Decision question.
Decision year: 1978. Data as-of: 1978-09-13. World: Past Reconstruction.
Deadline.
Who decides: virtual local health team formation meeting.
Mandate.
The three options.
Severity: A Significant Decision.
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1The meeting before the meeting
Synthetic scene.
The room is a kitchen. It is late afternoon in 1978, and the table has not been cleared. There is a pot, two cups, a folded newspaper, and under the newspaper a single typed sheet. The sheet is the agenda for the first team formation meeting. Four words are written across the top of it: roles, training, referral, resident trust.
A practitioner sits at the table. They have lived on this street for years. Across from them is a resident who has come without being asked. The new health facility is across the neighbourhood. It has a door, a sign, a telephone number, and a set of hours. The resident has not been there.
The resident talks about the winter. About the small money, the long queue, the cousin who stopped working. They say the things they have not said at the new facility. They say them because this practitioner has been there before, for longer than the facility has existed.
In the synthetic setting, some residents first tell a local practitioner, whom they have known longer than the new facility, about the difficulties of daily life and health.
The practitioner listens and writes nothing down. They have experience. They have set a shoulder back in a kitchen, cleaned a wound at a sink, talked a neighbour through a fever at midnight. Nobody on the new team has seen a record of any of it. The capability needed for the role to be assigned in the new health team remains unverified.
That practitioner has experience, but the capability needed for the role to be assigned in the new health team remains unverified.
Outside, the residents are already treating the practitioner as the one they go to. The team knows this. If the practitioner is not brought in, the contact may go cold and the information the team would need will not arrive. If the practitioner is brought in with a wide brief, the team's own boundary moves, and the team becomes answerable for work nobody has checked.
If they do not work together, important contacts may break down; if the role is broadened, the team's responsibility boundary must be redefined.
The resident leaves. The practitioner folds the agenda sheet, looks at the four words, and puts it back on the table under the newspaper.
That is the whole scene. Nothing has been decided in it. What the scene holds is a person whom residents trust, a team that cannot yet verify what that person can do, and a deadline that arrives in sixty days whether or not anyone is ready.
Two frames sit on the table with the agenda. The first is a question the meeting is working inside, not an answer:
How does the expansion of healing change the community's distributive promise?
The second is a rule about how the choice must be argued:
The benefits and costs of the option are attributed to different parties. Which loss to accept remains undecided.
The second frame is the one that shapes everything below. Every option in this record hands its benefit to one party and its cost to another. The meeting cannot avoid choosing a loss. It can only choose which party carries it, and say so.
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2The question
2.1Who decides, by when
One body decides, and it decides once before the clock runs out. The virtual local health team formation meeting is the decision-maker. Its mandate is four things: roles, training, referral, and resident trust. It is not asked to judge clinical outcomes. It is asked to place one existing practitioner inside or outside a team that does not exist yet.
Within the 60 days up to the first team formation
The reason the meeting exists at all is stated in the record:
In the synthetic setting, some residents first tell a local practitioner, whom they have known longer than the new facility, about the difficulties of daily life and health. Decision deadline: within the 60 days up to the first team formation.
Notice what the first half of that sentence does and does not say. It says where residents go first. It does not say that the practitioner is competent for the new team's work. It does not say that residents are right. It says only that a channel exists and that it predates the facility.
The sixty days are not a grace period. They are the whole of the decision. Whatever the meeting does not settle inside them arrives at the first team formation unsettled, and the team begins work with a boundary that has not been drawn.
2.2Where the authority does not reach
The meeting's authority is narrow, and one judgment states the edge of it exactly:
This decision has effect only as an internal formation decision managing role, training, referral, resident trust over the 60 days up to the first team formation. It is not a decision recognizing the practitioner's general clinical capability, legal qualification, or the trust of residents as a whole. Additional work that passes verification is not permitted without a separate re-decision.
Three things sit outside that edge. The meeting cannot certify general clinical capability, because no verification exists yet. It cannot certify legal qualification, because the record contains no evidence establishing it. It cannot certify that residents trust the practitioner as a whole, because trust has been observed only as a pattern of who people approach first.
Authority also does not reach past day 60 on its own terms. Every judgment in the record treats the first team formation as a re-decision point rather than a seal. Roles granted at that point can be widened, held, or reduced. Roles refused at that point are not permanently refused either.
The meeting's authority stops short of the residents themselves. It can explain a scope. It cannot control how a scope is read. That gap is where one of the two event branches lives, and chapter 4 returns to it.
2.3The three options and what each costs
Option O1. The practitioner joins the team, but only after capability has been checked role by role and the training has been done.
Join the team after capability verification and training
Its stated trade-off is:
It connects local trust with the new system, but takes on the training resources and the responsibility of the actual role.
