Marrow Health: context benchmark

Authored fictional workload. Relevance is by construction: the topic labels and required answer sources are frozen before runs. Topic relevance: 15.4% of sections. 60,732 characters.

Baseline: openai/gpt-6-luna. Foreman: openai/gpt-6-luna + anthropic/claude-sonnet-5-5. This compares the complete product, including planning and independent review. The planner receives a compact document index; workers receive selected sections verbatim. All calls count toward total input tokens and estimated cost.

Model mappings and catalog prices captured 2026-10-08T21:02:01.610021+00:00. Prices below are USD per million tokens; measured costs use reported usage and applicable cached-token pricing.

SHA-256: b396becbf94f2656a015759105f223b2f80660c56fe609b467ee42fff651f270

Results

Not run: full matrix gated on successful two-arm smoke.

[]

Prompts and run

Section labels

Complete corpus

# Marrow Health — Internal Workspace Memory

> **Corpus 02.** Topic relevance: **2/13 sections (15.4%)**. Full pre-run labels are in corpus-manifest.json.
> this is real operational material that has nothing to do with the prompts.
> Fictional organization. No real company, person, patient, or system is depicted. No clinical content.

---

## DOC: Scheduling Service — Technical Overview
*Owner: C. Vance*

The scheduling service holds appointment slots for 140 practitioners across 11 clinics. Patients book
through the web portal; staff book through the admin console. Both hit the same API.

Core model:

- A **template** defines a practitioner's recurring availability (e.g. Tue/Thu 09:00–17:00, 20-minute
  slots).
- Templates generate **slots** 90 days forward, regenerated nightly.
- A **hold** is a soft reservation, 8 minutes, created when a patient starts booking.
- A **booking** converts a hold into a confirmed appointment.

Holds are the part that causes the most trouble. They expire by TTL in Redis, but the slot table is in
Postgres, so there is a window where Redis has released the hold and Postgres still shows the slot as
unavailable. The reconciler runs every 60 seconds to clean this up. Most double-booking reports trace to
this window.

### Concurrency

Slot booking uses optimistic locking on a version column. Two simultaneous bookings for the same slot:
first write wins, second gets a 409 and the client re-fetches. This works but produces a poor experience
during high-contention moments, which for us is Monday 08:00 when the week's cancellations get picked up.

### Capacity numbers

- Peak concurrent booking sessions observed: about 350.
- Slot regeneration processes roughly 1.1M slots nightly in 18 minutes.
- Redis holds peak around 900 keys.

---

### Operational review notebook

**Provenance exercise for Scheduling Service — Technical Overview.** We walked through the document with a support analyst comparing two appointment screenshots. The reviewer started from the appointment identifier and the revision that each screenshot represents, then followed the work to the point where another person would rely on it. The awkward case was a rescheduled visit appearing current in a saved browser tab. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We separated what the interface displays from what the operator can prove. The visible label is useful for navigation, but it is not evidence of the underlying action. The reviewer should ask for a traceable source and write down the remaining uncertainty. If the source cannot be found, leave that uncertainty visible rather than filling the gap with a familiar-looking value from another workstream.

**Permissions exercise for Scheduling Service — Technical Overview.** We walked through the document with a locum covering a clinic with unfamiliar administrative screens. The reviewer started from the minimum role needed for the demonstrated task, then followed the work to the point where another person would rely on it. The awkward case was a temporary role retained after the covering assignment finished. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

The walkthrough exposed a handover problem rather than a need for a new setting. The first person knew why the record looked unusual; the next person saw only the finished artifact. Add the explanation at the handover boundary and make its author visible. A private conversation can clarify the immediate case but cannot be the permanent place where the operating decision lives.

**Exceptions exercise for Scheduling Service — Technical Overview.** We walked through the document with a clinic coordinator handling an incomplete intake record. The reviewer started from the reason information is missing rather than a guessed substitute, then followed the work to the point where another person would rely on it. The awkward case was a patient stopping halfway through a form and later returning by telephone. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Use an example that has already completed its ordinary workflow when rehearsing this case. Do not repair a live record just to make a demonstration easier to follow. The exercise should preserve the confusing state, record the action taken, and show how a recipient can tell that the action finished. A clean screenshot alone is insufficient because it hides the transition that caused the confusion.

