{"decision_id": "DEC-healthcare-2026-04-25-1", "date": "2026-04-25", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-25-2", "date": "2026-04-25", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-25-3", "date": "2026-04-25", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-25-4", "date": "2026-04-25", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-25-5", "date": "2026-04-25", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-26-1", "date": "2026-04-26", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-26-2", "date": "2026-04-26", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "defer", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-26-3", "date": "2026-04-26", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-26-4", "date": "2026-04-26", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-26-5", "date": "2026-04-26", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-27-1", "date": "2026-04-27", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-27-2", "date": "2026-04-27", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-27-3", "date": "2026-04-27", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-27-4", "date": "2026-04-27", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-27-5", "date": "2026-04-27", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-28-1", "date": "2026-04-28", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-28-2", "date": "2026-04-28", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "defer", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-28-3", "date": "2026-04-28", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-28-4", "date": "2026-04-28", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-28-5", "date": "2026-04-28", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-29-1", "date": "2026-04-29", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-29-2", "date": "2026-04-29", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "defer", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-29-3", "date": "2026-04-29", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-29-4", "date": "2026-04-29", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-29-5", "date": "2026-04-29", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-30-1", "date": "2026-04-30", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-30-2", "date": "2026-04-30", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-30-3", "date": "2026-04-30", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-30-4", "date": "2026-04-30", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-04-30-5", "date": "2026-04-30", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-01-1", "date": "2026-05-01", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-01-2", "date": "2026-05-01", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-01-3", "date": "2026-05-01", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-01-4", "date": "2026-05-01", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-01-5", "date": "2026-05-01", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-02-1", "date": "2026-05-02", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-02-2", "date": "2026-05-02", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-02-3", "date": "2026-05-02", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-02-4", "date": "2026-05-02", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-02-5", "date": "2026-05-02", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-03-1", "date": "2026-05-03", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-03-2", "date": "2026-05-03", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-03-3", "date": "2026-05-03", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-03-4", "date": "2026-05-03", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-03-5", "date": "2026-05-03", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-04-1", "date": "2026-05-04", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-04-2", "date": "2026-05-04", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-04-3", "date": "2026-05-04", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-04-4", "date": "2026-05-04", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-04-5", "date": "2026-05-04", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-05-1", "date": "2026-05-05", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-05-2", "date": "2026-05-05", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "defer", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-05-3", "date": "2026-05-05", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-05-4", "date": "2026-05-05", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-05-5", "date": "2026-05-05", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-06-1", "date": "2026-05-06", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-06-2", "date": "2026-05-06", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-06-3", "date": "2026-05-06", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-06-4", "date": "2026-05-06", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-06-5", "date": "2026-05-06", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-07-1", "date": "2026-05-07", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-07-2", "date": "2026-05-07", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-07-3", "date": "2026-05-07", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-07-4", "date": "2026-05-07", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-07-5", "date": "2026-05-07", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-08-1", "date": "2026-05-08", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-08-2", "date": "2026-05-08", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-08-3", "date": "2026-05-08", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-08-4", "date": "2026-05-08", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-08-5", "date": "2026-05-08", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-09-1", "date": "2026-05-09", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-09-2", "date": "2026-05-09", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "defer", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-09-3", "date": "2026-05-09", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-09-4", "date": "2026-05-09", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-09-5", "date": "2026-05-09", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-10-1", "date": "2026-05-10", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-10-2", "date": "2026-05-10", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-10-3", "date": "2026-05-10", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-10-4", "date": "2026-05-10", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-10-5", "date": "2026-05-10", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-11-1", "date": "2026-05-11", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-11-2", "date": "2026-05-11", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-11-3", "date": "2026-05-11", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-11-4", "date": "2026-05-11", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-11-5", "date": "2026-05-11", