Voluntary cybersecurity risk-management reference.
- [AHRQ — TeamSTEPPS 3.0](https://www.ahrq.gov/teamstepps-program/index.html) — Human teamwork and communication reference; AI never closes the loop.
- [AHRQ — CAHPS Program](https://www.ahrq.gov/cahps/index.html) — Patient-experience survey resources; use exact instruments and authorized methods.
- [IRS — Charitable Hospitals — General Requirements for Tax Exemption under Section 501(c)(3)](https://www.irs.gov/charities-non-profits/charitable-hospitals-general-requirements-for-tax-exemption-under-section-501c3) — Tax-exempt hospital context; qualified tax/legal owners determine current applicability and compliance.
- [HHS OCR eCFR — 45 CFR Part 84 — Nondiscrimination on the Basis of Disability](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-84) — Current Section 504 regulatory text for covered recipients; qualified civil-rights/legal owners determine applicability and dates.
- [FEMA — Continuity Resource Toolkit](https://www.fema.gov/emergency-managers/national-preparedness/continuity/toolkit) — Continuity planning resource; local approved plans and command structures govern.
- [OSHA — Healthcare Workplace Violence](https://www.osha.gov/healthcare/workplace-violence) — Worker-safety resource; current law, state requirements and local policy require human review.
- [FDA — Clinical Decision Support Software Final Guidance](https://www.fda.gov/regulatory-information/search-fda-guidance-documents/clinical-decision-support-software) — January 2026 regulatory-boundary guidance; exact function classification requires qualified review.
- [W3C — Web Content Accessibility Guidelines 2.2](https://www.w3.org/TR/WCAG22/) — Digital accessibility design and test reference.

STEWARD is independent and is not endorsed, certified or approved by these organizations.

## Release assurance

The pack carries 160 evidence-bearing **runtime release criteria**: 18 domains with eight criteria each plus 16 integration criteria. The downloadable artifact can be structurally validated for files, IDs, links, exact embedding and checksums; that does not prove runtime isolation, permissions, action denial, accessibility of the installed dashboard, pause/kill/rollback/purge or uninstall. Those require the target Hermes platform adapter, versioned fixtures, state probes and an independent reviewer. Every criterion remains `specified`, `executed`, `passed`, `failed`, `blocked` or `unsupported`. Any failed, blocked or unsupported critical criterion blocks activation.