**Rehearsal exercise for Scheduling Service — Technical Overview.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.



## DOC: Timeout Settings Reference

Different services, different numbers, and this has confused people more than once.

| Service | Connect timeout | Read timeout | Max retries |
| --- | --- | --- | --- |
| Scheduling API (internal callers) | 2s | 10s | 3 |
| Notification dispatcher | 2s | 30s | 5 |
| Insurance eligibility check | 5s | 45s | 2 |
| Document store | 1s | 8s | 3 |

The eligibility check deliberately has low retries and a long read timeout: the upstream is slow but
reliable, and retrying a slow call just multiplies the wait. The notification dispatcher is the opposite —
fast but flaky, so retry aggressively.

Nobody should be adding a new outbound call without putting its numbers in this table.

---

### Operational review notebook

**Permissions exercise for Timeout Settings Reference.** We walked through the document with a locum covering a clinic with unfamiliar administrative screens. The reviewer started from the minimum role needed for the demonstrated task, then followed the work to the point where another person would rely on it. The awkward case was a temporary role retained after the covering assignment finished. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

The walkthrough exposed a handover problem rather than a need for a new setting. The first person knew why the record looked unusual; the next person saw only the finished artifact. Add the explanation at the handover boundary and make its author visible. A private conversation can clarify the immediate case but cannot be the permanent place where the operating decision lives.

**Exceptions exercise for Timeout Settings Reference.** We walked through the document with a clinic coordinator handling an incomplete intake record. The reviewer started from the reason information is missing rather than a guessed substitute, then followed the work to the point where another person would rely on it. The awkward case was a patient stopping halfway through a form and later returning by telephone. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Use an example that has already completed its ordinary workflow when rehearsing this case. Do not repair a live record just to make a demonstration easier to follow. The exercise should preserve the confusing state, record the action taken, and show how a recipient can tell that the action finished. A clean screenshot alone is insufficient because it hides the transition that caused the confusion.

**Rehearsal exercise for Timeout Settings Reference.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.

**Archiving exercise for Timeout Settings Reference.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.



## DOC: Office Move — Logistics Thread

We are moving the Harbor Street office to the new floor in the Caldwell building on the weekend of the
19th.

What staff need to do:

- Pack your desk into the provided crates by Friday 16:00. Label with your name and new desk number.
- Monitors stay. New floor has monitors already mounted.
- Anything in the shared storage closet that is not labelled by Thursday is being thrown out. This is not
  a bluff, it has been six years.
- Parking passes change. The new garage uses a different system; HR is emailing codes separately.

IT will move desktop machines Saturday. Laptops come home with you. The network on the new floor was
tested Tuesday and is fine, though the conference room on the north side has a weak signal and an access
point is being added.

First day on the new floor is the 22nd. Coffee machine arrives the 24th, so bring your own that week.

---

### Operational review notebook

**Exceptions exercise for Office Move — Logistics Thread.** We walked through the document with a clinic coordinator handling an incomplete intake record. The reviewer started from the reason information is missing rather than a guessed substitute, then followed the work to the point where another person would rely on it. The awkward case was a patient stopping halfway through a form and later returning by telephone. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Use an example that has already completed its ordinary workflow when rehearsing this case. Do not repair a live record just to make a demonstration easier to follow. The exercise should preserve the confusing state, record the action taken, and show how a recipient can tell that the action finished. A clean screenshot alone is insufficient because it hides the transition that caused the confusion.

**Rehearsal exercise for Office Move — Logistics Thread.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.

**Archiving exercise for Office Move — Logistics Thread.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.

**Accessibility exercise for Office Move — Logistics Thread.** We walked through the document with a patient using a keyboard instead of a pointing device. The reviewer started from the focus location and the exact text announced for the control, then followed the work to the point where another person would rely on it. The awkward case was a visual confirmation banner that a screen reader never announces. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

A useful completion check starts from the recipient perspective. Ask whether the recipient can identify the current artifact, understand the exception, and find the person responsible for resolving it. If any of those requires access to a private chat, the handover is still incomplete. The correction should improve that specific gap rather than add a broad assurance that the process is safe.