The gain and the cost fall on different parties. Residents and the team gain the connection. The team pays the training and the supervision. The practitioner waits for verification before being treated as an authority. Read against the value frame, O1 buys connection by making the team answerable for work it has not yet checked.
Option O2. The practitioner takes a contact and guidance role: listening, passing information, guiding people to the right person on the agreed path. The record's trade-off for this option says it keeps the resident contact point alive, but that what the practitioner and residents expect of the role may run against the narrower official scope. The cost here is not money. It is friction at the boundary, plus the work of explaining the boundary repeatedly.
Option O3. The practitioner works alongside the team but outside it. The record's trade-off for this option says it keeps the team's internal standards distinct, and accepts that field information and referrals will be split apart. The cost is a divided channel: the practitioner hears things the team does not, and refers them through a path nobody owns.
All three costs are real. None of the three is priced in the record. The value material is explicit that the pricing is the meeting's job:
The benefits and costs of the option are attributed to different parties. Which loss to accept remains undecided.
2.4What is still unknown
Three things are unverified. They are unverified at the moment the decision is taken, and they remain unverified through every milestone in chapter 3.
The verification and training needed for each role to be assigned
Two more sit beside it:
The specific reasons resident trust arose
The referral path for difficulties encountered outside the role
The first unknown is about the practitioner and the team. The second is about the residents and the reason they come first. The third is about what happens to a problem that does not fit the role at all.
Each unknown carries a re-opening instruction. The record fixes the shape of the check before the check is performed:
Determine what observation, person in charge, and confirmation window will verify “…the verification and training needed for each role to be assigned,” and re-judge if a new verification changes the cost of the option.
Determine what observation, person in charge, and confirmation window will verify “…the specific reasons resident trust arose,” and re-judge if a new verification changes the cost of the option.
Determine what observation, person in charge, and confirmation window will verify “…the referral path for difficulties encountered outside the role,” and re-judge if a new verification changes the cost of the option.
Three sentences, one pattern each: name the observation, name the person who checks it, name the window, and re-open the decision if the answer changes what the option costs.
The meeting cannot yet answer three further questions, which the record holds for the reader. They are flagged here and handed back in chapter 6:
How different are group averages and individual responses?
Two more of the same kind:
Who sets the order of access opportunities?
What obligations arise before effects are verified?
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3The prediction
3.1Where the thirteen judgments converge
Thirteen judgments were written on this record. They are AI-generated, they were written on 2026-09-08, and their confidence is MEDIUM except for one at LOW. They disagree about the option. They do not disagree about four things.
First: nobody grants authority on unverified capability. Not one of the thirteen lets the practitioner perform independent health judgment, treatment, or a wider team role before role-by-role verification. The five that choose O1 grant team membership only after verification and training are complete. What is allowed in the meantime is worded differently by each. Domain Analysis limits the interim work to contact, guidance, and preparatory work under supervision, and Operations Planning to the contact and guidance role alone. Review Coordination withholds only unverified treatment and procedure work. Judgment Synthesis takes on no unverified work at all. Decision-Maker's View says only that roles follow verified capability rather than unverified experience. The eight that choose O2 grant a narrower role from the start. The difference is the order of operations, not the standard.
Second: every judgment sets conditions before acting. All thirteen set their conditions before any resident-facing role begins. Most of them write down permitted and prohibited work, and most name a person in charge for verification, for resident contact, and for referral. The conditions are not observations. They are requirements the meeting must create.
Third: all thirteen treat the sixty days as an observation schedule rather than a result. Each judgment states plainly that its milestones are a plan to be carried out, not something already confirmed. None reports that trust was preserved, that training was completed, or that a referral reached its destination. The record contains no post-implementation outcome at all.
Fourth: all three unknowns get an owner and a confirmation window. Every judgment assigns who checks U1, U2, and U3, and by when. Where they differ is the day: day 10, day 14, day 15, day 20, day 25, day 30, day 35, day 45. The differences are scheduling, not substance.
The split. Eight judgments choose O2. Five choose O1. No judgment chooses O3 first. O3 appears in every one of the thirteen. In twelve it is a fallback: the place to go when boundaries cannot be enforced, when a referral path fails to materialize, or when the responsibility of O1 proves unmanageable inside sixty days. In Review Coordination it appears only as that judgment's stated opposing view, the position it weighs and then rejects in favour of a conditional O1.
That distribution is not a vote on which option is right. It is a record of what each judgment was willing to lose.
3.2Majority and minority side by side
The five that choose O1.
