Free PDF framework · Direct download · No email required
Make APP judgment a usable decision input
The Decision-Use Framework shows cardiac surgery programs how to build the infrastructure that turns experienced APP judgment into a repeatable OR decision system.
The decision-use problem
Your experienced APP saw the problem. The system had no way to use the judgment.
Programs hire APPs for clinical judgment, then often leave the moments where that judgment matters most undefined. An APP may recognize a marginal conduit, a hemodynamic trend, or a plan change early, but the assessment can remain silent, untrusted, or disconnected from the decision.
This framework addresses that infrastructure gap: when the APP surfaces an assessment, how the team weighs it, and where the assessment becomes a documented decision.
What is inside
A three-layer operating architecture
Communication Triggers
Define when the APP is expected to surface a clinical assessment.
Readiness Standards
Make per-APP, per-decision-point readiness and decision weight legible.
Decision-Use Systems
Route each assessment into an explicit decision and record what happened.
The framework also includes:
- The twelve named decision points of the cardiac case
- Supervised, Contributing, Authoritative, and Teaching stages
- The Surface → Acknowledge → Decide → Record loop
- A three-wave rollout sequence and qualitative economics posture
- A 10-question self-assessment scored from 0 to 20
Who it is for
For leaders building a more usable decision system
Cardiac surgery program directors and medical directors
APP leads and experienced surgical APPs
CVOR managers and OR team leaders
Leaders responsible for local review, ownership, and measurement
Use it as a working framework
Start with one decision point, then build the system locally
Use the PDF to establish shared language, choose a high-value decision point, and identify the local owners, approvals, documentation, and measures required for implementation. It is an operational framework, not clinical teaching or a substitute for institutional policy, scope, credentialing, or surgeon-led clinical authority.
Download the free frameworkNeed help adapting a framework to one bounded organizational need?Explore consulting.