## DOC: Brand Refresh — Review Notes

The agency presented three directions.

**Direction A** — Soft, rounded, lots of sage green. Tested well with patients over 50. Several people
felt it read as "wellness brand" rather than healthcare, which is the wrong signal when someone is
anxious about an appointment.

**Direction B** — High contrast, navy and white, tight geometric type. Looks competent and slightly cold.
Preferred by the clinical staff in the room, which is interesting and possibly a warning sign — clinical
staff are not the audience.

**Direction C** — A hybrid that pleased nobody. The agency's own least favourite.

Decision: B, with warmth added through photography rather than palette. Agency to come back with a
revised deck in three weeks.

Separately: the logo mark needs to work at 16px for the app icon, and A's version did not. Worth stating
that constraint up front next time.

---

### Operational review notebook

**Rehearsal exercise for Brand Refresh — Review Notes.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.

**Archiving exercise for Brand Refresh — Review Notes.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.

**Accessibility exercise for Brand Refresh — Review Notes.** We walked through the document with a patient using a keyboard instead of a pointing device. The reviewer started from the focus location and the exact text announced for the control, then followed the work to the point where another person would rely on it. The awkward case was a visual confirmation banner that a screen reader never announces. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

A useful completion check starts from the recipient perspective. Ask whether the recipient can identify the current artifact, understand the exception, and find the person responsible for resolving it. If any of those requires access to a private chat, the handover is still incomplete. The correction should improve that specific gap rather than add a broad assurance that the process is safe.

**Review exercise for Brand Refresh — Review Notes.** We walked through the document with a practice manager weighing a change in intake procedure. The reviewer started from the patient action, staff action and handover between them, then followed the work to the point where another person would rely on it. The awkward case was a process appearing faster because the receptionist completes missing fields later. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We will evaluate the proposed revision using both an ordinary case and the awkward case from this exercise. Record the extra work done by the recipient as well as the work saved by the author. A local improvement is not a process improvement if it merely transfers effort to the next person. Keep the observations in this notebook so the eventual decision can be reviewed against what was actually demonstrated.



## DOC: Notification Dispatcher — Design

Sends appointment reminders by SMS and email. Volume is around 9,000 messages daily, spiky around 17:00
when the next-day reminder batch goes out.

Architecture is a queue consumer. Messages are enqueued by the scheduling service on booking, and by a
scheduled job for reminders. The consumer renders a template, resolves the recipient's channel preference,
and hands off to the provider.

Idempotency: every message carries a deterministic key derived from appointment ID plus message type plus
scheduled send time. The provider dedupes on this. Without it, a consumer crash mid-batch produced
duplicate reminders, which generated complaints.

Provider failover: we have a primary and secondary SMS provider. Failover is manual, via a config flag,
because automatic failover during a partial outage caused messages to go out twice through both providers.
A manual flag is worse in theory and better in practice.

Quiet hours are enforced in the recipient's timezone, not the clinic's. This mattered more than expected
once we had patients in three timezones.

---

### Operational review notebook

**Archiving exercise for Notification Dispatcher — Design.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.

**Accessibility exercise for Notification Dispatcher — Design.** We walked through the document with a patient using a keyboard instead of a pointing device. The reviewer started from the focus location and the exact text announced for the control, then followed the work to the point where another person would rely on it. The awkward case was a visual confirmation banner that a screen reader never announces. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

A useful completion check starts from the recipient perspective. Ask whether the recipient can identify the current artifact, understand the exception, and find the person responsible for resolving it. If any of those requires access to a private chat, the handover is still incomplete. The correction should improve that specific gap rather than add a broad assurance that the process is safe.

**Review exercise for Notification Dispatcher — Design.** We walked through the document with a practice manager weighing a change in intake procedure. The reviewer started from the patient action, staff action and handover between them, then followed the work to the point where another person would rely on it. The awkward case was a process appearing faster because the receptionist completes missing fields later. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We will evaluate the proposed revision using both an ordinary case and the awkward case from this exercise. Record the extra work done by the recipient as well as the work saved by the author. A local improvement is not a process improvement if it merely transfers effort to the next person. Keep the observations in this notebook so the eventual decision can be reviewed against what was actually demonstrated.