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-12-1", "date": "2026-05-12", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-12-2", "date": "2026-05-12", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-12-3", "date": "2026-05-12", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-12-4", "date": "2026-05-12", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-12-5", "date": "2026-05-12", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-13-1", "date": "2026-05-13", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-13-2", "date": "2026-05-13", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-13-3", "date": "2026-05-13", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-13-4", "date": "2026-05-13", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-13-5", "date": "2026-05-13", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-14-1", "date": "2026-05-14", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-14-2", "date": "2026-05-14", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-14-3", "date": "2026-05-14", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-14-4", "date": "2026-05-14", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-14-5", "date": "2026-05-14", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-15-1", "date": "2026-05-15", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-15-2", "date": "2026-05-15", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-15-3", "date": "2026-05-15", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-15-4", "date": "2026-05-15", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-15-5", "date": "2026-05-15", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-16-1", "date": "2026-05-16", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "defer", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-16-2", "date": "2026-05-16", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-16-3", "date": "2026-05-16", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-16-4", "date": "2026-05-16", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-16-5", "date": "2026-05-16", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-17-1", "date": "2026-05-17", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-17-2", "date": "2026-05-17", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-17-3", "date": "2026-05-17", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-17-4", "date": "2026-05-17", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-17-5", "date": "2026-05-17", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-18-1", "date": "2026-05-18", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-18-2", "date": "2026-05-18", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-18-3", "date": "2026-05-18", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-18-4", "date": "2026-05-18", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-18-5", "date": "2026-05-18", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-19-1", "date": "2026-05-19", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-19-2", "date": "2026-05-19", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "defer", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-19-3", "date": "2026-05-19", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "defer", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-19-4", "date": "2026-05-19", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-19-5", "date": "2026-05-19", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-20-1", "date": "2026-05-20", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-20-2", "date": "2026-05-20", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-20-3", "date": "2026-05-20", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-20-4", "date": "2026-05-20", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-20-5", "date": "2026-05-20", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-21-1", "date": "2026-05-21", "priority": "P0", "decision": "Activate elective surgery throttle KL Damansara dengue spike", "agents_involved": ["DBCA", "CWFA"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "approve", "why": "Auto-generated from DBCA, CWFA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-21-2", "date": "2026-05-21", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["SLPA", "PSCA"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "escalate", "why": "Auto-generated from SLPA, PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-21-3", "date": "2026-05-21", "priority": "P0", "decision": "Pre-order cold-chain insulin for Sabah facility", "agents_involved": ["PSCA"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "escalate", "why": "Auto-generated from PSCA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-21-4", "date": "2026-05-21", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00", "agents_involved": ["FAOA"], "rm_impact": "+RM 240k/month", "recommended_action": "defer", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-21-5", "date": "2026-05-21", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["FAOA"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Auto-generated from FAOA agents based on the prior 24-hour signal window."}
{"decision_id": "DEC-healthcare-2026-05-22-1", "date": "2026-05-22", "priority": "P0", "decision": "Activate elective surgery throttle at KL Damansara ahead of dengue spike", "agents_involved": ["Bed Capacity Agent", "Clinical Agent"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Dengue trajectory at KL Damansara (FAC-01) is breaching bed-capacity headroom; throttling category-3 electives for 7 days preserves ward and ICU capacity and avoids forced cancellations. MoH weekly dengue case-count Petaling district: 412 -> 478 (W-on-W +16%).", "justifications": [{"agent": "Bed Capacity Agent", "headline": "Early-warning dengue signals consistent with 2024 outbreak precursor", "commentary": "Admissions forecast for KL Damansara now exceeds available med-surg headroom inside the 72-hour window. Throttling category-3 electives (joint-replacement, hernia, cosmetic) frees 14-18 beds per day and keeps ICU buffer >=20% as MoH dengue protocol mandates.", "evidence": ["Aedes Index Klang Valley: 2.2 -> 2.7 in 12 days (iDengue), MET monsoon pattern matches 2024 outbreak precursor", "Dengue admissions at KL Damansara: 22 active inpatients (+22% WoW), forecast 33 by D+3", "Med-surg bed occupancy FAC-01: 83% (threshold 85%), ICU 8/14 utilised", "MoH weekly dengue case-count Petaling district: 412 -> 478 (W-on-W +16%)", "MET Malaysia 14-day rainfall anomaly +38% over Klang Valley (monsoon-dengue correlation r=0.71, 2019-2025)"], "actions": ["Throttle category-3 electives at FAC-01 for 7 days; auto-reschedule via HIS", "Open 12 contingency beds in Ward 5B (currently soft-closed) and pre-stage IV fluids per MoH dengue protocol", "Notify Allianz, AIA, Great Eastern case managers of reschedules to preserve service-level credit"], "risk": "Early-warning conditions met; p=0.45 of bed-shortage trigger within 5-7 days absent action. Conservative throttle on lowest-acuity electives preserves RM 1.9M downside protection without revenue loss.", "confidence": 