NHS Clinical Entrepreneur Programme · Cohort 10
CauseACTION is a Microsoft-native intelligence layer that bridges the gap between how NHS care is supposed to be delivered and how it actually is — in real time, at every level of the system. Built within the tools NHS staff already use. No new infrastructure required.
Work as Done WELL
The NHS generates more information than almost any other system on earth — records, device logs, checklists, team messages, maintenance reports. Each fragment captures part of how care is actually delivered. But they are siloed, disconnected, and designed for transactions rather than understanding. The result is harm, waste, and burnout that nobody intended and nobody can easily see.
A national NHS study across 78 Trusts found that over a third of day-of-surgery cancellations were potentially preventable — caused by poor drug management, untreated comorbidities, or incomplete workup. The information to prevent them exists. It is just never surfaced in time to act.
Against hundreds of thousands of transfusions annually, only a small fraction of incidents reach formal reporting through SHOT — the UK's national haemovigilance programme. The vast majority of variation goes unexamined.
Test. Replace. Datix. Supplier call. MHRA review. Team debrief. Safety report. MDT discussion. Each step done in isolation, recorded separately, learned by nobody.
A high-risk sickle cell patient. An emergency Teams call. Six of eight colleagues on their day off — because no system had assembled the clinical picture in time for a planned response.
"Healthcare often feels like a conveyor belt where we never make the same thing twice. Staff are mixed like lottery balls; no one quite knows who made what or how — and the building is on fire."
CauseACTION grew from years of frontline cardiac surgery experience — watching brilliant people make heroic adaptations to broken systems, with no mechanism to capture what they learned or feed it back into meaningful improvement.
For our founder, John, learning about human factors and Safety-II thinking in 2018 reframed everything. These disciplines revealed that the problem was never motivation or individual failure — it was system design. The gap between how care is planned and how it is actually delivered is not an exception. It is the norm. And for years, the ambition was to close that gap through reflection, conversation, and improvement cycles. But every attempt ran into the same wall: capturing work as done required extra effort from already stretched people. When it happened at all, it generated actions that nobody had time to follow through — or observations that were forgotten entirely before the next shift began. The method was right. The infrastructure was missing.
We don't lack information in the NHS — we have more than we can process. What we lack are systems that connect these fragments automatically, without adding to anyone's workload. Not another dashboard. Real-time quality assurance that works with us, not against us.
CauseACTION is built by NHS clinicians who have already used data to identify a hidden national patient safety crisis — and driven systemic change as a result. The methodology is not theoretical. It has already worked at national scale.
John conducted a national survey of perfusion services across the UK, examining adherence to the N+1 staffing standard — the minimum safe staffing model for cardiac surgery. The survey uncovered a significant national lapse in patient safety compliance, modelled the workforce deficit, and provided the evidence base that the College of Clinical Perfusion Scientists has used to drive enforcement of national standards. This is precisely the methodology CauseACTION is built to scale — identifying invisible system failures through data, quantifying their impact, and creating the conditions for sustained, structural improvement.
Chief Perfusionist at Barts Heart Centre and founder of CauseACTION. John has spent two decades working in cardiac surgery at the clinical frontline, developing expertise in human factors, systems thinking, and Safety-II methodology. His work spans clinical practice, national quality improvement, and device innovation. He has presented on safety and innovation topics at the national conference six times, and has served on the College of Clinical Perfusion Scientists since 2017, currently as Secretary. He brings deep clinical insight, frontline experience, and a clear vision for what a genuinely connected NHS could become.
NHS Clinical Entrepreneur · Cohort 10Chief Clinical Perfusionist at Aberdeen Royal Infirmary and one of the UK's leading voices in perfusion quality management. James holds an MBA with specialist focus in interorganisational performance and perfusion data management systems. He has worked across multiple NHS Trusts, private organisations, and two global industry leaders, presenting at international congresses. His contribution to CauseACTION is the universal QMS architecture — the living standard operating procedure framework that makes the platform a genuine quality assurance system, not simply a data tool.