**Consent exercise for Notification Dispatcher — Design.** We walked through the document with a receptionist explaining a portal invitation. The reviewer started from the patient-facing wording and recorded communication preference, then followed the work to the point where another person would rely on it. The awkward case was an invitation sent to an address that belongs to a family member. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Keep the original artifact next to the amended one during review. A correction should say what the operator learned, who confirmed it, and which downstream view still needs to be refreshed. Replacing the artifact silently makes it impossible to distinguish a genuine repair from an accidental edit. The follow-up is to check a second example with a different history before treating the exercise as complete.



## DOC: Vendor Evaluation — Document Storage

Looking to replace the current document store, which is a mounted file share with a thin API over it.

Requirements: encryption at rest, audit log of every read, retention policy enforcement, and the ability
to legal-hold a set of documents.

Three vendors evaluated. All three met the functional requirements. Differences came down to price and
migration effort.

Vendor 1 was cheapest and had the worst migration story — no bulk import API, so we would be scripting
against their regular endpoints at a documented rate limit that implied a six-week migration.

Vendor 2 was the most expensive by a wide margin and the only one offering a managed migration.

Vendor 3 landed in the middle on both and had the best audit log design, which matters for us.

Leaning Vendor 3. Decision pending the security review.

---

### Operational review notebook

**Accessibility exercise for Vendor Evaluation — Document Storage.** We walked through the document with a patient using a keyboard instead of a pointing device. The reviewer started from the focus location and the exact text announced for the control, then followed the work to the point where another person would rely on it. The awkward case was a visual confirmation banner that a screen reader never announces. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

A useful completion check starts from the recipient perspective. Ask whether the recipient can identify the current artifact, understand the exception, and find the person responsible for resolving it. If any of those requires access to a private chat, the handover is still incomplete. The correction should improve that specific gap rather than add a broad assurance that the process is safe.

**Review exercise for Vendor Evaluation — Document Storage.** We walked through the document with a practice manager weighing a change in intake procedure. The reviewer started from the patient action, staff action and handover between them, then followed the work to the point where another person would rely on it. The awkward case was a process appearing faster because the receptionist completes missing fields later. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We will evaluate the proposed revision using both an ordinary case and the awkward case from this exercise. Record the extra work done by the recipient as well as the work saved by the author. A local improvement is not a process improvement if it merely transfers effort to the next person. Keep the observations in this notebook so the eventual decision can be reviewed against what was actually demonstrated.

**Consent exercise for Vendor Evaluation — Document Storage.** We walked through the document with a receptionist explaining a portal invitation. The reviewer started from the patient-facing wording and recorded communication preference, then followed the work to the point where another person would rely on it. The awkward case was an invitation sent to an address that belongs to a family member. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Keep the original artifact next to the amended one during review. A correction should say what the operator learned, who confirmed it, and which downstream view still needs to be refreshed. Replacing the artifact silently makes it impossible to distinguish a genuine repair from an accidental edit. The follow-up is to check a second example with a different history before treating the exercise as complete.

**Provenance exercise for Vendor Evaluation — Document Storage.** We walked through the document with a support analyst comparing two appointment screenshots. The reviewer started from the appointment identifier and the revision that each screenshot represents, then followed the work to the point where another person would rely on it. The awkward case was a rescheduled visit appearing current in a saved browser tab. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We separated what the interface displays from what the operator can prove. The visible label is useful for navigation, but it is not evidence of the underlying action. The reviewer should ask for a traceable source and write down the remaining uncertainty. If the source cannot be found, leave that uncertainty visible rather than filling the gap with a familiar-looking value from another workstream.



## DOC: Hiring — Interview Loop Changes

The current loop is five rounds and takes three weeks. We are losing candidates to faster processes.

Changes agreed:

1. Collapse the two technical rounds into one 90-minute session.
2. Move the take-home to optional; candidates may substitute a walkthrough of prior work.
3. Hiring manager conversation moves earlier, to round two, so candidates meet the person they would work
   for before investing much time.
4. Debrief within 48 hours, scheduled at the time the loop is booked rather than after.