0.81, "signals": ["aedes_index_klang_valley=2.7", "dengue_admissions_fac01_active=22", "bed_occupancy_fac01=0.83", "icu_utilisation_fac01=0.57", "wow_growth_admissions=0.22"]}, {"agent": "Clinical Agent", "headline": "Elective OT demand exceeds capacity; staged throttle keeps roster within MMC limits", "commentary": "Roster simulation shows on-call anaesthetist and medical-ward nursing cover cannot safely run full elective list alongside surging dengue inflow without breaching MMC hours-per-week limits. Throttling category-3 electives keeps rostering within compliance and prevents burnout-driven sick leave.", "evidence": ["OT minutes at KL Damansara (FAC-01): 2,010 vs 2,140 needed; 130 min deficit", "Anaesthetist roster gap at FAC-01: 3 sessions short across the 7-day horizon vs MMC safe-staffing reference", "Nurse hours-per-week at FAC-01: 47.8 average vs 48.0 MMC ceiling; 9 nurses on dengue secondment", "Locum cost to backfill full schedule: RM 38k/day at current Klang Valley spot rate", "Historical pairing (2024 dengue wave): unthrottled facilities recorded 11% nurse sick-leave spike inside 10 days"], "actions": ["Re-route category-1/2 (oncology, cardiac) electives onto retained list; preserve full theatre access", "Re-roster 6 OT nurses to dengue-ward augmentation; document under MMC roster-change protocol", "Submit weekly compliance attestation to MMC and Private Healthcare Facilities and Services Act register"], "risk": "Without throttle, p=0.55 of MMC roster-compliance breach within 10 days and resultant escalation to Pharmacy Board / MoH joint inspection. Reputational and licensing risk.", "confidence": 0.79, "signals": ["elective_ot_demand_min=2140", "ot_capacity_min=2010", "anaesthetist_roster_gap=1", "nurse_hpw_compliance=0.96", "mmc_roster_compliance=0.98"]}], "signal_trend": {"name": "Aedes Index - Klang Valley (iDengue)", "dates": ["2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25", "2026-05-26"], "values": [2.2, 2.3, 2.4, 2.4, 2.5, 2.6, 2.7], "threshold": 2.5, "annotation": "Aedes Index above MoH 2.5 watch threshold"}}
{"decision_id": "DEC-healthcare-2026-05-22-2", "date": "2026-05-22", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["Service Line Agent", "Pharmacy Agent"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Penang oncology pathway has demonstrated durable margin and outcome advantages; replicating to JB (FAC-07) and Ipoh (FAC-10) before competitors close the gap secures RM 2.9M annualised contribution.", "justifications": [{"agent": "Service Line Agent", "headline": "Penang oncology model is replication-ready and economics are robust", "commentary": "The Penang protocol (multidisciplinary tumour board, navigator-led patient journey, integrated radiotherapy) consistently outperforms group average on outcomes and margin. Catchment analysis confirms JB and Ipoh have addressable demand (1,840 and 1,210 oncology cases/yr respectively).", "evidence": ["Penang oncology 30-day readmission: 6.5% vs group avg 11.4% (24 months, n=2,118)", "Penang oncology EBITDA margin: 28.2% vs JB 18.7% / Ipoh 16.9% (FY26 YTD)", "Catchment oncology demand (Iskandar Malaysia): 1,840 cases/yr, 41% private-payer mix (Allianz, AIA, AXA, Great Eastern)", "Catchment oncology demand (Kinta Valley): 1,210 cases/yr, 37% private-payer mix", "Competitive scan: Sunway and IHH announced JB oncology expansions (2026 H2 commissioning)"], "actions": ["Approve RM 4.2M capex envelope for JB + Ipoh oncology pathway build-out (linac upgrade at FAC-10)", "Second 4 Penang oncologists for 6-month rotation; align with MMC credentialing windows", "Lock insurer panel pricing with Allianz, AIA, AXA, Great Eastern before competitor launches"], "risk": "Pathway evidence base is solid; replication economics confirmed. p=0.42 of full uplift in FY26 if business case is approved this quarter; downside is opportunity cost of competitor moves.", "confidence": 0.8, "signals": ["penang_oncology_readmit_30d=0.065", "penang_oncology_ebitda_margin=0.282", "jb_oncology_ebitda_margin=0.187", "ipoh_oncology_ebitda_margin=0.169", "pathway_readiness_score=0.80"]}, {"agent": "Pharmacy Agent", "headline": "Formulary and cold-chain supply lines viable at JB and Ipoh", "commentary": "94% formulary match achievable via existing Pharmaniaga and Zuellig contracts. Remaining 11 SKUs (mostly biologics) need cold-chain re-qualification and Pharmacy Board notification under PHFSA. No critical lead-time blockers.", "evidence": ["Pharmacy SKU readiness: 88% of Penang oncology formulary (161/183) procurable at JB and Ipoh; cold-chain mapping under review", "Cold-chain capacity at JB (FAC-07): 480L pharmacy-grade vs 320L typical oncology load; Ipoh (FAC-10): 420L vs 290L", "Pharmacy Board audit window: open through Q3 2026; pre-clearance feasible", "Pharmaniaga lead time on Trastuzumab biosimilar and Pembrolizumab: 11-13 days (no allocation constraints reported)", "PDPA mapping for oncology patient registry: re-use Penang DPIA template; 4-week sign-off path"], "actions": ["Submit Pharmacy Board SKU notification for 11 biologic additions at FAC-07 and FAC-10", "Pre-position 60-day buffer of cytotoxics and biosimilars at JB and Ipoh pharmacy hubs", "Validate cold-chain temperature logging (2-8C) against Pharmacy Board GDP audit checklist"], "risk": "Without pre-clearance, p=0.35 of Pharmacy Board notification delay slipping launch 30-45 days. Manageable but on the critical path.", "confidence": 0.78, "signals": ["formulary_match_rate=0.88", "cold_chain_capacity_jb_l=480", "cold_chain_capacity_ipoh_l=420", "pharmacy_board_audit_window=open", "supplier_lead_days_pharmaniaga=13"]}], "signal_trend": {"name": "Oncology Pathway Replication Readiness Score", "dates": ["2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25", "2026-05-26"], "values": [0.56, 0.6, 0.65, 0.7, 0.74, 0.77, 0.8], "threshold": 0.85, "annotation": "Pathway readiness building; remediation actions on cold-chain SKUs in flight"}}
{"decision_id": "DEC-healthcare-2026-05-22-3", "date": "2026-05-22", "priority": "P0", "decision": "Pre-order cold-chain insulin shipment for Sabah facility", "agents_involved": ["Pharmacy Agent"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Insulin days-on-hand at Sabah facility (FAC-12) has fallen below the Pharmacy Board's 7-day safe-stock floor; pre-ordering a refrigerated air shipment closes the gap before clinical risk materialises.", "justifications": [{"agent": "Pharmacy Agent", "headline": "Sabah insulin stock will breach safe-stock floor without immediate action", "commentary": "Demand at FAC-12 has risen with the East Malaysia diabetes screening campaign; combined with monsoon-related ferry delays to Sandakan and Tawau clinics, the next scheduled road resupply will not arrive in time. A pre-ordered cold-chain air shipment via Kota Kinabalu re-stocks within 48 hours and stays within Pharmacy Board GDP audit thresholds.", "evidence": ["Lantus 100U/mL - 1,720 doses on hand at Sabah facility (FAC-12); 1,840 forecast 7-day demand", "Days-on-hand: 6.5 vs Pharmacy Board minimum 7.0; below floor for first time in 6 weeks", "MET Sabah monsoon advisory: ferry/road disruption probability 0.58 over next 5 days", "Substitute SKU (Novomix 30) on hand: 320 doses, unit cost +38% vs Lantus; clinical switch not recommended in stable patients", "Pharmacy Board GDP audit window: cold-chain temperature deviations >2 hrs trigger root-cause investigation"], "actions": ["Place expedite order with Pharmaniaga: 2,400 doses Lantus 100U/mL on next-available MAS Cargo cold-chain to KK", "Pre-stage temperature loggers (2-8C) and notify FAC-12 pharmacy lead of arrival window", "Update Pharmacy Board stock-position return for the next reporting cycle"], "risk": "Early signal: pre-order now uses standard 5-day Pharmaniaga lead time and avoids paying expedite premium later. p=0.33 of stockout risk if no action over 10 days; cost of action is low.", "confidence": 0.82, "signals": ["lantus_doses_on_hand_fac12=1,720", "days_on_hand_fac12=6.5", "monsoon_disruption_prob=0.58", "novomix_substitute_premium=0.38", "pharmacy_board_safe_stock_min_days=7.0"]}], "signal_trend": {"name": "Lantus Days-on-Hand - Sabah (FAC-12)", "dates": ["2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25", "2026-05-26"], "values": [11.2, 10.4, 9.6, 8.8, 8.0, 7.2, 6.5], "threshold": 7.0, "annotation": "Days-on-hand dropped below 7.0 Pharmacy Board minimum"}}
