diff --git a/src/modules/bmm/workflows/4-implementation/batch-super-dev/instructions.md b/src/modules/bmm/workflows/4-implementation/batch-super-dev/instructions.md
index 2242d558..a14e5df8 100644
--- a/src/modules/bmm/workflows/4-implementation/batch-super-dev/instructions.md
+++ b/src/modules/bmm/workflows/4-implementation/batch-super-dev/instructions.md
@@ -44,8 +44,86 @@ This workflow helps you "mind the gap" between story requirements and codebase r
 <critical>The workflow execution engine is governed by: {project-root}/_bmad/core/tasks/workflow.xml</critical>
 <critical>You MUST have already loaded and processed: {project-root}/_bmad/bmm/workflows/4-implementation/batch-super-dev/workflow.yaml</critical>
 
+<critical>⚕️ HOSPITAL-GRADE CODE STANDARDS ⚕️</critical>
+<critical>This code may be used in healthcare settings where LIVES ARE AT STAKE.</critical>
+<critical>Every line of code must meet hospital-grade reliability standards.</critical>
+<critical>QUALITY >> SPEED. Take 5 hours to do it right, not 1 hour to do it poorly.</critical>
+
 <workflow>
 
+<step n="0" goal="Select Execution Mode (Interactive vs Fully Autonomous)">
+  <action>Present execution mode options to user</action>
+
+  <output>
+╔═══════════════════════════════════════════════════════════════════╗
+║  BATCH SUPER-DEV: Execution Mode Selection                        ║
+╚═══════════════════════════════════════════════════════════════════╝
+
+⚕️ HOSPITAL-GRADE CODE STANDARDS ACTIVE ⚕️
+Lives are at stake. All code must meet safety-critical reliability standards.
+
+Choose execution mode:
+
+[I] INTERACTIVE CHECKPOINT MODE (Recommended for oversight)
+    - After each story completes, pause for your review
+    - You approve before proceeding to next story
+    - Allows course correction if issues detected
+    - Best for: Critical features, new team members, complex epics
+
+[A] FULLY AUTONOMOUS MODE (Maximum quality, zero interaction)
+    - Process all selected stories without pausing
+    - ENHANCED quality standards (even more rigorous than interactive)
+    - Hospital-grade code verification at every step
+    - NO shortcuts, NO skimping, NO corner-cutting
+    - Best for: Well-defined stories, experienced implementation
+
+⚠️  AUTONOMOUS MODE = HIGHER QUALITY, NOT LOWER
+In autonomous mode, quality standards are ENHANCED because there's no
+human oversight in the loop. Every decision is double-checked.
+
+QUALITY >> DURATION. We prioritize correctness over speed.
+
+Which mode? [I/A]:
+  </output>
+
+  <action>Read user input</action>
+
+  <check if="user selects 'I' or 'i'">
+    <action>Set execution_mode = "interactive_checkpoint"</action>
+    <output>
+✅ Interactive Checkpoint Mode Selected
+
+After each story implementation:
+- Full quality report displayed
+- You approve before next story begins
+- Allows real-time oversight and intervention
+    </output>
+  </check>
+
+  <check if="user selects 'A' or 'a'">
+    <action>Set execution_mode = "fully_autonomous"</action>
+    <output>
+⚕️ Fully Autonomous Mode Selected - HOSPITAL-GRADE STANDARDS ENFORCED
+
+Quality enhancements for autonomous mode:
+✅ Double validation at each step
+✅ Comprehensive error checking
+✅ Detailed audit trail generation
+✅ Zero-tolerance for shortcuts
+✅ Hospital-grade code verification
+
+Processing will continue until ALL selected stories complete.
+NO human interaction required until completion.
+
+QUALITY OVER SPEED: Taking time to ensure correctness.
+    </output>
+    <action>Activate hospital_grade_mode = true</action>
+    <action>Set quality_multiplier = 1.5</action>
+  </check>
+
+  <action>Store execution_mode for use in subsequent steps</action>
+</step>
+
 <step n="1" goal="Load and parse sprint-status.yaml">
   <action>Read {sprint_status} file</action>
   <action>Parse metadata: project, project_key, tracking_system</action>
@@ -674,6 +752,64 @@ Enter number (2-10) or 'all':
       <check if="reconciliation succeeded">
         <output>✅ COMPLETED: {{story_key}} (reconciled)</output>
         <action>Increment completed counter</action>
+
+        <check if="execution_mode == 'interactive_checkpoint'">
+          <action>PAUSE FOR USER REVIEW</action>
+          <output>
+╔═══════════════════════════════════════════════════════════════════╗
+║  INTERACTIVE CHECKPOINT: Story {{story_key}} Complete             ║
+╚═══════════════════════════════════════════════════════════════════╝
+
+✅ Story {{story_key}} successfully implemented and reconciled
+
+Quality Summary:
+- All tests passing
+- Type checks passing
+- Linter passing
+- Code review completed
+- Sprint status updated
+
+Remaining stories: {{remaining}}
+
+Options:
+[C] Continue to next story
+[R] Review implementation details
+[P] Pause batch (exit workflow)
+
+Your choice [C/R/P]:
+          </output>
+
+          <action>Read user input</action>
+
+          <check if="user selects 'C' or 'c'">
+            <output>✅ Continuing to next story...</output>
+          </check>
+
+          <check if="user selects 'R' or 'r'">
+            <output>📋 Implementation Details for {{story_key}}</output>
+            <action>Display story file, test results, review findings</action>
+            <output>
+Press [C] to continue or [P] to pause:
+            </output>
+            <action>Read user input</action>
+            <check if="user selects 'C' or 'c'">
+              <output>✅ Continuing to next story...</output>
+            </check>
+            <check if="user selects 'P' or 'p'">
+              <output>⏸️  Batch paused. Run batch-super-dev again to continue with remaining stories.</output>
+              <action>Jump to Step 5 (Summary)</action>
+            </check>
+          </check>
+
+          <check if="user selects 'P' or 'p'">
+            <output>⏸️  Batch paused. Run batch-super-dev again to continue with remaining stories.</output>
+            <action>Jump to Step 5 (Summary)</action>
+          </check>
+        </check>
+
+        <check if="execution_mode == 'fully_autonomous'">
+          <output>✅ {{story_key}} complete. Automatically continuing to next story (autonomous mode)...</output>
+        </check>
       </check>
 