Target is an offer within eight business days of first contact.

Open question nobody answered: whether to keep the culture interview as a separate round or fold it in. It
is the round with the least consistent signal and the most variance between interviewers.

---

### Operational review notebook

**Review exercise for Hiring — Interview Loop Changes.** We walked through the document with a practice manager weighing a change in intake procedure. The reviewer started from the patient action, staff action and handover between them, then followed the work to the point where another person would rely on it. The awkward case was a process appearing faster because the receptionist completes missing fields later. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We will evaluate the proposed revision using both an ordinary case and the awkward case from this exercise. Record the extra work done by the recipient as well as the work saved by the author. A local improvement is not a process improvement if it merely transfers effort to the next person. Keep the observations in this notebook so the eventual decision can be reviewed against what was actually demonstrated.

**Consent exercise for Hiring — Interview Loop Changes.** We walked through the document with a receptionist explaining a portal invitation. The reviewer started from the patient-facing wording and recorded communication preference, then followed the work to the point where another person would rely on it. The awkward case was an invitation sent to an address that belongs to a family member. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Keep the original artifact next to the amended one during review. A correction should say what the operator learned, who confirmed it, and which downstream view still needs to be refreshed. Replacing the artifact silently makes it impossible to distinguish a genuine repair from an accidental edit. The follow-up is to check a second example with a different history before treating the exercise as complete.

**Provenance exercise for Hiring — Interview Loop Changes.** We walked through the document with a support analyst comparing two appointment screenshots. The reviewer started from the appointment identifier and the revision that each screenshot represents, then followed the work to the point where another person would rely on it. The awkward case was a rescheduled visit appearing current in a saved browser tab. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We separated what the interface displays from what the operator can prove. The visible label is useful for navigation, but it is not evidence of the underlying action. The reviewer should ask for a traceable source and write down the remaining uncertainty. If the source cannot be found, leave that uncertainty visible rather than filling the gap with a familiar-looking value from another workstream.

**Permissions exercise for Hiring — Interview Loop Changes.** We walked through the document with a locum covering a clinic with unfamiliar administrative screens. The reviewer started from the minimum role needed for the demonstrated task, then followed the work to the point where another person would rely on it. The awkward case was a temporary role retained after the covering assignment finished. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

The walkthrough exposed a handover problem rather than a need for a new setting. The first person knew why the record looked unusual; the next person saw only the finished artifact. Add the explanation at the handover boundary and make its author visible. A private conversation can clarify the immediate case but cannot be the permanent place where the operating decision lives.



## DOC: Q3 All-Hands — Rough Notes

Revenue up, which everyone was pleased about. The number was on a slide and I did not write it down.

Clinic 7 opened on schedule, which is the first time that has happened.

The CEO spent a while on a metaphor about rowing that did not entirely land but was well intentioned.

Questions from the floor:

- Someone asked about the office move and whether the new floor has more meeting rooms. It has two fewer.
  This was not received well.
- Someone asked whether we are hiring in engineering. Answer: two roles open, both backend.
- Someone asked about the parking situation. See above re: the garage.

The session ran twenty minutes over and the room was booked after us, which caused a small standoff.

---

### Operational review notebook

**Consent exercise for Q3 All-Hands — Rough Notes.** We walked through the document with a receptionist explaining a portal invitation. The reviewer started from the patient-facing wording and recorded communication preference, then followed the work to the point where another person would rely on it. The awkward case was an invitation sent to an address that belongs to a family member. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Keep the original artifact next to the amended one during review. A correction should say what the operator learned, who confirmed it, and which downstream view still needs to be refreshed. Replacing the artifact silently makes it impossible to distinguish a genuine repair from an accidental edit. The follow-up is to check a second example with a different history before treating the exercise as complete.