{"decision_id": "DEC-healthcare-2026-05-22-4", "date": "2026-05-22", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00 to dodge TNB peak", "agents_involved": ["Facility Agent"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Shifting OT pre-cooling to 02:00-04:00 off-peak window cuts TNB peak-demand charges without affecting daytime OT thermal envelope; the FAC-03 pilot demonstrated RM 240k/month at scale.", "justifications": [{"agent": "Facility Agent", "headline": "Pre-cooling shifts load out of TNB peak window with no clinical impact", "commentary": "BMS scheduling can drop OT suite setpoints between 02:00 and 04:00 (off-peak) to bank thermal mass, then return to standard setpoints before first case. Independent validation at FAC-03 (Penang) over 90 days showed RM 21k/month saving per OT pair with zero infection-control or particulate-count deviations.", "evidence": ["TNB peak (14:00-22:00) demand at KL Damansara HVAC chillers: 596 kW vs 540 kW off-peak", "TNB ToU tariff differential: RM 0.52/kWh peak vs RM 0.29/kWh off-peak", "FAC-03 pilot result (Q1 2026): RM 84k/month saved across 4 OT suites; ASHRAE 170 envelope compliant", "OT environmental compliance: ISO Class 7 particulate counts within tolerance during ramp", "Biomed sign-off: chiller short-cycle risk mitigated by 30-minute lockout in BMS logic"], "actions": ["Deploy BMS schedule to OT suites 3-6 at KL Damansara (FAC-01); enable 02:00-04:00 pre-cool block", "Run 14-day shadow-monitoring with biomed before locking schedule; report exceptions to Chief of Staff", "Reconcile against TNB monthly invoice and Private Healthcare Facilities and Services Act energy register"], "risk": "Pattern matching predicts a peak-demand spike; pre-cooling pilot validated last quarter at FAC-03 with no clinical incidents. Low cost of action.", "confidence": 0.8, "signals": ["hvac_peak_demand_kw_fac01=00-22", "tnb_tou_peak_tariff_rm_kwh=0.52", "tnb_tou_offpeak_tariff_rm_kwh=0.29", "ot_particulate_iso_class=7", "fac03_pilot_savings_rm_month=84000"]}], "signal_trend": {"name": "OT HVAC Peak-Hour Demand kW - KL Damansara", "dates": ["2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25", "2026-05-26"], "values": [535, 542, 552, 562, 575, 588, 596], "threshold": 600, "annotation": "Peak-hour HVAC demand rising into peak window"}}
{"decision_id": "DEC-healthcare-2026-05-22-5", "date": "2026-05-22", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["Facility Agent"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Clinical waste manifest and pickup compliance has degraded at FAC-04 (Subang) and FAC-09 (Melaka); without immediate cure-notice and back-up vendor activation, MoH inspection risk and ward-level suspension exposure rise.", "justifications": [{"agent": "Facility Agent", "headline": "Clinical waste vendor compliance breach exposes group to PHFSA action", "commentary": "Manifest discrepancies and missed pickup windows at FAC-04 and FAC-09 mean PHFSA Schedule 6 compliance scoring has fallen below the licensing renewal floor. A cure-notice plus immediate qualification of contingency vendor (Cenviro / Tex Cycle) protects the group from a worst-case 14-day clinical waste service suspension at affected wards.", "evidence": ["1 manifest discrepancy and 1 late-pickup at FAC-04 (Subang) in past 14 days; second incident pattern emerging at FAC-09", "PHFSA Schedule 6 compliance score: 0.81 (threshold 0.90)", "MoH circular MOH/PHFSA/2025/09: enforcement focus on private clinical waste manifest accuracy in 2026", "Contingency vendor capacity: Cenviro confirmed 1.8 t/day spare capacity in Klang Valley and Melaka corridor", "PDPA mapping: patient-linked waste labelling remains compliant; no data-handling escalation needed"], "actions": ["Issue 14-day cure notice to incumbent vendor with weekly KPI checkpoints", "Qualify Cenviro and Tex Cycle as contingency vendors at FAC-04 and FAC-09 within 10 days", "Brief MoH compliance liaison proactively; escalate to Group CEO if score does not return above 0.85 inside 21 days"], "risk": "Early signal: trajectory consistent with vendor under operational strain. p=0.35 of escalation if not addressed. Cure-notice and contingency vendor sounding-out are low-cost moves.", "confidence": 0.8, "signals": ["phfsa_schedule6_compliance_score=0.81", "manifest_discrepancies_14d=1", "moh_inspection_risk_prob=0.35", "contingency_vendor_capacity_tpd=1.8", "ward_suspension_downside_rm=1400000"]}], "signal_trend": {"name": "PHFSA Schedule 6 Compliance Score - FAC-04 & FAC-09", "dates": ["2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25", "2026-05-26"], "values": [0.9, 0.88, 0.86, 0.85, 0.84, 0.82, 0.81], "threshold": 0.75, "annotation": "Compliance score declining toward 0.75 escalation trigger"}}
{"decision_id": "DEC-healthcare-2026-05-23-1", "date": "2026-05-23", "priority": "P0", "decision": "Activate elective surgery throttle at KL Damansara ahead of dengue spike", "agents_involved": ["Bed Capacity Agent", "Clinical Agent"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Dengue trajectory at KL Damansara (FAC-01) is breaching bed-capacity headroom; throttling category-3 electives for 7 days preserves ward and ICU capacity and avoids forced cancellations. MoH weekly dengue case-count Petaling district: 412 -> 521 (W-on-W +26%).", "justifications": [{"agent": "Bed Capacity Agent", "headline": "Bed pipeline tightening; dengue admissions rising", "commentary": "Admissions forecast for KL Damansara now exceeds available med-surg headroom inside the 72-hour window. Throttling category-3 electives (joint-replacement, hernia, cosmetic) frees 14-18 beds per day and keeps ICU buffer >=20% as MoH dengue protocol mandates.", "evidence": ["Aedes Index Klang Valley: 2.3 -> 2.9 in 13 days (iDengue), MoH watch-list", "Dengue admissions at KL Damansara: 29 active inpatients (+38% WoW), forecast 44 by D+3", "Med-surg bed occupancy FAC-01: 86% (threshold 85%), ICU 9/14 utilised", "MoH weekly dengue case-count Petaling district: 412 -> 521 (W-on-W +26%)", "MET Malaysia 14-day rainfall anomaly +38% over Klang Valley (monsoon-dengue correlation r=0.71, 2019-2025)"], "actions": ["Throttle category-3 electives at FAC-01 for 7 days; auto-reschedule