heartbeat-framework.org Open access · CC BY 4.0 · Zenodo-registered

The Heartbeat
Framework

An open-access estate of clinical governance instruments for AI deployed in health and care — written from the ward, published on Zenodo, free to use and adapt.

DEPLOYMENT RISK = CAPABILITY × CULTURE Regulation assesses the first term. This estate instruments the second.
Download the Instrument Deck Browse the estate
Deployment sequence Gate→ Screen→ Specify→ Oversee→ Trial→ Audit→ Measure→ Record

Reason for observation

What this is

Most AI governance measures what a system can do. Almost none of it measures the culture the system lands in — how a team leans on it, defers to it, covers for it, or quietly reorganises itself around it. Risk multiplies across both terms, and the second one is currently unwatched.

The Heartbeat Framework treats a deployed AI the way a good ward treats any powerful psychological presence: it is observed, its interactions are recorded, and the humans around it keep structured, honest notes. Eight instruments cover the full deployment sequence — from the decision to let a system in, through live oversight, to the audit trail that survives it.

Everything here is free to read, use, and adapt under CC BY 4.0. Every document carries a DOI and is permanently archived on Zenodo, independent of this site.

Start here

Three entry points

Instruments

The Instrument Deck

All eight instruments in one document, ordered by the deployment sequence. If you only download one file, make it this one.

doi.org/10.5281/zenodo.22045477
Orientation

The Reading Map

How the seventeen documents fit together and the order to read them in, depending on the seat you occupy.

doi.org/10.5281/zenodo.21516401
Thesis

The Cultural Safety Case

Why a licence to deploy is a licence to amplify — the argument for assessing culture alongside capability, with registered falsifiable predictions.

doi.org/10.5281/zenodo.21443120

The complete estate

Seventeen records, in build order

No.PublishedTitleDOI
012026-07-07The 24-Hour Team10.5281/zenodo.21243118
022026-07-07The Mixed Shift10.5281/zenodo.21245130
032026-07-07The Long Handover10.5281/zenodo.21245205
042026-07-07The Character Pathway10.5281/zenodo.21249771
052026-07-08Same Monsters, New Casings10.5281/zenodo.21260388
062026-07-08The Endless Shift10.5281/zenodo.21264935
072026-07-09The Overseer's Bible10.5281/zenodo.21279944
082026-07-09The Second Signature10.5281/zenodo.21282804
092026-07-13The Second Pair of Hands10.5281/zenodo.21340572
102026-07-14The AI Interaction Risk Screen10.5281/zenodo.21357450
112026-07-19The Cultural Safety Case10.5281/zenodo.21443120
122026-07-19Before the Machine10.5281/zenodo.21445040
132026-07-19The Floor Test10.5281/zenodo.21445071
142026-07-20The Damping Audit10.5281/zenodo.21455540
152026-07-23After the Machine10.5281/zenodo.21515932
162026-07-23The Glass Ledger10.5281/zenodo.21515861
172026-07-23The Heartbeat Framework: Reading Map10.5281/zenodo.21516401

The Instrument Deck (published 2026-08-21, doi 10.5281/zenodo.22045477) collects all eight instruments from the estate into a single 38-page document.

Author

Written from the ward

This estate was written by Paul Blatherwick RMN, a registered mental health nurse — the person who countersigns the chart, does the 3am checks, and carries the handover. The instruments exist because the habits that keep a ward safe around people turn out to be exactly the habits missing around deployed AI.

Questions, corrections, and accounts of the framework in use are welcome.

paulblatherwick@heartbeat-framework.org.uk

Licence: CC BY 4.0 — reuse and adapt with attribution. Every record is independently archived on Zenodo; the DOIs above will resolve even if this site does not.