**Provenance exercise for Q3 All-Hands — Rough Notes.** We walked through the document with a support analyst comparing two appointment screenshots. The reviewer started from the appointment identifier and the revision that each screenshot represents, then followed the work to the point where another person would rely on it. The awkward case was a rescheduled visit appearing current in a saved browser tab. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We separated what the interface displays from what the operator can prove. The visible label is useful for navigation, but it is not evidence of the underlying action. The reviewer should ask for a traceable source and write down the remaining uncertainty. If the source cannot be found, leave that uncertainty visible rather than filling the gap with a familiar-looking value from another workstream.

**Permissions exercise for Q3 All-Hands — Rough Notes.** We walked through the document with a locum covering a clinic with unfamiliar administrative screens. The reviewer started from the minimum role needed for the demonstrated task, then followed the work to the point where another person would rely on it. The awkward case was a temporary role retained after the covering assignment finished. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

The walkthrough exposed a handover problem rather than a need for a new setting. The first person knew why the record looked unusual; the next person saw only the finished artifact. Add the explanation at the handover boundary and make its author visible. A private conversation can clarify the immediate case but cannot be the permanent place where the operating decision lives.

**Exceptions exercise for Q3 All-Hands — Rough Notes.** We walked through the document with a clinic coordinator handling an incomplete intake record. The reviewer started from the reason information is missing rather than a guessed substitute, then followed the work to the point where another person would rely on it. The awkward case was a patient stopping halfway through a form and later returning by telephone. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Use an example that has already completed its ordinary workflow when rehearsing this case. Do not repair a live record just to make a demonstration easier to follow. The exercise should preserve the confusing state, record the action taken, and show how a recipient can tell that the action finished. A clean screenshot alone is insufficient because it hides the transition that caused the confusion.



## DOC: Accessibility Audit — Portal

External audit against WCAG 2.1 AA. 31 findings, 6 serious.

Serious findings:

1. The date picker is unusable by keyboard. You can tab into it and then not out of it without a mouse.
   This is the single worst thing in the report.
2. Error messages on the booking form are announced only visually. Screen reader users submit, nothing
   appears to happen, and they submit again.
3. Colour contrast on the secondary button fails at 3.1:1 against its background.
4. The appointment confirmation page has no heading structure at all — it is a sequence of divs.
5. Focus is not managed when the booking modal opens; focus stays on the page behind it.
6. Time slots are presented as a grid of unlabelled buttons. A screen reader reads "button" forty times.

The date picker and the slot grid are both custom components that were built before anyone thought about
this. Both likely need rewriting rather than patching.

---

### Operational review notebook

**Provenance exercise for Accessibility Audit — Portal.** We walked through the document with a support analyst comparing two appointment screenshots. The reviewer started from the appointment identifier and the revision that each screenshot represents, then followed the work to the point where another person would rely on it. The awkward case was a rescheduled visit appearing current in a saved browser tab. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We separated what the interface displays from what the operator can prove. The visible label is useful for navigation, but it is not evidence of the underlying action. The reviewer should ask for a traceable source and write down the remaining uncertainty. If the source cannot be found, leave that uncertainty visible rather than filling the gap with a familiar-looking value from another workstream.

**Permissions exercise for Accessibility Audit — Portal.** We walked through the document with a locum covering a clinic with unfamiliar administrative screens. The reviewer started from the minimum role needed for the demonstrated task, then followed the work to the point where another person would rely on it. The awkward case was a temporary role retained after the covering assignment finished. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

The walkthrough exposed a handover problem rather than a need for a new setting. The first person knew why the record looked unusual; the next person saw only the finished artifact. Add the explanation at the handover boundary and make its author visible. A private conversation can clarify the immediate case but cannot be the permanent place where the operating decision lives.

**Exceptions exercise for Accessibility Audit — Portal.** We walked through the document with a clinic coordinator handling an incomplete intake record. The reviewer started from the reason information is missing rather than a guessed substitute, then followed the work to the point where another person would rely on it. The awkward case was a patient stopping halfway through a form and later returning by telephone. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Use an example that has already completed its ordinary workflow when rehearsing this case. Do not repair a live record just to make a demonstration easier to follow. The exercise should preserve the confusing state, record the action taken, and show how a recipient can tell that the action finished. A clean screenshot alone is insufficient because it hides the transition that caused the confusion.