via HIS", "Open 12 contingency beds in Ward 5B (currently soft-closed) and pre-stage IV fluids per MoH dengue protocol", "Notify Allianz, AIA, Great Eastern case managers of reschedules to preserve service-level credit"], "risk": "Trajectory points to >85% bed occupancy persisting through next week; p=0.62 of forced cancellations in 72-96h window if no throttle. RM 1.9M downside intact under base case.", "confidence": 0.86, "signals": ["aedes_index_klang_valley=2.9", "dengue_admissions_fac01_active=29", "bed_occupancy_fac01=0.86", "icu_utilisation_fac01=0.64", "wow_growth_admissions=0.38"]}, {"agent": "Clinical Agent", "headline": "OT staffing gap opens as anaesthetist leave overlaps dengue ward demand", "commentary": "Roster simulation shows on-call anaesthetist and medical-ward nursing cover cannot safely run full elective list alongside surging dengue inflow without breaching MMC hours-per-week limits. Throttling category-3 electives keeps rostering within compliance and prevents burnout-driven sick leave.", "evidence": ["OT minutes at KL Damansara (FAC-01): 1,920 vs 2,140 needed; 220 min deficit", "Anaesthetist roster gap at FAC-01: 3 sessions short across the 7-day horizon vs MMC safe-staffing reference", "Nurse hours-per-week at FAC-01: 47.8 average vs 48.0 MMC ceiling; 9 nurses on dengue secondment", "Locum cost to backfill full schedule: RM 38k/day at current Klang Valley spot rate", "Historical pairing (2024 dengue wave): unthrottled facilities recorded 11% nurse sick-leave spike inside 10 days"], "actions": ["Re-route category-1/2 (oncology, cardiac) electives onto retained list; preserve full theatre access", "Re-roster 6 OT nurses to dengue-ward augmentation; document under MMC roster-change protocol", "Submit weekly compliance attestation to MMC and Private Healthcare Facilities and Services Act register"], "risk": "Without throttle, p=0.55 of MMC roster-compliance breach within 10 days and resultant escalation to Pharmacy Board / MoH joint inspection. Reputational and licensing risk.", "confidence": 0.83, "signals": ["elective_ot_demand_min=2140", "ot_capacity_min=1920", "anaesthetist_roster_gap=2", "nurse_hpw_compliance=0.95", "mmc_roster_compliance=0.98"]}], "signal_trend": {"name": "Aedes Index - Klang Valley (iDengue)", "dates": ["2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25"], "values": [2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9], "threshold": 2.5, "annotation": "Aedes Index trending toward MoH 3.0 trigger"}}
{"decision_id": "DEC-healthcare-2026-05-23-2", "date": "2026-05-23", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["Service Line Agent", "Pharmacy Agent"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Penang oncology pathway has demonstrated durable margin and outcome advantages; replicating to JB (FAC-07) and Ipoh (FAC-10) before competitors close the gap secures RM 2.9M annualised contribution.", "justifications": [{"agent": "Service Line Agent", "headline": "Penang oncology model is replication-ready and economics are robust", "commentary": "The Penang protocol (multidisciplinary tumour board, navigator-led patient journey, integrated radiotherapy) consistently outperforms group average on outcomes and margin. Catchment analysis confirms JB and Ipoh have addressable demand (1,840 and 1,210 oncology cases/yr respectively).", "evidence": ["Penang oncology 30-day readmission: 6.3% vs group avg 11.4% (24 months, n=2,150)", "Penang oncology EBITDA margin: 28.4% vs JB 19.0% / Ipoh 17.1% (FY26 YTD)", "Catchment oncology demand (Iskandar Malaysia): 1,840 cases/yr, 41% private-payer mix (Allianz, AIA, AXA, Great Eastern)", "Catchment oncology demand (Kinta Valley): 1,210 cases/yr, 37% private-payer mix", "Competitive scan: Sunway and IHH announced JB oncology expansions (2026 H2 commissioning)"], "actions": ["Approve RM 4.2M capex envelope for JB + Ipoh oncology pathway build-out (linac upgrade at FAC-10)", "Second 4 Penang oncologists for 6-month rotation; align with MMC credentialing windows", "Lock insurer panel pricing with Allianz, AIA, AXA, Great Eastern before competitor launches"], "risk": "Pathway maturity converging on launch-readiness. p=0.58 of capturing full RM 2.9M annualised uplift if launch starts within 30 days; delay risk compounding.", "confidence": 0.84, "signals": ["penang_oncology_readmit_30d=0.063", "penang_oncology_ebitda_margin=0.284", "jb_oncology_ebitda_margin=0.190", "ipoh_oncology_ebitda_margin=0.171", "pathway_readiness_score=0.83"]}, {"agent": "Pharmacy Agent", "headline": "Formulary and cold-chain supply lines viable at JB and Ipoh", "commentary": "94% formulary match achievable via existing Pharmaniaga and Zuellig contracts. Remaining 11 SKUs (mostly biologics) need cold-chain re-qualification and Pharmacy Board notification under PHFSA. No critical lead-time blockers.", "evidence": ["Pharmacy SKU readiness: 91% of Penang oncology formulary (167/183) procurable at JB and Ipoh; 9 SKUs require cold-chain re-qualification", "Cold-chain capacity at JB (FAC-07): 480L pharmacy-grade vs 320L typical oncology load; Ipoh (FAC-10): 420L vs 290L", "Pharmacy Board audit window: open through Q3 2026; pre-clearance feasible", "Pharmaniaga lead time on Trastuzumab biosimilar and Pembrolizumab: 11-13 days (no allocation constraints reported)", "PDPA mapping for oncology patient registry: re-use Penang DPIA template; 4-week sign-off path"], "actions": ["Submit Pharmacy Board SKU notification for 11 biologic additions at FAC-07 and FAC-10", "Pre-position 60-day buffer of cytotoxics and biosimilars at JB and Ipoh pharmacy hubs", "Validate cold-chain temperature logging (2-8C) against Pharmacy Board GDP audit checklist"], "risk": "Without pre-clearance, p=0.35 of Pharmacy Board notification delay slipping launch 30-45 days. Manageable but on the critical path.", "confidence": 0.81, "signals": ["formulary_match_rate=0.91", "cold_chain_capacity_jb_l=480", "cold_chain_capacity_ipoh_l=420", "pharmacy_board_audit_window=open", "supplier_lead_days_pharmaniaga=12"]}], "signal_trend": {"name": "Oncology Pathway Replication Readiness Score", "dates": ["2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25"], "values": [0.59, 0.64, 0.7, 0.74, 0.77, 0.8, 0.83], "threshold": 0.85, "annotation": "Pathway readiness approaching 0.85 launch threshold"}}