Review Coordination states the majority-of-the-minority position in one sentence:
It is decided to admit the existing local practitioner to the official health team as the resident contact point and referral liaison for each role, after completing role-by-role capability verification and the necessary training. Unverified treatment and procedure work is not assigned, and additional work is granted only after the relevant capability has been separately verified.
The ground for that call is a weighing, not a measurement:
A conditional decision that weighs together the need to preserve the existing contact point with residents, the current unverified capability, and the opposing risks of a breakdown in cooperation and an expansion of responsibility.
What it accepts losing is stated in full:
It accepts the loss of committing team resources to training and supervision and of not fully recognizing the practitioner's existing experience as official work authority until verification is complete. It also accepts the loss of specifying role boundaries, which may restrict the autonomy or immediacy that the practitioner and some residents expect.
And its counterposition names O3, not O2, as the opposing view:
The opposing view is that putting a practitioner whose capability and referral system are unverified into the official team will increase confusion of responsibility, so only collaboration outside the team should be maintained as in O3. This view points to a valid risk, but considering the possibility that important contacts will break down and the value of participation close to daily life, O1 is decided with verification, training, and stop conditions rather than immediate exclusion.
Domain Analysis reaches the same option with a heavier account of the cost:
The meeting accepts the resources spent on evaluation and training, the burden of supervision, and the loss that the team must redefine its responsibility boundary as the role expands. The practitioner may lose part of their existing autonomy, the team takes on additional responsibility, and residents may not receive immediately expanded services during the verification period. Whether this distribution is just is re-judged on day 60 together with the benefit of avoiding a break in the resident contact point.
Its uncertainty is direct: whether O1 improves trust, accessibility, or health outcomes is not judged at all, and confidence is set at medium.
Operations Planning turns the option into a dated programme:
Within 15 days, the evaluator designated by the meeting must document role-by-role verification criteria and training items and completion criteria, and the person in charge of the resident contact point must set a window and recording method for confirming the reasons for trust with residents. Before starting the official role, the referral team member and the handover procedure must be designated, and the procedure by which the practitioner passes difficulties outside the role through that path must be confirmed.
Judgment Synthesis is the bluntest about what it is assuming rather than knowing:
It is provisionally assumed that resident trust is maintained also in the official role, that required capability can be met through training, and that a workable referral path can be created within 60 days. Since all three items are still unverified, confidence is medium, and if a new confirmation overturns this assumption, the scope of O1's role or the choice itself is re-judged.
Decision-Maker's View puts the same choice in plainer language:
It is decided to include the existing local practitioner in the new health team after completing capability verification and required training. Roles are not assigned on unverified experience alone, only roles corresponding to verified capability. This is a decision to connect the contact point residents have with the health team while also taking on the team's responsibility that comes with it.
Its accepted loss names the parties separately: the team pays verification, training, supervision, and referral; the practitioner gets a scope narrower than expected; residents may find that trust does not transfer to all team work at once.
Its counterposition is O2, and it is explicit that O2 is the realistic alternative if the conditions fail:
The strongest opposing view is that it should first be limited to O2, maintaining resident contact points while avoiding the team's assumption of responsibility for unverified capability. This becomes more persuasive when evaluation and training cannot be completed within 60 days or when referral boundaries cannot be set. However, fixing O2 from the start as the final role closes off the possibility of allowing participation matched to capability after verification and may continue to leave conflicts in role expectations, so at present a conditional O1 is decided.
The five O1 judgments share one shape: keep the contact point, pay the verification, and let the role follow the evidence. Their common ground is a belief that sixty days is enough to check capability, and that the checking is worth the resources.
The eight that choose O2.
Multi-Perspective Final Judgment states the position the record's title most directly describes:
The virtual local health team formation meeting decides to conditionally assign the existing local practitioner the O2 contact and guidance role in the first team. The practitioner listens to residents' difficulties, guides team information, and connects to the person in charge designated in advance, but does not perform unverified health judgment or treatment. When capability and training by role are verified, expand to O1; if even the limited role cannot be safely demarcated, reduce to O3.
It names the loss it takes:
The meeting accepts the loss of not immediately utilizing the practitioner's experience and resident trust for broader team roles. It also bears that the existing expectations of the practitioner and residents may conflict with the limited official scope, and that the team bears the burden of boundary explanation, basic training, supervision, and referral coordination. It judged instead not to transfer responsibility for unverified capability to residents, nor to leave it only outside the official team where the risk of split contact remains.
Its stop condition is a three-part test:
If the minimum capability and training standard for contact and guidance is not set or met within 60 days, and a responsible referral path is not finalized either, O2 is rejected and O3 is decided again. If, during implementation, records show that conduct exceeding the approved scope is repeated, or that matters outside the role are not conveyed to the designated recipient, or that the resident's misunderstanding of authority persists after explanation, that role is stopped immediately. Conversely, if capability and training completion for the broader role and referral responsibility are confirmed, O2 is not fixed and the transition to O1 is re-reviewed.