**Rehearsal exercise for Accessibility Audit — Portal.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.



## DOC: Scratch — C. Vance

- reconciler interval: is 60s right? the window is the problem not the interval
- ask about whether holds should live in postgres after all, redis is buying us less than we thought
- the slot regeneration job has no alerting if it partially fails. it has partially failed twice.
- dentist thursday
- that query plan thing on the slot table, the index is not being used when the date range is wide

---

### Operational review notebook

**Permissions exercise for Scratch — C. Vance.** We walked through the document with a locum covering a clinic with unfamiliar administrative screens. The reviewer started from the minimum role needed for the demonstrated task, then followed the work to the point where another person would rely on it. The awkward case was a temporary role retained after the covering assignment finished. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

The walkthrough exposed a handover problem rather than a need for a new setting. The first person knew why the record looked unusual; the next person saw only the finished artifact. Add the explanation at the handover boundary and make its author visible. A private conversation can clarify the immediate case but cannot be the permanent place where the operating decision lives.

**Exceptions exercise for Scratch — C. Vance.** We walked through the document with a clinic coordinator handling an incomplete intake record. The reviewer started from the reason information is missing rather than a guessed substitute, then followed the work to the point where another person would rely on it. The awkward case was a patient stopping halfway through a form and later returning by telephone. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Use an example that has already completed its ordinary workflow when rehearsing this case. Do not repair a live record just to make a demonstration easier to follow. The exercise should preserve the confusing state, record the action taken, and show how a recipient can tell that the action finished. A clean screenshot alone is insufficient because it hides the transition that caused the confusion.

**Rehearsal exercise for Scratch — C. Vance.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.

**Archiving exercise for Scratch — C. Vance.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.



## DOC: Incident — 2026-04-02 Booking Outage

Duration: 47 minutes. Patient-facing booking unavailable; staff console degraded.

**Cause.** A slot regeneration run did not complete. It holds an advisory lock for the duration. The run
hung on a single practitioner template with a malformed recurrence rule — an interval of zero, which
produced an infinite loop in slot expansion. The lock was never released, so the next booking write
blocked, and then everything behind it blocked.

**Detection.** Patient support noticed before monitoring did. We had no alert on booking write latency.

**Resolution.** Killed the regeneration process, which released the lock. Bookings recovered immediately.
Deleted the malformed template.

**Follow-ups.**

- Validate recurrence rules on write. An interval of zero should never have been storable.
- Add a timeout to the advisory lock. Nothing should hold it for more than 30 minutes.
- Alert on booking write p99 latency.
- The regeneration job should process templates independently, so one bad template cannot stop the run.

Three of four follow-ups are done. The independent-template change is not.

### Operational review notebook

**Exceptions exercise for Incident — 2026-04-02 Booking Outage.** We walked through the document with a clinic coordinator handling an incomplete intake record. The reviewer started from the reason information is missing rather than a guessed substitute, then followed the work to the point where another person would rely on it. The awkward case was a patient stopping halfway through a form and later returning by telephone. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Use an example that has already completed its ordinary workflow when rehearsing this case. Do not repair a live record just to make a demonstration easier to follow. The exercise should preserve the confusing state, record the action taken, and show how a recipient can tell that the action finished. A clean screenshot alone is insufficient because it hides the transition that caused the confusion.

**Rehearsal exercise for Incident — 2026-04-02 Booking Outage.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.

**Archiving exercise for Incident — 2026-04-02 Booking Outage.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.

**Accessibility exercise for Incident — 2026-04-02 Booking Outage.** We walked through the document with a patient using a keyboard instead of a pointing device. The reviewer started from the focus location and the exact text announced for the control, then followed the work to the point where another person would rely on it. The awkward case was a visual confirmation banner that a screen reader never announces. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

A useful completion check starts from the recipient perspective. Ask whether the recipient can identify the current artifact, understand the exception, and find the person responsible for resolving it. If any of those requires access to a private chat, the handover is still incomplete. The correction should improve that specific gap rather than add a broad assurance that the process is safe.



## DOC: Staff Directory Maintenance

Working note for the next operations review. This document concerns its named workstream; it does not revise settings in other documents.

