SQD™ diagnostic output
3.1
- Signal3.8
- Intent2.4
- Grounding2.6
- Need3.4
- Anchoring2.8
- Leadership4.2
SIGNAL™ Framework - Worked examples
Two fictional programmes. One framework in use.
This page shows SIGNAL™ applied end-to-end on two invented programmes at very different scales — a 90-person SaaS scaleup rolling out an operating cadence, and a 4,000-staff hospital group deploying a new electronic health records system. All names, numbers, and scenarios are fictional. The point is to make the framework legible in action.
Example 1 — Scaleup diagnostic
Relay: 90-person SaaS formalising its first operating cadence.
Relay is a Series B developer-tooling company that has grown from 25 to 90 staff in 18 months. The founders want to introduce quarterly OKRs, weekly team reviews, and structured decision rights before scaling further. The COO runs an SQD™ before the rollout to understand where the organisation actually stands.
What the heatmap shows
Leadership (4.2) is strong — founders are active and aligned. Signal (3.8) is high because in a 90-person company, transparency is baked in. Need (3.4) is adequate; the current ad-hoc mode is painful enough that people want structure.
The two critical flags are where attention needs to go. Intent (2.4)reflects a mid-tier engineer cohort who view OKRs as “enterprise bureaucracy we came here to avoid.” Grounding (2.6) is the mechanical fact that nobody at Relay has ever run a real OKR cycle before, whatever the templates claim.
What Relay does next
- Intent. Co-design the OKR template with three mid-tier engineers before rollout. Ship an opt-out mechanism for anyone who can articulate a better approach.
- Grounding. Publish a one-page OKR primer written by someone who has actually used the practice. Run a trial cycle on the platform team only before rolling company-wide.
- Anchoring. Add OKR progress to weekly 1:1 templates from week one. Make the reinforcement structural, not cultural.
Why SIGNAL™ at this scale
The instinct at 90 staff is to skip diagnostics and just roll the change out. Relay's SQD™ takes 15 minutes and surfaces two problems the founders would otherwise have discovered three months into a struggling OKR cycle. That's the point.
Example 2, Act 1 — Programme context
Meridian Health: an EHR rollout across three hospitals.
Meridian is a fictional regional hospital group. After two near-miss incidents attributed to legacy system integration gaps — and a new national reporting mandate arriving next year — the board has approved an 18-month programme to replace three disparate clinical systems and remaining paper records with a single unified EHR.
4,000staff
3acute-care sites
18 moprogramme length
5stakeholder groups
Stakeholder groups shown across the arc
- Clinicians (~1,800)
- Nursing (~1,400)
- Allied health (~500)
- Admin & billing (~250)
- Executive & medical leadership (~50)
The question the CNO asks before committing the budget is not “will this succeed” but “where, specifically, is it likely to fail — and what can we change now.”
Why SIGNAL™ for an EHR programme
EHR rollouts fail in predictable ways: training that doesn't translate to the bedside, clinician resistance framed as patient-safety concern, leadership cascade breaking at middle-management level, and pre-existing change load that the programme makes worse. SIGNAL™ measures all four of these before they materialise.
Act 2 — The initial SQD™
Three critical flags, two weeks before programme kick-off.
The CNO completes the 12-question SQD™ in under 15 minutes, drawing on the programme's current state rather than projected state. The output reframes the go-live conversation.
Reading the readout
Intent (2.1) is the lowest score. Clinicians report significant scepticism — a pattern that shows up in every major EHR rollout and that training alone does not fix. Grounding (1.9) is the most actionable flag: the training plan exists on paper but is generic, not role-specific. Need (2.3) is the quietest but most dangerous: three other active change programmes are already consuming capacity. Stacking a further major rollout on top is the single most likely failure mode.
Anchoring (3.2) and Leadership (3.6) are adequate but not strong. Signal (2.8) is borderline — formal communication has happened, but rumours are filling the gaps.
Why the SQDRI isn't the main number
An SQDRI of 2.6 would, as a headline, suggest the programme is simply 'at risk'. The real diagnosis is that three separate dimensions require three different interventions. A single composite score would conceal that.
SQD™ diagnostic output
2.6
- Signal2.8
- Intent2.1
- Grounding1.9
- Need2.3
- Anchoring3.2
- Leadership3.6
Act 3 — Intervention design
One intervention path per flagged dimension.