Its counterposition is the O1 argument in full:
The strongest opposing view is the claim that only by targeting O1 from the start, completing evaluation and training, and then admitting the person as an official team member can resident trust and the new system be fully connected. If capability and training completion by role, responsibility boundary, and referral path are verified within 60 days, this opposing view may take precedence over O2. However, since those conditions are currently unverified and O1 pre-emptively takes over training resources and broader responsibilities, at this stage O2 with its narrow and recallable scope is decided.
Evidence and Sources Review keeps the choice provisional on its face, and pays for it in expectation:
This choice accepts the loss that the existing role expected by the practitioner and residents may conflict with the official contact and guidance scope. The formation meeting also takes on the burden of explaining boundaries and of verification work. In exchange, it makes a value judgment to reduce the risk that important contacts and referrals will split when kept only outside the official team.
Its stop condition is where O3 becomes concrete: if the referral path does not function, or the needed capability cannot be verified, or boundary conflicts cannot be corrected, the scope reduces to O3 and the decision is made again.
Independent Challenge defends O2 while keeping a dissent alive:
The strong dissenting opinion to preserve is the argument that until capability and the referral path are confirmed, only collaboration outside the official team under O3 should be maintained. Since an official title itself can widen role expectations and increase confusion about the responsibility boundary, if a signal appears that boundaries cannot be enforced, this dissent takes precedence over O2. O1 can be re-compared only after role-by-role capability verification and the required training are actually met.
Authority and Legal Review writes the tightest scope and the sharpest stop line:
This decision has effect only as an internal formation decision managing role, training, referral, resident trust over the 60 days up to the first team formation. It is not a decision recognizing the practitioner's general clinical capability, legal qualification, or the trust of residents as a whole. Additional work that passes verification is not permitted without a separate re-decision.
If a referral is confirmed with no designated recipient person in charge, or if it is confirmed that the practitioner performed an independent health judgment beyond the approved scope, that role is stopped immediately. If education and verification results fall below the minimum standard for contact and guidance, or records appear showing residents repeatedly understand the role as broader authority, stop O2 and switch to O3 for re-examination. If new information establishes capability and the responsibility boundary sufficiently, then instead of stopping, re-decide whether to transition to O1.
Its uncertainty separates two kinds of confidence: medium for the internal allocation of authority, low for field effects.
Decision Quality Review is the only judgment at LOW confidence, and it says why:
It is still unknown from what act or relationship of the practitioner resident trust arose, what verification and training the contact and guidance role also requires, and where out-of-role difficulties will be referred. Therefore, the result that O2 actually preserves trust or reduces contact breakdown is unverified, and confidence in this decision is low.
Its counterposition concedes that O1 may well be the better option if verification and training can be finished in time, and that O3 may be the more consistent boundary if they cannot. It holds the middle only because neither has been shown.
Outcome Review argues from reversibility, and names what O2 gives up:
O1 can connect resident trust and the new system more directly, but currently the necessary capability is unverified, making it difficult to select immediately. O3 makes the team's responsibility boundary clearest, but important contact and referral may split. If signals emerge that capability verification is sufficient and the referral path works, change to O1; if boundary confusion or connection failure is confirmed even in contact and guidance, change to O3.
Improvement Design justifies O2 on a different ground altogether, which is worth quoting in its own words:
At the point of first team formation, it is decided to have the existing local practitioner participate in a limited contact and guidance role. Work requiring unverified capability is not assigned, and until the results of capability verification and training are available, only the role of connecting the resident contact point and the official referral path is granted. This is not a permanent rejection of O1 or O3, but a reversible first step to distinguish the causes of error.
For this judgment, a narrow role has value beyond safety: it separates the causes. If something fails later, a limited role tells you whether the failure came from capability, from trust, or from the referral path.
Solo Judgment takes the loss and puts it in front of all three parties:
This choice accepts the friction that may arise because official authority is narrower than the role expected by the practitioner and residents. The team bears the burden of setting guidance standards and handing over and checking contact, and the practitioner cannot take on a broad role before verification even with existing experience. For residents, the inconvenience may fall that the familiar practitioner does not directly solve all problems but connects them to another person in charge.
Its stop condition carries a warning in both directions:
If the designated referral person in charge or contact method disappears before actual operation, the official role is stopped. If, after the role scope has been explained and one correction made, subsequent records confirm that the practitioner repeats unverified work, or that resident contacts intended for handover are repeatedly not passed on to the team, participation is suspended and O3 is re-examined. Conversely, the mere absence of stop signals does not approve the expanded role of O1.
