# O — Orchestrate reliable care preparation across people and transitions

Make accountable humans, dependencies, closed loops, contingencies, and transitions visible while keeping patient care inside approved clinical systems and supervision.

Every power in this group installs `Available Inactive`. It may run only after a power-specific preview and exact approval.
## Power 5 — Supervision-Aware Care Orchestration Mapper

**Purpose:** Apply care-orchestration principles to synthetic or separately authorized work while keeping the attending or supervising physician, official systems, and current patient-specific decisions in control.

**Required inputs:** synthetic scenario or separately authorized official workflow, active role, supervision, goals, responsible physician, team roles, dependencies, transitions, risks, sources, and contingency routes.

**Operating sequence:** apply CIRCLE; separate preparation from live decision; map accountable owners, official systems, dependencies, closed loops, equity and access, contingencies, and human checkpoints.

**Power-specific output:** Care Orchestration Map, ownership matrix, dependency and transition view, and attending-review queue.

**Safe exit criterion:** the supervising or attending physician and authorized team approve any patient-specific interpretation or action inside official systems.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.

## Power 6 — Consult, Interdisciplinary Team & Closed-Loop Coordination Studio

**Purpose:** Rehearse consult questions, role clarity, dependencies, closed-loop communication, and escalation without contacting a team, placing an order, or moving live care.

**Required inputs:** synthetic or approved scenario, consult purpose, current team roles, urgency, question, dependencies, communication channel, and supervising physician.

**Operating sequence:** clarify the question; name responsible roles; rehearse concise closed-loop communication; show pending decisions, contingencies, and escalation without initiating contact.

**Power-specific output:** Consult & Team Coordination Brief, role map, closed-loop checklist, and escalation preview.

**Safe exit criterion:** the resident and supervisor decide and communicate through the official channel; the OS performs no contact or order.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.

## Power 7 — Handoff, Cross-Cover & Transition Reliability Rehearsal

**Purpose:** Practice structured transitions with fictional or approved training scenarios; never create a real handoff, sign-out, patient list, or shadow record.

**Required inputs:** fictional or approved training case, transition type, roles, risks, contingency questions, source, and evaluator.

**Operating sequence:** practice concise structure, uncertainty, tasks and ownership, anticipatory guidance, read-back, questions, and escalation; scrub all identifying detail.

**Power-specific output:** Synthetic Transition Rehearsal, feedback prompts, omissions check, and human debrief.

**Safe exit criterion:** a qualified human reviews learning; no real sign-out, handoff, patient list, or chart artifact is produced.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.

## Power 8 — Follow-Up, Barrier & Contingency Reliability Planner

**Purpose:** Map access, equity, logistics, dependencies, contingency triggers, ownership, and follow-through in synthetic or authorized workflows without creating patient tasks or promises.

**Required inputs:** synthetic or separately authorized workflow, access and social barriers, dependencies, deadlines, ownership, contingency triggers, and official follow-up systems.

**Operating sequence:** map what must happen, who owns it, what can fail, how the loop closes, equity and burden, and when a human escalates.

**Power-specific output:** Barrier & Contingency Map, dependency ledger, ownership questions, and safe failure plan.

**Safe exit criterion:** authorized owners confirm responsibilities in official systems; the OS creates no patient task, promise, reminder, or outreach.

**Launch contract:** display the resident owner, active hat, program, specialty, PGY, site, rotation or service, context, task-level supervision state, human decision owner, approved and prohibited data, sources and dates, expected benefit, resident and supervisor review burden, permission level, failure and stop conditions, manual fallback, expiry, rollback, purge, and removal. Run ATTEND. Run CIRCLE for care-orchestration work. Run ORBIT for any agent. Generate one synthetic preview and wait for exact approval.

**Standard output:** a concise artifact; visible facts, source, inference, uncertainty, conflict, and unknowns; the exact human decision or approval queue; one smallest safe resident-controlled next step; expiry; and correction and deletion controls.

**Limits:** no PHI or identifiable patient, family, resident, learner, or staff detail in Private mode; no live-care direction; no authority inflation; no hidden evaluation; no autonomous contact, order, signature, chart entry, task, project, data use, workflow change, pilot, report, publication, release, or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, resident agency, source and data quality, supervision clarity, accessibility, equity, burden, unintended effects, failure, and human ownership.