{"decision_id": "DEC-healthcare-2026-05-23-3", "date": "2026-05-23", "priority": "P0", "decision": "Pre-order cold-chain insulin shipment for Sabah facility", "agents_involved": ["Pharmacy Agent"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Insulin days-on-hand at Sabah facility (FAC-12) has fallen below the Pharmacy Board's 7-day safe-stock floor; pre-ordering a refrigerated air shipment closes the gap before clinical risk materialises.", "justifications": [{"agent": "Pharmacy Agent", "headline": "Sabah insulin stock will breach safe-stock floor without immediate action", "commentary": "Demand at FAC-12 has risen with the East Malaysia diabetes screening campaign; combined with monsoon-related ferry delays to Sandakan and Tawau clinics, the next scheduled road resupply will not arrive in time. A pre-ordered cold-chain air shipment via Kota Kinabalu re-stocks within 48 hours and stays within Pharmacy Board GDP audit thresholds.", "evidence": ["Lantus 100U/mL - 1,540 doses on hand at Sabah facility (FAC-12); 1,840 forecast 7-day demand", "Days-on-hand: 5.9 vs Pharmacy Board minimum 7.0; trending down 0.7/day", "MET Sabah monsoon advisory: ferry/road disruption probability 0.58 over next 5 days", "Substitute SKU (Novomix 30) on hand: 320 doses, unit cost +38% vs Lantus; clinical switch not recommended in stable patients", "Pharmacy Board GDP audit window: cold-chain temperature deviations >2 hrs trigger root-cause investigation"], "actions": ["Place expedite order with Pharmaniaga: 2,400 doses Lantus 100U/mL on next-available MAS Cargo cold-chain to KK", "Pre-stage temperature loggers (2-8C) and notify FAC-12 pharmacy lead of arrival window", "Update Pharmacy Board stock-position return for the next reporting cycle"], "risk": "p=0.52 of crossing critical 5-day floor inside 48h. Pre-order placed now arrives within Pharmacy Board safe stock window. RM 720k stockout exposure if held.", "confidence": 0.87, "signals": ["lantus_doses_on_hand_fac12=1,540", "days_on_hand_fac12=5.9", "monsoon_disruption_prob=0.58", "novomix_substitute_premium=0.38", "pharmacy_board_safe_stock_min_days=7.0"]}], "signal_trend": {"name": "Lantus Days-on-Hand - Sabah (FAC-12)", "dates": ["2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25"], "values": [10.0, 9.2, 8.4, 7.6, 6.8, 6.3, 5.9], "threshold": 7.0, "annotation": "Days-on-hand approaching 5.0 floor"}}
{"decision_id": "DEC-healthcare-2026-05-23-4", "date": "2026-05-23", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00 to dodge TNB peak", "agents_involved": ["Facility Agent"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Shifting OT pre-cooling to 02:00-04:00 off-peak window cuts TNB peak-demand charges without affecting daytime OT thermal envelope; the FAC-03 pilot demonstrated RM 240k/month at scale.", "justifications": [{"agent": "Facility Agent", "headline": "Pre-cooling shifts load out of TNB peak window with no clinical impact", "commentary": "BMS scheduling can drop OT suite setpoints between 02:00 and 04:00 (off-peak) to bank thermal mass, then return to standard setpoints before first case. Independent validation at FAC-03 (Penang) over 90 days showed RM 21k/month saving per OT pair with zero infection-control or particulate-count deviations.", "evidence": ["TNB peak (14:00-22:00) demand at KL Damansara HVAC chillers: 605 kW vs 540 kW off-peak", "TNB ToU tariff differential: RM 0.52/kWh peak vs RM 0.29/kWh off-peak", "FAC-03 pilot result (Q1 2026): RM 84k/month saved across 4 OT suites; ASHRAE 170 envelope compliant", "OT environmental compliance: ISO Class 7 particulate counts within tolerance during ramp", "Biomed sign-off: chiller short-cycle risk mitigated by 30-minute lockout in BMS logic"], "actions": ["Deploy BMS schedule to OT suites 3-6 at KL Damansara (FAC-01); enable 02:00-04:00 pre-cool block", "Run 14-day shadow-monitoring with biomed before locking schedule; report exceptions to Chief of Staff", "Reconcile against TNB monthly invoice and Private Healthcare Facilities and Services Act energy register"], "risk": "Peak-demand charge trajectory mirrors April; p=0.55 of crossing RM 260k monthly billing if untreated. Low-risk control change.", "confidence": 0.84, "signals": ["hvac_peak_demand_kw_fac01=00-22", "tnb_tou_peak_tariff_rm_kwh=0.52", "tnb_tou_offpeak_tariff_rm_kwh=0.29", "ot_particulate_iso_class=7", "fac03_pilot_savings_rm_month=84000"]}], "signal_trend": {"name": "OT HVAC Peak-Hour Demand kW - KL Damansara", "dates": ["2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25"], "values": [540, 552, 565, 578, 590, 598, 605], "threshold": 600, "annotation": "Peak-hour HVAC demand approaching 600 kW threshold"}}
{"decision_id": "DEC-healthcare-2026-05-23-5", "date": "2026-05-23", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["Facility Agent"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Clinical waste manifest and pickup compliance has degraded at FAC-04 (Subang) and FAC-09 (Melaka); without immediate cure-notice and back-up vendor activation, MoH inspection risk and ward-level suspension exposure rise.", "justifications": [{"agent": "Facility Agent", "headline": "Clinical waste vendor compliance breach exposes group to PHFSA action", "commentary": "Manifest discrepancies and missed pickup windows at FAC-04 and FAC-09 mean PHFSA Schedule 6 compliance scoring has fallen below the licensing renewal floor. A cure-notice plus immediate qualification of contingency vendor (Cenviro / Tex Cycle) protects the group from a worst-case 14-day clinical waste service suspension at affected wards.", "evidence": ["2 manifest discrepancies and 1 late-pickup at FAC-04 (Subang) and FAC-09 (Melaka) in past 14 days", "PHFSA Schedule 6 compliance score: 0.76 (threshold 0.90) - inside escalation band", "MoH circular MOH/PHFSA/2025/09: enforcement focus on private clinical waste manifest accuracy in 2026", "Contingency vendor capacity: Cenviro confirmed 1.8 t/day spare capacity in Klang Valley and Melaka corridor", "PDPA mapping: patient-linked waste labelling remains compliant; no data-handling escalation needed"], "actions": ["Issue 14-day cure notice to incumbent vendor with weekly KPI checkpoints", "Qualify Cenviro and Tex Cycle as contingency vendors at FAC-04 and FAC-09 within 10 days", "Brief MoH compliance liaison proactively; escalate to Group CEO if score does not return above 0.85 inside 21 days"], "risk": "p=0.48 of inspection finding inside 45 days; cure-notice path still available. RM 1.4M suspension downside if escalation continues unchecked.", "confidence": 0.85, "signals": ["phfsa_schedule6_compliance_score=0.76", "manifest_discrepancies_14d=2", "moh_inspection_risk_prob=0.48", "contingency_vendor_capacity_tpd=1.8", "ward_suspension_downside_rm=1400000"]}], "signal_trend": {"name": "PHFSA Schedule 6 Compliance Score - FAC-04 & FAC-09", "dates": ["2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24", "2026-05-25"], "values": [0.88, 0.85, 0.83, 0.81, 0.79, 0.78, 0.76], "threshold": 0.75, "annotation": "Compliance score within escalation band"}}
{"decision_id": "DEC-healthcare-2026-05-24-1", "date": "2026-05-24", "priority": "P0", "decision": "Activate elective surgery throttle at KL Damansara ahead of dengue spike", "agents_involved": ["Bed Capacity Agent", "Clinical Agent"], "rm_impact": "+RM 1.9M avoided risk", "recommended_action": "escalate", "why": "Dengue trajectory at KL Damansara (FAC-01) is breaching bed-capacity headroom; throttling category-3 electives for 7 days preserves ward and ICU capacity and avoids forced cancellations. MoH weekly dengue case-count Petaling district: 412 -> 587 (W-on-W +42%).", "justifications": [{"agent": "Bed Capacity Agent", "headline": "Bed pipeline collapsing under dengue inflow", "commentary": "Admissions forecast for KL Damansara now exceeds available med-surg headroom inside the 72-hour window. Throttling category-3 electives (joint-replacement, hernia, cosmetic) frees 14-18 beds per day and keeps ICU buffer >=20% as MoH dengue protocol mandates.", "evidence": ["Aedes Index Klang Valley: 2.4 -> 3.1 in 14 days (iDengue), MoH circular MOH/DGH/2026/14 issued", "Dengue admissions at KL Damansara: 38 active inpatients (+62% WoW), forecast 