feat: approval workflows

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Feature (supports #118)

• Hospitals can optionally configure approval workflows for tickets. AI agent looks up hospital policy, automatically recognizes if certain actions (tickets) need approval from hospital stakeholders to continue
• Examples:
  • "Biomed needs to sign off on all vendor visits to hospital" policy means that tickets related to vendor visits are automatically routed to biomed users, and must get approval before progressing
  • Hospital admin and biomed must approve downtime for devices in a certain revenue class. A vendor can't just update an MRI, even on a PM schedule, without direct approval/acknowledgement from hospital stakeholders
• Hospitals can configure their own policies and approval groups
• This is very similar to what Ramp does for business expenses today

Value to hospitals today

• Helps enforce communication with stricter approval/permissions flow
• Decisions that may incur legal risk are evidence-backed, and spread out over multiple stakeholder groups, giving hospitals defense

Value to UPGRADE vision

• Helps hospitals set up guardrails for autonomous patching system, if automatically scheduled remediations must go through same approval flow. Necessarily enforces visibility of agent actions