NHS Clinical Entrepreneur · Cohort 10CauseACTION works within the tools NHS staff already use — no new login, no behaviour change, no survey fatigue. It connects clinical, operational, safety, and financial data into a single intelligent system that learns from work as it actually happens, not as it was planned.
The architecture is built on the SEIPS 3.0 framework — the established systems engineering model for patient safety — combined with Safety-II methodology and network theory. This is not a dashboard bolted onto existing systems. It is a structured model of how healthcare work is actually organised, where variation originates, and what it costs — deployed within Microsoft Teams, Power Apps, and Azure, using infrastructure NHS Trusts already operate.
Each Trust retains full ownership and control of its own data. CauseACTION maintains a central intelligence layer — the ontology, causal models, protocol logic, and benchmarking standards — that is deployed locally within each Trust's own environment. The Trust owns the data. CauseACTION owns the logic that makes it meaningful. This federated design aligns with NHS information governance requirements and the architecture of the NHS Federated Data Platform.
At its core is a living quality management system — built on James Tyrrell's universal QMS architecture — that captures real-time deviations from protocol, surfaces the cost of variation, and creates a continuous feedback loop between frontline staff and organisational learning. The system is designed for people at every level. It aims to amplify the weak signals that help staff understand each other better, and faster.
The same architecture scales from a single clinical pathway to a whole Trust, from a Trust to national oversight — connecting cause to action at every level, without adding to the burden of the people already keeping the system alive.
Rather than isolated data points, CauseACTION assembles the full picture of a patient's journey — giving clinical teams the context to act on what they see, not just react to individual alerts.
Staff contribute to quality intelligence through the conversations and tools they already use. The system learns from every adaptation, every near-miss, and every workaround — without adding a single extra form.
Standards and protocols are living documents — updated by evidence from real practice rather than periodic review cycles. What works is amplified. What fails is surfaced before it causes harm.
A digital twin of the ideal service allows teams to understand the gap between current and optimal performance — and model the clinical and financial impact of closing it before committing to change.
Real-time visibility of stock, usage patterns, and supply fragility at both local and national level. Aggregated data informs the optimal response to supply chain breakdown — enabling mutual aid, early warning, and procurement aligned to actual clinical demand.
Benchmarking that goes beyond headline metrics — revealing whether variation between services reflects genuine clinical difference or unwarranted divergence from safe, effective care.
In cardiac surgery, we once relied on a single timed test to assess whether a patient's blood was protected against clotting on bypass. It gave us a number. It told us almost nothing about why — about the dynamic interplay of clotting factors, platelet function, fibrinolysis, and drug effect that determines whether a patient bleeds or thromboses. A more sophisticated test changed that entirely: instead of one value, it gives a time-resolved picture of the whole clotting process — its speed, its strength, its breakdown. The difference is not just more data. It is a fundamentally richer understanding that enables earlier, more targeted, and more effective intervention.
One number. No context. No trend. No interaction between variables. An answer without understanding.
Multiple signals. Interactions tracked. Trends identified. A complexity score that reflects the real state of a pathway — not a simplified proxy of it.
CauseACTION applies this same principle to clinical pathways, workforce, safety, and quality — replacing single-metric dashboards with a dynamic, multi-dimensional understanding of system health. The stress fractures in a service appear long before the system breaks — if you know how to look.
Acute kidney injury after cardiac surgery is common, costly, and — in a significant proportion of cases — connected to a single measurable intraoperative signal that is already being generated in every cardiac theatre in the country.
CauseACTION is actively developing its first clinical pilots across NHS sites, each targeting a different level of the system to demonstrate the breadth and scalability of the architecture. The pilots range from a single clinical pathway to national safety oversight, deliberately chosen to show that the same approach works at every scale — from Barts Heart Centre in London to Aberdeen Royal Infirmary in Scotland.