54 by D+3", "Med-surg bed occupancy FAC-01: 89% (threshold 85%), ICU 11/14 utilised", "MoH weekly dengue case-count Petaling district: 412 -> 587 (W-on-W +42%)", "MET Malaysia 14-day rainfall anomaly +38% over Klang Valley (monsoon-dengue correlation r=0.71, 2019-2025)"], "actions": ["Throttle category-3 electives at FAC-01 for 7 days; auto-reschedule via HIS", "Open 12 contingency beds in Ward 5B (currently soft-closed) and pre-stage IV fluids per MoH dengue protocol", "Notify Allianz, AIA, Great Eastern case managers of reschedules to preserve service-level credit"], "risk": "If electives proceed as scheduled, p=0.78 of stat-bed shortage within 72h and forced cancellations triggering insurer service-level claims (Allianz, Great Eastern). Estimated downside RM 1.9M (refunds, transfers, brand damage).", "confidence": 0.91, "signals": ["aedes_index_klang_valley=3.1", "dengue_admissions_fac01_active=38", "bed_occupancy_fac01=0.89", "icu_utilisation_fac01=0.79", "moh_circular=MOH/DGH/2026/14"]}, {"agent": "Clinical Agent", "headline": "Clinical roster cannot safely cover both dengue surge and full elective load", "commentary": "Roster simulation shows on-call anaesthetist and medical-ward nursing cover cannot safely run full elective list alongside surging dengue inflow without breaching MMC hours-per-week limits. Throttling category-3 electives keeps rostering within compliance and prevents burnout-driven sick leave.", "evidence": ["OT minutes available at KL Damansara (FAC-01): 1,840 vs 2,140 needed for full elective schedule", "Anaesthetist roster gap at FAC-01: 3 sessions short across the 7-day horizon vs MMC safe-staffing reference", "Nurse hours-per-week at FAC-01: 47.8 average vs 48.0 MMC ceiling; 9 nurses on dengue secondment", "Locum cost to backfill full schedule: RM 38k/day at current Klang Valley spot rate", "Historical pairing (2024 dengue wave): unthrottled facilities recorded 11% nurse sick-leave spike inside 10 days"], "actions": ["Re-route category-1/2 (oncology, cardiac) electives onto retained list; preserve full theatre access", "Re-roster 6 OT nurses to dengue-ward augmentation; document under MMC roster-change protocol", "Submit weekly compliance attestation to MMC and Private Healthcare Facilities and Services Act register"], "risk": "Without throttle, p=0.55 of MMC roster-compliance breach within 10 days and resultant escalation to Pharmacy Board / MoH joint inspection. Reputational and licensing risk.", "confidence": 0.88, "signals": ["elective_ot_demand_min=2140", "ot_capacity_min=1840", "anaesthetist_roster_gap=3", "nurse_hpw_compliance=0.94", "mmc_roster_compliance=0.97"]}], "signal_trend": {"name": "Aedes Index - Klang Valley (iDengue)", "dates": ["2026-05-18", "2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24"], "values": [2.4, 2.5, 2.6, 2.7, 2.9, 3.0, 3.1], "threshold": 2.5, "annotation": "Aedes Index breached 3.0 threshold (D-1); MoH Aedes >2.5 flag active"}}
{"decision_id": "DEC-healthcare-2026-05-24-2", "date": "2026-05-24", "priority": "P0", "decision": "Replicate Penang oncology pathway to JB and Ipoh", "agents_involved": ["Service Line Agent", "Pharmacy Agent"], "rm_impact": "+RM 2.9M annualised", "recommended_action": "approve", "why": "Penang oncology pathway has demonstrated durable margin and outcome advantages; replicating to JB (FAC-07) and Ipoh (FAC-10) before competitors close the gap secures RM 2.9M annualised contribution.", "justifications": [{"agent": "Service Line Agent", "headline": "Penang oncology model is replication-ready and economics are robust", "commentary": "The Penang protocol (multidisciplinary tumour board, navigator-led patient journey, integrated radiotherapy) consistently outperforms group average on outcomes and margin. Catchment analysis confirms JB and Ipoh have addressable demand (1,840 and 1,210 oncology cases/yr respectively).", "evidence": ["Penang oncology 30-day readmission: 6.1% vs group avg 11.4% (24 months, n=2,184)", "Penang oncology EBITDA margin: 28.7% vs JB 19.2% / Ipoh 17.4% (FY26 YTD)", "Catchment oncology demand (Iskandar Malaysia): 1,840 cases/yr, 41% private-payer mix (Allianz, AIA, AXA, Great Eastern)", "Catchment oncology demand (Kinta Valley): 1,210 cases/yr, 37% private-payer mix", "Competitive scan: Sunway and IHH announced JB oncology expansions (2026 H2 commissioning)"], "actions": ["Approve RM 4.2M capex envelope for JB + Ipoh oncology pathway build-out (linac upgrade at FAC-10)", "Second 4 Penang oncologists for 6-month rotation; align with MMC credentialing windows", "Lock insurer panel pricing with Allianz, AIA, AXA, Great Eastern before competitor launches"], "risk": "Window of advantage is narrowing as 2 competitors (Sunway, IHH) announced JB oncology expansions. p=0.72 that delaying replication >60 days erodes 30-40% of capturable share. Annualised upside RM 2.9M at risk.", "confidence": 0.89, "signals": ["penang_oncology_readmit_30d=0.061", "penang_oncology_ebitda_margin=0.287", "jb_oncology_ebitda_margin=0.192", "ipoh_oncology_ebitda_margin=0.174", "pathway_readiness_score=0.87"]}, {"agent": "Pharmacy Agent", "headline": "Formulary and cold-chain supply lines viable at JB and Ipoh", "commentary": "94% formulary match achievable via existing Pharmaniaga and Zuellig contracts. Remaining 11 SKUs (mostly biologics) need cold-chain re-qualification and Pharmacy Board notification under PHFSA. No critical lead-time blockers.", "evidence": ["Pharmacy SKU readiness: 94% of Penang oncology formulary (172/183) procurable via Pharmaniaga and Zuellig at JB and Ipoh within 14 days", "Cold-chain capacity at JB (FAC-07): 480L pharmacy-grade vs 320L typical oncology load; Ipoh (FAC-10): 420L vs 290L", "Pharmacy Board audit window: open through Q3 2026; pre-clearance feasible", "Pharmaniaga lead time on Trastuzumab biosimilar and Pembrolizumab: 11-13 days (no allocation constraints reported)", "PDPA mapping for oncology patient registry: re-use Penang DPIA template; 4-week sign-off path"], "actions": ["Submit Pharmacy Board SKU notification for 11 biologic additions at FAC-07 and FAC-10", "Pre-position 60-day buffer of cytotoxics and biosimilars at JB and Ipoh pharmacy hubs", "Validate cold-chain temperature logging (2-8C) against Pharmacy Board GDP audit checklist"], "risk": "Without pre-clearance, p=0.35 of Pharmacy Board notification delay slipping launch 30-45 days. Manageable but on the critical path.", "confidence": 0.86, "signals": ["formulary_match_rate=0.94", "cold_chain_capacity_jb_l=480", "cold_chain_capacity_ipoh_l=420", "pharmacy_board_audit_window=open", "supplier_lead_days_pharmaniaga=11"]}], "signal_trend": {"name": "Oncology Pathway Replication Readiness Score", "dates": ["2026-05-18", "2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24"], "values": [0.62, 0.68, 0.74, 0.78, 0.81, 0.84, 0.87], "threshold": 0.85, "annotation": "Pathway readiness score crossed 0.85 launch threshold"}}