That last clause matters. Silence is not evidence. It is also Solo Judgment's alone: no other of the eight O2 judgments states that the absence of failure does not by itself license a wider role. The other seven say something close — that O2 is not fixed, and that verified capability, completed training, and a working referral path reopen the case for O1.
The grounds, side by side. Neither side claims an observation. The O2 side rests on a judgment about reversibility and attribution:
It is a provisional and reversible choice that considers together the value of the resident contact point, unverified capability, and the possibility of contact breaking down when collaboration is declined.
The required verification and training, the reasons resident trust arose, and the referral path outside the role are all unresolved. Therefore whether O2 actually preserves trust or reduces contact breakdown is unverified. Confidence is medium, and this is a judgment about the limited and reversible nature of O2, not a statement that its effect has been observed.
The O1 side rests on a judgment about connection and about what sixty days can settle:
This is a phased implementation that connects existing local trust to the new system without immediately recognizing unverified capability as authority. The community participation and referral system presented by the background document support direction but do not prove the effects of this choice.
The content that some residents turn to the practitioner first is also a synthetic setting of this synthetic event, not actual observation data. Therefore whether O1 actually improves trust, accessibility, or health outcomes is not judged, and confidence is set at medium.
Read together, the two sides differ on one question: whether it is worse to wait for verification and risk a gap in the connection, or to open a narrow role now and risk a mismatch with what residents expect. Both accept a loss. Neither has observed the outcome.
3.3The timeline from decision to deadline
The thirteen judgments' conditions, stop conditions, and milestones can be laid end to end. What follows is one schedule in relative time. Each line names where it comes from. Nothing on this schedule has happened yet.
Day 0the meeting decides.
The virtual local health team formation meeting chooses an option. No authority exists yet for any work that requires unverified capability. Permitted and prohibited work is not written down until the days below. Whatever is decided, the practitioner's existing experience is not yet official work authority.
Day 10 to 15 after the decisionowners and criteria exist.
The role list, the verification criteria, and the reviewer in charge are set (Review Coordination). The detailed roles and prohibited work are set, and the person in charge of capability evaluation and the person in charge of resident contact are appointed (Domain Analysis). The capability and training person in charge, the resident contact person in charge, and the referral responsible person are named, and a draft of permitted and prohibited work is produced (Multi-Perspective Final Judgment). The evaluator documents role-by-role verification criteria, training items, and completion criteria, and the resident contact point sets a window and a recording method for confirming the reasons for trust (Operations Planning). The contact and guidance work and the verification criteria by role are defined (Outcome Review). Within 10 days the training person in charge records the verification items and the training plan by role (Improvement Design).
Day 20 to 30 after the decisionthe three unknowns get recorded.
A capability and training table by task and a referral responsibility table are prepared (Authority and Legal Review). Role-by-role capability and training requirements and the referral path are checked (Independent Challenge). The referral path and the responsible party are checked for existence (Decision Quality Review). The practitioner's relevant capability and the necessary training are checked (Outcome Review). The resident participation person in charge verifies in the designated manner why residents trust, while the referral responsible person checks where requests outside the role are blocked (Improvement Design).
Day 35 to 45 after the decisioncompletion and record check.
Education and role-by-role verification are conducted (Authority and Legal Review). Training completion and the referral procedure for cases outside the role are checked by the supervising person in charge (Domain Analysis). The evaluator records whether role-by-role capability verification and training are complete (Operations Planning). Within the limited contact and guidance operation, records show whether contact was completed, whether out-of-role requests occurred, and whether referral failed (Independent Challenge). Contact and referral records are reviewed for scope misapprehension and missed handover (Authority and Legal Review). Within 45 days why residents trust is verified, and the referral path outside the role is checked for being understood and workable (Outcome Review). The decision is re-judged against new confirmations before the final day (Decision Quality Review).
Day 50 after the decisionthe referral path confirmed or rejected.
If the person in charge and the handover procedure for the referral path have not been confirmed, or if records show that out-of-role matters could not be passed during the pilot, official admission under O1 is rejected and O2 or O3 is re-decided (Operations Planning).
Day 60 after the decisionre-decision at the first team formation.
The meeting confirms, reduces, or rejects the granted authority based on the records (Review Coordination, Domain Analysis). It decides among transition to O1, retention of O2, and transition to O3 (Independent Challenge, Authority and Legal Review, Outcome Review). It confirms one of retention of O2, expansion of O1, and transition to O3 (Decision Quality Review). It reviews whether capability fulfilment, the coexistence of trust and role, and referral acceptance changed the cost of the option (Multi-Perspective Final Judgment). It compares the three options again if any verification changed the loss (Improvement Design, Judgment Synthesis, Decision-Maker's View, Evidence and Sources Review, Solo Judgment).
