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3 minute read
In healthcare teams, governance issues rarely come from access mistakes, they come from systems that allow work to move forward too early.
In healthcare teams using Airtable, governance problems usually aren’t caused by the wrong person editing a record. They happen because the base allows work to move forward before the required approvals are complete.
Permissions control who can edit. Governance controls whether the record should move at all.
Most teams lock the first and miss the second.
Where the problem actually starts
In Airtable, most bases show work as soon as it exists. A record appears in shared views, statuses can be changed right away, and other teams can see and act on that record even if it’s still under review.
That setup feels helpful:
- Visibility keeps teams aligned
- Status fields keep things moving
- No one thinks of this as a governance risk at first.
The issue starts when a record that’s still being reviewed looks the same as a record that’s been approved. Once that happens, people don’t wait for confirmation, they move forward because the system looks like it’s telling them they can.
How this plays out in real healthcare work
A vendor needs to be onboarded. Someone creates the record in Airtable, fills in the details, attaches documents, and sets a status so the work doesn’t stall. But:
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Legal still needs to review the paperwork
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Compliance still needs to sign off
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Procurement still needs to confirm vendor eligibility
The record is visible and the status has moved, so a downstream team assumes approval is complete and starts preparing next steps. Nothing explicitly says it’s approved, but nothing clearly says it isn’t.
So the work continues.
When governance questions show up
The problem surfaces later, when someone asks a question the system should be able to answer easily.
- Was compliance approval completed before activation?
- Which documents were approved?
- Who signed off, and when?
Instead of getting answers from Airtable, the team starts digging through comments, Slack messages, and emails to reconstruct what happened.
Nothing broke. Access was correct. Everyone followed the process as best they could.
The system simply allowed the work to move forward too early.
Why permissions don’t fix this
Permissions decide who can edit a record. They don’t decide whether the record should be allowed to progress.
In regulated healthcare work, most risk doesn’t come from someone editing the wrong field. It comes from downstream teams acting on records that aren’t actually approved yet.
When governance relies only on permissions, teams end up managing risk manually:
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reminding people not to move things forward
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double-checking work after it’s already progressed
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fixing issues once they’ve already reached downstream teams
What governance actually looks like in Airtable
Good governance in Airtable isn’t about locking things down; it’s about making it impossible for work to advance before it’s ready.
That means records that clearly show when they’re still in review, approvals that are explicit and recorded, and workflows that prevent downstream action until those approvals are complete.
When that structure exists, people don’t have to guess or remember rules under pressure. The system does the work for them.
That’s why governance isn’t a feature you turn on. It’s how the base is designed to control flow. And in regulated healthcare teams, that’s what keeps work compliant without slowing it down.
A simple governance blueprint for your Airtable base
1. Make “under review” impossible to confuse with “approved”
Draft records should never look ready. Different interfaces, different visibility, different states. If a record still needs approval, the system should make that obvious without explanation.
2. Treat approvals as records, not signals
An approval shouldn’t be inferred from a comment, a status change, or a message. It should exist as its own thing: who approved, what they approved, and when. If it can’t stand alone in Airtable, it will be questioned later.
3. Enforce sequence, not behavior
Don’t rely on people remembering what comes next. Design the workflow so downstream steps simply cannot happen until upstream approvals are complete.
4. Control what downstream teams can act on
Visibility is not neutral. If a team can see a record and act on it, they will. Governance means showing the right information at the right time — not everything as soon as it exists.
5. Make the system explain itself
When someone asks, “Why did this move forward?” the answer should be in the base, not in Slack, email, or memory. If Airtable can’t explain the sequence, governance is already compromised.