Most theatre cancellations have upstream causes — but the inverse is equally important: patients who are not optimised but proceed to surgery anyway, carrying preventable risk. This pilot maps the whole pre-operative pathway to understand both failures — the cancellation and the inappropriate go-ahead — as two symptoms of the same underlying gap between how care is planned and how it is delivered.
Applying language processing to pre-operative documentation to automatically surface high-risk conditions — sickle cell disease, coagulopathies, complex drug interactions — that current systems identify late or miss entirely. Earlier flagging triggers the right pathway, the right specialists, and the right planning — before the patient reaches theatre.
Connecting stock data, usage patterns, and supplier status across services — locally and nationally. Aggregated data reveals patterns of fragility that no single centre can see alone, enabling mutual aid between sites, proactive procurement, and an optimal system-wide response when supply chains break down.
Only a tiny fraction of transfusion safety incidents reach formal reporting nationally. This pilot applies the CauseACTION architecture to blood transfusion — connecting procedural data, clinical outcomes, and near-miss signals to surface the vast majority of variation that currently goes unexamined, creating the conditions for genuine national learning rather than tip-of-iceberg oversight.
Cardiac surgery is where CauseACTION begins — because it is where the founders work, where the data is time-critical and the acuity is high. But the architecture is universal. The same system that monitors a perfusion protocol can monitor a medicines pathway, a discharge process, or a neighbourhood health network.
The N+1 survey demonstrated that a clinician with the right methodology and the right data can surface a national patient safety problem that had been invisible for years. CauseACTION is that methodology — operationalised, automated, and designed to make that kind of discovery routine rather than exceptional.
The goal is not another reporting system. It is a learning architecture — one that connects cause to action, at every level, without adding to the burden of the people who are already keeping the system alive.
The NHS cannot afford avoidable harm — financially or morally. The cost of getting it wrong is already embedded across every Trust budget, every litigation settlement, and every cancelled theatre list. CauseACTION is not an additional cost. It is the architecture that makes the existing cost of poor quality visible — and therefore reducible.
CauseACTION's commercial model is structured around demonstrated value, not software licensing. The system is deployed within each Trust's existing Microsoft infrastructure — no new platforms, no additional IT procurement. The commercial relationship is built on what the system helps the Trust achieve, making the business case straightforward for any finance director prepared to look at where quality costs are already being absorbed.
NHS Resolution estimates the annual cost of harm covered by the Clinical Negligence Scheme for Trusts at £4.6 billion — and that is only what is claimed. The National Audit Office estimates only 4% of people who experience harm ever make a claim. Source ↗
The cost of cancelled surgery in lost operating theatre time alone reaches £400 million per year across the NHS. The majority of avoidable cancellations have upstream causes that a connected pathway system could identify in advance. Source ↗
Preventable adverse events generate £1–2.5 billion in additional NHS care costs annually — longer stays, repeat procedures, complications that compound. These costs are largely invisible within standard reporting. Source ↗
The NHS Patient Safety Strategy has demonstrated that targeted, systematic safety improvement saves £100 million annually alongside 1,000 lives. CauseACTION is the infrastructure that makes that kind of improvement scalable and routine — not exceptional. Source ↗
"The NHS is drowning in safety recommendations it cannot action." — National Audit Office, cited in Parliamentary review of clinical negligence costs, 2026
CauseACTION does not add to that burden. It reduces it — by making the gap between protocol and reality visible in real time, so that the right action happens at the right moment, rather than appearing in a report six months later that nobody has capacity to act on.
We are building the intelligence layer healthcare deserves — and we are looking for the right partners to build it with.
If your service is dealing with preventable cancellations, unexplained variation, or quality data that never feeds back to frontline staff — we would like to understand your pathway.
If you are working within a Microsoft 365 or Azure environment and exploring how existing data infrastructure can be turned into operational intelligence — let's talk architecture.
If you are working on NHS innovation, funding early-stage health technology, or exploring partnership with a CEP Cohort 10 team — we are at the right stage for the right conversation.