Stop conditions fall at several points inside that schedule, and one of them falls at its very end rather than before it:
Day 30boundaries unset means O2 is rejected and O3 re-examined.
If role boundaries or the actual referral path cannot be set within 30 days, official participation stops and O3 is looked at again (Independent Challenge). Decision Quality Review puts a gate on the same day: if the referral path is not actually assigned or the responsible party is not agreed, participation does not start and O3 is examined instead.
Day 35O1's official grant stops for any role whose criteria are not met.
If the verification criteria for a specific role or the required training are not met, that role is limited to contact and guidance (Operations Planning).
Day 35 to 45O2 stops if education falls below the minimum standard or if records show residents reading the role as broader authority.
Education and role-by-role verification run within 35 days and contact and referral records are reviewed within 45 (Authority and Legal Review). If education and verification results fall below the minimum standard for contact and guidance, or records appear showing residents repeatedly understand the role as broader authority, O2 is stopped and O3 is re-examined.
Within 60 daysunverified capability or an unconfirmed referral path stops O1 admission.
If verification or training is incomplete, or the referral path and the responsible party are not finalized, admission to the official team is stopped (Review Coordination, Decision-Maker's View). Improvement Design holds a gate of the same width: if role boundaries or a workable referral path cannot be set within 60 days, implementation of O2 is suspended and O3 is re-decided.
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4The branches
Two event cards sit beside the initial state. They are alternatives, not a sequence. Neither has been observed. Each one activates conditions already written into the judgments above.
4.1Branch B1
Synthetic scene.
Residents took the practitioner's participation in a contact and guidance role as official recognition of all of their practice.
Synthetic scene.
It happens without anyone deciding it. The practitioner is named to a contact and guidance role. A resident hears the name, then tells two neighbours. By the end of the week the phrase in circulation is not that the practitioner listens and refers. It is that the team has taken the practitioner on, and that everything the practitioner does is now the team's work.
A woman brings a persistent cough and asks for medicine by name. A man arrives with a dressing that needs changing and expects it done there and then. A third person asks the practitioner to say whether the clinic visit is needed at all. Each request is reasonable from where the resident stands. Each sits outside a scope that has been written down but not understood.
This is the branch where a narrow role widens by interpretation rather than by decision.
Which conditions it triggers. Authority and Legal Review wrote the exact line for this:
If a referral is confirmed with no designated recipient person in charge, or if it is confirmed that the practitioner performed an independent health judgment beyond the approved scope, that role is stopped immediately. If education and verification results fall below the minimum standard for contact and guidance, or records appear showing residents repeatedly understand the role as broader authority, stop O2 and switch to O3 for re-examination. If new information establishes capability and the responsibility boundary sufficiently, then instead of stopping, re-decide whether to transition to O1.
Outcome Review sets the same test from a different angle: if a signal is verified that residents misperceive the role as the team's verified health capability, the contact and guidance role is stopped, and collaboration is reduced to working outside the team while the cause and the boundaries are re-examined.
Multi-Perspective Final Judgment stops the role when the resident's misunderstanding of authority persists after explanation. Solo Judgment suspends participation and re-examines O3 if records confirm, after explanation and one correction, that the practitioner repeats unverified work. Improvement Design stops the work if unverified work is repeatedly assigned, and goes further: if contact and guidance itself continuously breaks important contact, O2 is rejected too and the connection structure is redesigned. Evidence and Sources Review reduces the scope to O3 without widening unverified authority, and makes the decision again.
What was supposed to prevent it. The O1 side wrote a condition aimed squarely at this failure. Decision-Maker's View requires that, before team participation, the meeting verifies the specific reasons for resident trust and reviews whether the official role misuses that trust. That review is the prophylactic: an explicit check on whether an official title will take the trust further than the role can carry it. Authority and Legal Review sets a matching procedure for explaining the scope of the role to residents. Multi-Perspective Final Judgment requires the practitioner and the team jointly to confirm the scope.
In B1, those conditions were either set and ignored, set and insufficient, or never set at all. The branch does not tell you which. That is one of the things the check in chapter 5 is for.
What B1 reopens. Under every one of these stop conditions, the role stops and the choice returns to O3, or the boundary is redrawn and the choice returns to O1. B1 does not refute O2 by itself. It refutes an O2 that was explained once and never checked.
4.2Branch B2
Synthetic scene.
The practitioner acknowledged their own limits and requested additional training and a clear referral agreement.
Synthetic scene.
The practitioner says it out loud at a table, unprompted. Not "I cannot do this," but "I should not do this alone, and I need to know who takes it when it is not mine." They ask for training. They ask for a referral agreement in writing: who receives, how it is delivered, who is responsible for replying.