{"decision_id": "DEC-healthcare-2026-05-24-3", "date": "2026-05-24", "priority": "P0", "decision": "Pre-order cold-chain insulin shipment for Sabah facility", "agents_involved": ["Pharmacy Agent"], "rm_impact": "+RM 720k avoided stockout", "recommended_action": "approve", "why": "Insulin days-on-hand at Sabah facility (FAC-12) has fallen below the Pharmacy Board's 7-day safe-stock floor; pre-ordering a refrigerated air shipment closes the gap before clinical risk materialises.", "justifications": [{"agent": "Pharmacy Agent", "headline": "Sabah insulin stock will breach safe-stock floor without immediate action", "commentary": "Demand at FAC-12 has risen with the East Malaysia diabetes screening campaign; combined with monsoon-related ferry delays to Sandakan and Tawau clinics, the next scheduled road resupply will not arrive in time. A pre-ordered cold-chain air shipment via Kota Kinabalu re-stocks within 48 hours and stays within Pharmacy Board GDP audit thresholds.", "evidence": ["Lantus 100U/mL - 1,200 doses on hand at Sabah facility (FAC-12); 1,840 forecast 7-day demand", "Days-on-hand: 4.6 vs Pharmacy Board minimum 7.0 for chronic-disease essentials", "MET Sabah monsoon advisory: ferry/road disruption probability 0.58 over next 5 days", "Substitute SKU (Novomix 30) on hand: 320 doses, unit cost +38% vs Lantus; clinical switch not recommended in stable patients", "Pharmacy Board GDP audit window: cold-chain temperature deviations >2 hrs trigger root-cause investigation"], "actions": ["Place expedite order with Pharmaniaga: 2,400 doses Lantus 100U/mL on next-available MAS Cargo cold-chain to KK", "Pre-stage temperature loggers (2-8C) and notify FAC-12 pharmacy lead of arrival window", "Update Pharmacy Board stock-position return for the next reporting cycle"], "risk": "p=0.74 of stockout within 5 days absent pre-order. Stockout would force substitution to Novomix at 38% higher unit cost and risk MoH chronic-disease KPI breach; estimated downside RM 720k (clinical risk, substitution premium, brand).", "confidence": 0.92, "signals": ["lantus_doses_on_hand_fac12=1,200", "days_on_hand_fac12=4.6", "monsoon_disruption_prob=0.58", "novomix_substitute_premium=0.38", "pharmacy_board_safe_stock_min_days=7.0"]}], "signal_trend": {"name": "Lantus Days-on-Hand - Sabah (FAC-12)", "dates": ["2026-05-18", "2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24"], "values": [9.2, 8.4, 7.6, 6.8, 6.1, 5.3, 4.6], "threshold": 7.0, "annotation": "Days-on-hand crossed below 5.0 critical floor"}}
{"decision_id": "DEC-healthcare-2026-05-24-4", "date": "2026-05-24", "priority": "P2", "decision": "Pre-cool 4 OT suites 02:00-04:00 to dodge TNB peak", "agents_involved": ["Facility Agent"], "rm_impact": "+RM 240k/month", "recommended_action": "approve", "why": "Shifting OT pre-cooling to 02:00-04:00 off-peak window cuts TNB peak-demand charges without affecting daytime OT thermal envelope; the FAC-03 pilot demonstrated RM 240k/month at scale.", "justifications": [{"agent": "Facility Agent", "headline": "Pre-cooling shifts load out of TNB peak window with no clinical impact", "commentary": "BMS scheduling can drop OT suite setpoints between 02:00 and 04:00 (off-peak) to bank thermal mass, then return to standard setpoints before first case. Independent validation at FAC-03 (Penang) over 90 days showed RM 21k/month saving per OT pair with zero infection-control or particulate-count deviations.", "evidence": ["TNB peak (14:00-22:00) demand at KL Damansara HVAC chillers: 612 kW vs 540 kW off-peak", "TNB ToU tariff differential: RM 0.52/kWh peak vs RM 0.29/kWh off-peak (Industrial E2 schedule)", "FAC-03 pilot result (Q1 2026): RM 84k/month saved across 4 OT suites; ASHRAE 170 envelope compliant", "OT environmental compliance: ISO Class 7 particulate counts within tolerance during ramp", "Biomed sign-off: chiller short-cycle risk mitigated by 30-minute lockout in BMS logic"], "actions": ["Deploy BMS schedule to OT suites 3-6 at KL Damansara (FAC-01); enable 02:00-04:00 pre-cool block", "Run 14-day shadow-monitoring with biomed before locking schedule; report exceptions to Chief of Staff", "Reconcile against TNB monthly invoice and Private Healthcare Facilities and Services Act energy register"], "risk": "p=0.68 of repeating last month's RM 280k peak-demand charge if no pre-cooling. Patient-comfort risk minimal given ASHRAE OT envelope tolerances; clinical risk negligible.", "confidence": 0.88, "signals": ["hvac_peak_demand_kw_fac01=00-22", "tnb_tou_peak_tariff_rm_kwh=0.52", "tnb_tou_offpeak_tariff_rm_kwh=0.29", "ot_particulate_iso_class=7", "fac03_pilot_savings_rm_month=84000"]}], "signal_trend": {"name": "OT HVAC Peak-Hour Demand kW - KL Damansara", "dates": ["2026-05-18", "2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24"], "values": [548, 562, 578, 591, 605, 614, 612], "threshold": 600, "annotation": "Peak-hour HVAC demand exceeded 600 kW threshold for 3rd consecutive day"}}
{"decision_id": "DEC-healthcare-2026-05-24-5", "date": "2026-05-24", "priority": "Esc", "decision": "Escalate: clinical waste vendor non-compliance at 2 facilities", "agents_involved": ["Facility Agent"], "rm_impact": "-RM 1.4M suspension risk", "recommended_action": "escalate", "why": "Clinical waste manifest and pickup compliance has degraded at FAC-04 (Subang) and FAC-09 (Melaka); without immediate cure-notice and back-up vendor activation, MoH inspection risk and ward-level suspension exposure rise.", "justifications": [{"agent": "Facility Agent", "headline": "Clinical waste vendor compliance breach exposes group to PHFSA action", "commentary": "Manifest discrepancies and missed pickup windows at FAC-04 and FAC-09 mean PHFSA Schedule 6 compliance scoring has fallen below the licensing renewal floor. A cure-notice plus immediate qualification of contingency vendor (Cenviro / Tex Cycle) protects the group from a worst-case 14-day clinical waste service suspension at affected wards.", "evidence": ["3 manifest discrepancies and 1 late-pickup at FAC-04 (Subang) and FAC-09 (Melaka) in past 14 days; current vendor: SWM Environment-affiliated", "PHFSA Schedule 6 compliance score: 0.71 (threshold 0.90) - below licensing renewal floor", "MoH circular MOH/PHFSA/2025/09: enforcement focus on private clinical waste manifest accuracy in 2026", "Contingency vendor capacity: Cenviro confirmed 1.8 t/day spare capacity in Klang Valley and Melaka corridor", "PDPA mapping: patient-linked waste labelling remains compliant; no data-handling escalation needed"], "actions": ["Issue 14-day cure notice to incumbent vendor with weekly KPI checkpoints", "Qualify Cenviro and Tex Cycle as contingency vendors at FAC-04 and FAC-09 within 10 days", "Brief MoH compliance liaison proactively; escalate to Group CEO if score does not return above 0.85 inside 21 days"], "risk": "p=0.62 of MoH inspection finding within 30 days based on historical patterns; consequence is up to 14-day suspension of clinical waste service at affected wards. Estimated downside RM 1.4M (operational disruption, regulator escalation, brand).", "confidence": 0.9, "signals": ["phfsa_schedule6_compliance_score=0.71", "manifest_discrepancies_14d=3", "moh_inspection_risk_prob=0.62", "contingency_vendor_capacity_tpd=1.8", "ward_suspension_downside_rm=1400000"]}], "signal_trend": {"name": "PHFSA Schedule 6 Compliance Score - FAC-04 & FAC-09", "dates": ["2026-05-18", "2026-05-19", "2026-05-20", "2026-05-21", "2026-05-22", "2026-05-23", "2026-05-24"], "values": [0.86, 0.84, 0.82, 0.79, 0.76, 0.73, 0.71], "threshold": 0.75, "annotation": "Compliance score breached 0.75 escalation trigger"}}