       <check if="reconciliation failed">
diff --git a/src/modules/bmm/workflows/4-implementation/super-dev-pipeline/steps/step-04-implement.md b/src/modules/bmm/workflows/4-implementation/super-dev-pipeline/steps/step-04-implement.md
index 912077f5..473c124a 100644
--- a/src/modules/bmm/workflows/4-implementation/super-dev-pipeline/steps/step-04-implement.md
+++ b/src/modules/bmm/workflows/4-implementation/super-dev-pipeline/steps/step-04-implement.md
@@ -1,19 +1,19 @@
 ---
-name: 'step-03-implement'
-description: 'Adaptive implementation - TDD for greenfield, refactor for brownfield, no vibe coding'
+name: 'step-04-implement'
+description: 'HOSPITAL-GRADE implementation - safety-critical code with comprehensive testing'
 
 # Path Definitions
 workflow_path: '{project-root}/_bmad/bmm/workflows/4-implementation/super-dev-pipeline'
 
 # File References
-thisStepFile: '{workflow_path}/steps/step-03-implement.md'
-nextStepFile: '{workflow_path}/steps/step-04-post-validation.md'
+thisStepFile: '{workflow_path}/steps/step-04-implement.md'
+nextStepFile: '{workflow_path}/steps/step-05-post-validation.md'
 
 # Role Continue
 role: dev
 ---
 
-# Step 3: Implement Story
+# Step 4: Implement Story (Hospital-Grade Quality)
 
 ## ROLE CONTINUATION
 
@@ -28,6 +28,46 @@ Implement all unchecked tasks using appropriate methodology:
 2. **Brownfield**: Refactor approach (understand existing, modify carefully)
 3. **Hybrid**: Mix both approaches as appropriate per task
 
+## ⚕️ HOSPITAL-GRADE CODE STANDARDS ⚕️
+
+**CRITICAL: Lives May Depend on This Code**
+
+This code may be used in healthcare/safety-critical environments.
+Every line must meet hospital-grade reliability standards.
+
+### Safety-Critical Quality Requirements:
+
+✅ **CORRECTNESS OVER SPEED**
+   - Take 5 hours to do it right, not 1 hour to do it poorly
+   - Double-check ALL logic, especially edge cases
+   - ZERO tolerance for shortcuts or "good enough"
+
+✅ **DEFENSIVE PROGRAMMING**
+   - Validate ALL inputs (never trust external data)
+   - Handle ALL error cases explicitly
+   - Fail safely (graceful degradation, never silent failures)
+
+✅ **COMPREHENSIVE TESTING**
+   - Test happy path AND all edge cases
+   - Test error handling (what happens when things fail?)
+   - Test boundary conditions (min/max values, empty/null)
+
+✅ **CODE CLARITY**
+   - Prefer readability over cleverness
+   - Comment WHY, not what (code shows what, comments explain why)
+   - No magic numbers (use named constants)
+
+✅ **ROBUST ERROR HANDLING**
+   - Never swallow errors silently
+   - Log errors with context (what, when, why)
+   - Provide actionable error messages
+
+⚠️ **WHEN IN DOUBT: ASK, DON'T GUESS**
+   If you're uncertain about a requirement, HALT and ask for clarification.
+   Guessing in safety-critical code is UNACCEPTABLE.
+
+---
+
 ## MANDATORY EXECUTION RULES
 
 ### Implementation Principles