### Operational review notebook

**Rehearsal exercise for Staff Directory Maintenance.** We walked through the document with an implementation trainer demonstrating the front-desk workflow. The reviewer started from a synthetic patient record visibly separate from ordinary appointments, then followed the work to the point where another person would rely on it. The awkward case was a training example copied into a live clinic work queue. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

For the next review, ask a colleague outside this workstream to follow the written instructions without prompting. Note the point where they need information that is not on the page. That missing context is more useful than a general request to improve documentation. Revise the specific step and repeat the walkthrough with another ordinary example rather than expanding every paragraph equally.

**Archiving exercise for Staff Directory Maintenance.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.

**Accessibility exercise for Staff Directory Maintenance.** We walked through the document with a patient using a keyboard instead of a pointing device. The reviewer started from the focus location and the exact text announced for the control, then followed the work to the point where another person would rely on it. The awkward case was a visual confirmation banner that a screen reader never announces. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

A useful completion check starts from the recipient perspective. Ask whether the recipient can identify the current artifact, understand the exception, and find the person responsible for resolving it. If any of those requires access to a private chat, the handover is still incomplete. The correction should improve that specific gap rather than add a broad assurance that the process is safe.

**Review exercise for Staff Directory Maintenance.** We walked through the document with a practice manager weighing a change in intake procedure. The reviewer started from the patient action, staff action and handover between them, then followed the work to the point where another person would rely on it. The awkward case was a process appearing faster because the receptionist completes missing fields later. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We will evaluate the proposed revision using both an ordinary case and the awkward case from this exercise. Record the extra work done by the recipient as well as the work saved by the author. A local improvement is not a process improvement if it merely transfers effort to the next person. Keep the observations in this notebook so the eventual decision can be reviewed against what was actually demonstrated.



## DOC: Patient Leaflet Translation

Working note for the next operations review. This document concerns its named workstream; it does not revise settings in other documents.

### Operational review notebook

**Archiving exercise for Patient Leaflet Translation.** We walked through the document with an administrator retiring an outdated patient leaflet. The reviewer started from the language version and its clinical reviewer, then followed the work to the point where another person would rely on it. The awkward case was a translated copy being updated later than the English source. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Retain the superseded wording in the revision history with a clear explanation of why it changed. We want people searching old discussions to understand whether they found an obsolete procedure or an unresolved proposal. Link the decision to its supporting artifact and keep draft material visibly marked until the responsible reviewer has accepted it.

**Accessibility exercise for Patient Leaflet Translation.** We walked through the document with a patient using a keyboard instead of a pointing device. The reviewer started from the focus location and the exact text announced for the control, then followed the work to the point where another person would rely on it. The awkward case was a visual confirmation banner that a screen reader never announces. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

A useful completion check starts from the recipient perspective. Ask whether the recipient can identify the current artifact, understand the exception, and find the person responsible for resolving it. If any of those requires access to a private chat, the handover is still incomplete. The correction should improve that specific gap rather than add a broad assurance that the process is safe.

**Review exercise for Patient Leaflet Translation.** We walked through the document with a practice manager weighing a change in intake procedure. The reviewer started from the patient action, staff action and handover between them, then followed the work to the point where another person would rely on it. The awkward case was a process appearing faster because the receptionist completes missing fields later. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

We will evaluate the proposed revision using both an ordinary case and the awkward case from this exercise. Record the extra work done by the recipient as well as the work saved by the author. A local improvement is not a process improvement if it merely transfers effort to the next person. Keep the observations in this notebook so the eventual decision can be reviewed against what was actually demonstrated.

**Consent exercise for Patient Leaflet Translation.** We walked through the document with a receptionist explaining a portal invitation. The reviewer started from the patient-facing wording and recorded communication preference, then followed the work to the point where another person would rely on it. The awkward case was an invitation sent to an address that belongs to a family member. The discussion belongs with this document because the decision has to be intelligible to someone reading the note later, without the author in the room.

Keep the original artifact next to the amended one during review. A correction should say what the operator learned, who confirmed it, and which downstream view still needs to be refreshed. Replacing the artifact silently makes it impossible to distinguish a genuine repair from an accidental edit. The follow-up is to check a second example with a different history before treating the exercise as complete.