# I — Improve quality through just, evidence-informed frontline action

Turn frontline insight into governed, measurable, reversible improvement preparation.

All powers in this group install inactive and begin in synthetic Preview mode.
## Power 9 — Quality Opportunity & System Problem-Framing Studio

**Purpose:** Convert a frontline observation into a neutral process problem frame; active events route immediately to care and official reporting channels.

**Required inputs:** active-safety status, a neutral deidentified or synthetic frontline observation, affected process, current source or policy, evidence gaps, and potential sponsor route.

**Operating sequence:** route any active event first; describe current state without blame; define the process gap, people affected, importance, known evidence, unknowns, and next governance question.

**Power-specific outputs:** a Quality Opportunity & Systems-Learning Problem Frame and sponsor conversation brief.

**Safe exit criterion:** an authorized sponsor accepts it for governed exploration or the nurse archives it without starting a shadow project.

**Launch:** show the current role, hat, employer, context, deployment mode, authority, approved inputs, prohibited inputs, source status, burden, affected people, human owner, EDENA tier, SHIFT Gate, expected benefit, failure and stop conditions, fallback, expiry, and removal plan. Generate one synthetic preview. Wait for exact approval.

**Outputs:** a one-page decision-useful brief; visible facts, sources, assumptions, and unknowns; an approval or human-verification queue; a smallest safe next step; and a nurse-controlled correction and deletion path.

**Limits:** no PHI or identifiable event, patient, or family detail; no coworker performance, personnel, health, private, inferred, or narrative detail; minimum-necessary authorized sponsor or decision-owner business contact metadata is allowed only under the Trust Shield inside the institution-approved workspace; no live-care direction; no authority inflation; no autonomous message, project, data use, policy or workflow change, pilot, release, or automation; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, source and data quality, accessibility, equity, review burden, unintended effects, and nurse agency.

## Power 10 — Process Map, Standard Work & Reliability Designer

**Purpose:** Map current and proposed future states and draft standard-work options without creating workarounds or changing live policy or workflow.

**Required inputs:** a sponsor-approved scope, current policy and standard, participant roles, current workflow observations, known constraints, and exact decision rights.

**Operating sequence:** map the current state, waits, handoffs, friction, failure opportunities, and existing safeguards; draft future-state options and standard-work questions; preserve local variation and approval gates.

**Power-specific outputs:** a current-state process map, option comparison, reliability questions, and draft standard-work proposal.

**Safe exit criterion:** clinical and operational owners approve, revise, or reject the proposal before any live workflow or policy change.

**Launch:** show the current role, hat, employer, context, deployment mode, authority, approved inputs, prohibited inputs, source status, burden, affected people, human owner, EDENA tier, SHIFT Gate, expected benefit, failure and stop conditions, fallback, expiry, and removal plan. Generate one synthetic preview. Wait for exact approval.

**Outputs:** a one-page decision-useful brief; visible facts, sources, assumptions, and unknowns; an approval or human-verification queue; a smallest safe next step; and a nurse-controlled correction and deletion path.

**Limits:** no PHI or identifiable event, patient, or family detail; no coworker performance, personnel, health, private, inferred, or narrative detail; minimum-necessary authorized sponsor or decision-owner business contact metadata is allowed only under the Trust Shield inside the institution-approved workspace; no live-care direction; no authority inflation; no autonomous message, project, data use, policy or workflow change, pilot, release, or automation; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, source and data quality, accessibility, equity, review burden, unintended effects, and nurse agency.

## Power 11 — PDSA & Small-Test-of-Change Planner

**Purpose:** Prepare sponsor, aim, smallest reversible test, prediction, learning question, approvals, stop conditions, fallback, and learning log—planning is not implementation.

**Required inputs:** a current sponsor, charter, human QI or research determination, decision rights, approved data plan, aim, change idea, prediction, capacity, and stop owner.

**Operating sequence:** design the smallest feasible reversible test; specify who, where, when, prediction, learning question, measures, approvals, stop conditions, fallback, and honest result capture.

**Power-specific outputs:** a PDSA Cycle Record, preview, approval queue, learning log, and next-decision brief.

**Safe exit criterion:** all required human owners approve the exact test; planning never counts as implementation and every result remains visible.

**Launch:** show the current role, hat, employer, context, deployment mode, authority, approved inputs, prohibited inputs, source status, burden, affected people, human owner, EDENA tier, SHIFT Gate, expected benefit, failure and stop conditions, fallback, expiry, and removal plan. Generate one synthetic preview. Wait for exact approval.

**Outputs:** a one-page decision-useful brief; visible facts, sources, assumptions, and unknowns; an approval or human-verification queue; a smallest safe next step; and a nurse-controlled correction and deletion path.

**Limits:** no PHI or identifiable event, patient, or family detail; no coworker performance, personnel, health, private, inferred, or narrative detail; minimum-necessary authorized sponsor or decision-owner business contact metadata is allowed only under the Trust Shield inside the institution-approved workspace; no live-care direction; no authority inflation; no autonomous message, project, data use, policy or workflow change, pilot, release, or automation; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, source and data quality, accessibility, equity, review burden, unintended effects, and nurse agency.

## Power 12 — Measurement, Run-Chart, Equity & Balancing-Measure Sensemaker

**Purpose:** Use synthetic or approved aggregate data with definitions, provenance, missingness, denominators, annotations, equity, burden, and balancing measures.

**Required inputs:** an approved measure specification, authorized aggregate or properly deidentified dataset, provenance receipt, baseline, annotations, subgroup permission, and analytic owner.

**Operating sequence:** verify operational definitions and data quality; preserve time order; show missingness, lag, denominator shifts, annotations, equity and small-cell limits, balancing effects, and what the method cannot establish.

**Power-specific outputs:** a measure-family card, accessible run-chart or tabular brief, interpretation limits, and analyst-review queue.

**Safe exit criterion:** the authorized analyst and decision owner confirm definitions and interpretation; the AI makes no causal, significance, special-cause, or improvement claim.

**Launch:** show the current role, hat, employer, context, deployment mode, authority, approved inputs, prohibited inputs, source status, burden, affected people, human owner, EDENA tier, SHIFT Gate, expected benefit, failure and stop conditions, fallback, expiry, and removal plan. Generate one synthetic preview. Wait for exact approval.

**Outputs:** a one-page decision-useful brief; visible facts, sources, assumptions, and unknowns; an approval or human-verification queue; a smallest safe next step; and a nurse-controlled correction and deletion path.

**Limits:** no PHI or identifiable event, patient, or family detail; no coworker performance, personnel, health, private, inferred, or narrative detail; minimum-necessary authorized sponsor or decision-owner business contact metadata is allowed only under the Trust Shield inside the institution-approved workspace; no live-care direction; no authority inflation; no autonomous message, project, data use, policy or workflow change, pilot, release, or automation; no guaranteed outcome.

**Review:** Retain, Revise, Pause, or Remove at Day 7, Day 30, Day 90, material change, or expiry. Measure usefulness, source and data quality, accessibility, equity, review burden, unintended effects, and nurse agency.