This is the branch where the unknown U1 and the unknown U3 stop being paperwork and become a request from the person the decision is about.
Which conditions it triggers. Review Coordination wrote the conditions that this request activates:
The formation meeting first sets the verification criteria and training items for each role, and official participation is approved only if the designated reviewer records the evaluation and the implementation of training within 45 days. Within the same period, the specific reasons for resident trust and the referral path for matters outside the role must be verified, and authority, responsibility, and scope of supervision must be specified to the parties.
A request for training converts an abstract precondition into a scheduled one. It gives the meeting a dated reason to appoint the reviewer.
Domain Analysis's stop condition then runs in reverse. Its rule is that if the minimum capability for each role is not verified, or the required training is not completed within sixty days, admission is stopped and reduced to O2's contact and guidance role. A request for additional training makes that reduction likely rather than merely possible. It tells the meeting that the training required is larger than assumed, and the sixty days are fixed.
Decision Quality Review's counterposition moves the other way:
The strongest dissenting view is that if capability verification and training can be completed within 60 days, O1 connects the practitioner's experience and resident trust more fully into the new system. If the role-by-role criteria are actually met and the referral path and responsibility boundary are confirmed, the limited choice of O2 should be rejected and expanded to O1; conversely, if those conditions cannot be set, O3 may be a more consistent boundary.
Multi-Perspective Final Judgment's counterposition is the same in substance: if capability, training completion, responsibility boundary, and referral path are verified within sixty days, the O1 argument takes precedence over O2.
Independent Challenge's stop condition is written for exactly this:
If role boundaries or the actual referral path cannot be set within 30 days, reject O2, stop official participation in the team, then re-examine O3. If repeated out-of-role acts or failures of referral connection are confirmed during operations, suspend that work immediately. Conversely, if a new signal appears that role-by-role capability and the required training have been confirmed and the burden of O1's responsibility has become manageable, reopen the decision.
Judgment Synthesis's counterposition closes the loop: O2 is the strongest counter-proposal while capability is unverified, and if O1's verification, training, and referral conditions fail, O2 is chosen first, with O3 re-examined if that cannot be safely compartmentalized.
What B2 reopens. Whether O2 should move to O1. The practitioner's own request is evidence about U1 and U3, but it is not verification of either. It changes the cost of waiting. It does not supply the verification.
The two branches are not a sequence. B1 does not follow from B2, and B2 does not repair B1. One is about how residents read a title. The other is about how a practitioner reads their own limits. Either can occur in the sixty days, or neither. Neither is an outcome. The record contains no observation that either happened.
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5The check
Present position: Before the deadline; awaiting the check.
The table below fixes now what will be observed, who observes it, when, which judgments each observation bears out, and what it reopens. It gives no scores. It names no right answer. The observations are the record's own conditions and stop conditions, written down before any of them can be tested.
| What to observe | Who checks it, and when | If it is observed, which judgments it bears out | What it reopens |
|---|---|---|---|
| Role-by-role verification criteria, training items and a named reviewer are documented | Review Coordination / Domain Analysis / Operations Planning, by day 15 | The O1 side's Conditions before acting | Whether O1 can start at all |
| A named recipient and handover method exist for referrals outside the role, and referrals reach them | Authority and Legal Review / Independent Challenge, by day 30 to 45 | All thirteen Conditions before acting | O2 versus O3 |
| Records show residents read the contact and guidance role as broader official authority | Authority and Legal Review, at the day-45 record review, and at day 60 | Event branch B1 and the O2 side's Stop condition | Reduction to O3 |
| The specific reasons resident trust arose are verified and either fit or do not fit the assigned role | The resident contact person in charge, by day 25 to 45 | Decision-Maker's View and Judgment Synthesis, Uncertainty | O1's premise |
| Training completion and capability verification are recorded, or not, by day 45 to 60 | The evaluator, at day 60 | Operations Planning, Stop condition and Decision Quality Review, Counterposition | Expansion to O1 |
| Out-of-role requests occur and are passed, or fail to pass, to the designated recipient | The referral responsible person, days 30 to 60 | Improvement Design and Outcome Review, Stop condition | Scope |
| The practitioner requests additional training and a clear referral agreement | The formation meeting, any time to day 60 | Event branch B2 | Whether O2 should move to O1 |
| Scope misapprehension persists after explanation | Authority and Legal Review, day 45 and day 60 | Multi-Perspective Final Judgment and Authority and Legal Review, Stop condition | The whole role |
5.1How to read the table
The first row is the gate. If criteria, training items, and a named reviewer exist by day 15, the O1 side's conditions are on paper and the option can begin. If they do not, the option that requires verification and training cannot begin, and O1 stays closed until the criteria, the training items, and the reviewer exist. O2 and O3 are untouched by that absence, and several of the judgments plan to compare all three again at day 60 on whatever verification has been obtained by then.