Over the next four weeks the CNO, the programme lead, and the clinical director commission a targeted intervention design. Each flagged dimension gets its own response — not a generic 'more comms and training'.
IIntent · 2.1
Clinician voice, not clinician monologue
A structured series of two-way forums by specialty, with pre-published questions and honest answers. A physician-champion programme recruits respected clinicians from each site. Opt-out mechanisms allow superusers to skip generic training and contribute to instance configuration.
GGrounding · 1.9
Training redesign, measured twice
The generic curriculum is replaced with role-specific simulation scenarios: ICU workflows, ED triage, outpatient clinic, medication reconciliation. Grounding is re-measured via a short follow-up SQD™ six weeks before go-live — not just “hours attended”.
NNeed · 2.3
Portfolio-level capacity decision
The Exec reviews concurrent change portfolio. One concurrent programme — the non-clinical rostering refresh — is deferred by six months. A capacity buffer is allocated to clinical teams during the final training window.
LLeadership · 3.6 → 4.0 target
Middle-management coaching
A short SAM™-guided sponsor plan is built for the 30 middle managers who carry the cascade. Weekly check-ins with their direct sponsor and a scripted message framework for their own team briefings.
Act 4 — SIGNAL™ Full at month 3
Group-level readiness becomes visible.
Ten weeks after intervention rollout, the CNO commissions the first proper SIGNAL™ Full assessment — 30 questions across all six dimensions, segmented by stakeholder group. This is where SIGNAL™ earns its keep: the group × dimension matrix shows exactly which cells are still failing and why.
SIGNAL™ Full — group × dimension matrix
GroupSIGNALSRIStatus
Clinicians3.02.92.2⚠2.63.13.32.9Critical flag
Nursing3.13.02.82.92.4⚠3.22.9Critical flag
Allied Health3.43.23.03.13.23.43.2Approaching ready
Admin & billing3.63.73.33.53.43.53.5Ready
Executive & medical leadership3.94.03.83.63.74.13.9Ready
What the matrix reveals
Intent has moved (2.1 → 2.9 for clinicians, 3.0 for nursing) — the physician-champion programme and structured forums worked. But Grounding for clinicians is still 2.2, a critical flag. The training redesign hasn't translated at the bedside for the medical staff. Nursing Grounding is 2.8 — approaching ready, trajectory is right.
Nursing Anchoring is a new flag at 2.4. Nobody saw it coming because it wasn't a flag in the SQD™ — this is what group-level measurement catches that programme-level can't. Workflow reinforcement for nursing staff needs a design pass.
Admin and Executive are operating at Ready band. Allied Health is Approaching Ready; no intervention needed beyond monitoring.
The go-live conversation shifts
Before the matrix, the conversation was 'are we ready'. After the matrix, the conversation is 'clinician Grounding and nursing Anchoring are our two remaining risks — here is what we do about each, and here is what we measure at the next pulse'.
Act 5 — Pulse at month 6 · go-live gate
From 'At risk' to 'Approaching Ready'.
The SVT™ velocity tracker pulls dimension scores forward four points: month 0 SQD, month 3 Full, month 4 mid-pulse, month 6 gate. The go-live decision is made from the trajectory, not a single snapshot.
SVT™ velocity — dimension trajectories
- IIntent2.1→3.0+0.9
- GGrounding1.9→3.1+1.2
- NNeed2.3→3.0+0.7
The gate decision
Grounding has moved 1.9 → 3.1 — the clinician training redesign took eight weeks to land but is now measurably effective. Intent is stable at 3.0; the physician-champion programme has become institutional. Need has settled at 3.0 — the deferred rostering programme freed enough capacity.
The programme enters go-live at a group-level SQDRI of 3.4 · Approaching Ready. Not perfect. But every score has a named intervention behind it and a measured trajectory. The staged rollout proceeds: hospital 1 at month 6, hospital 2 at month 8, hospital 3 at month 10.
What SIGNAL™ produced here
A defensible go-live decision with traceable evidence, surfaced failure modes before they became incidents, and a living record of which interventions actually moved which dimensions — data that feeds the next programme's SQD™ baseline.
These are fictional. Your programme isn’t.
Run the same 12-question SQD™ diagnostic on your live programme. Fifteen minutes, one score per dimension, one recommendation path.