The second row is the shared condition. Every one of the thirteen judgments requires a referral path with a named owner before resident-facing work starts. This is the row where an O1 decision and an O2 decision most resemble each other, and where both of them differ from an O3 arrangement in which the path is by definition outside the team.
The third and eighth rows watch the same failure from two directions. One asks whether residents are reading the role too widely. The other asks whether that reading survives explanation. Together they carry branch B1.
The fourth row is the only one that tests the reason residents come first. It can come back with an answer that does not fit the assigned role. If trust arose for reasons unrelated to health work competence, several judgments say O1 should not be insisted upon.
The fifth and seventh rows carry the two branches apart. Row five is verification that lets O2 widen. Row seven is a request that lets O2 widen. Neither row is an outcome; both are signals the meeting must act on before day 60.
The state of the record is the state of the table: eight rows written, none checked.
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6The questions that remain
The record hands three questions to whoever reads it. They are not answered here.
How different are group averages and individual responses?
Who sets the order of access opportunities?
What obligations arise before effects are verified?
The first matters because the record's premises describe a pattern among residents, not a uniform one. Some residents come first to this practitioner. Others may go straight to the new facility, or to nobody. A role sized for the group can be wrong for the individual who walks in next.
The second matters because somebody has to decide who is seen first, and in this record that decision is implied by whichever option the meeting picks. A contact and guidance role quietly makes the practitioner the order-setter for a set of residents. An official team role makes the order a matter of team procedure. Working outside the team leaves the order with no owner.
The third matters because every option in this record creates obligations before any effect has been verified. Training time, supervision time, boundary explanation, referral coordination: these are owed as soon as the decision is taken, and the benefit they are meant to produce is not observed until later.
Now three prompts for your own setting.
Who is the practitioner here? Name the person, or the small group of people, whom your residents, users, students, members, or neighbours turn to first — the ones who were there before the new service, and who are not on the new service's roster. Write down what you actually know about their capability, and mark what you have only assumed.
What are your three unknowns? The record used the verification and training needed for each role to be assigned, the specific reasons resident trust arose, and the referral path for difficulties encountered outside the role. Write your own three in the same shape. For each, name the observation, the person in charge, and the confirmation window. If you cannot name all three, the unknown is still unowned.
What is your stop condition? Choose the observation that, if you saw it, would make you stop the role you have assigned and re-open the decision. Write it before you start, while the decision is still reversible. Say who will see it and on what day. Say what it reopens.
The three options — join after verification, participate in a limited role, collaborate only outside — are available to you in almost the same form whenever a trusted existing relationship meets a new structure. The record does not tell you which to pick. It tells you that whichever you pick, you are accepting a loss that falls on someone other than the person who benefits, and that the loss is yours to argue.
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7Sources and notices
7.1Background document
Declaration of Alma-Ata · original text 1978-09-12
Published 1978-09-12. Its scope in the record:
A declaration of the time addressing the right to health, community participation, primary health care close to daily life and sustainable cost, cooperation across sectors of life, and the referral system. It does not prove the clinical effects of the synthetic event or the policy outcomes known later.
The document supplies direction and norms for this record. It does not prove the effect of any option chosen here.
Two further materials frame the meeting:
How does the expansion of healing change the community's distributive promise?
The benefits and costs of the option are attributed to different parties. Which loss to accept remains undecided.
7.2Notices
Every person, institution, event and figure in this piece is part of a synthetic setting. The three situational premises and the two branching events were fabricated under the record's stated premise policy; the data as-of date is 1978-09-13, and only the explicitly stated original text of the time is used as background. Actual outcomes, revised systems and success cases known later are not used as facts of the initial input. This is a modern retrospective question construction. It does not claim that a person of the time made this decision.
The thirteen judgments were generated by AI on 2026-09-08. Confidence is MEDIUM for twelve of them and LOW for Decision Quality Review. Their agreement is not evidence, and their disagreement is not a vote.
This piece is an AI-written expansion of the record. It quotes the record's judgments, options, premises, unknowns, event branches, watch questions and materials as they stand. It adds scenes and connective prose, and it does not add facts.
Input hash: 0f82673f92519847e07fd9a0f86f3d139b8756df438f5784079acddb9a17417c
Translation note: this is an English translation of the Korean record, which is the original. Original Korean-record hash: e003d12e883e95f1a39b49b81cec053d94fc326b8c2ab9d8f9661a59cc061581