Health system leaders ask me
a version of the same question
after every governance review.
Why are our clinicians
not raising concerns
about the AI we just approved.
The answer is always the same.
They are raising them.
Just not to the board.
Not because they do not want to tell you.
Because the cost of raising
a clinical AI concern
inside an institution
that has not named who owns it
is too high.
So the board gets the polite version.
The version curated
for institutional comfort.
Governance decisions get made
on a reality already filtered.
Here is what your clinicians know
that no one has told your board.
↳ We are testing the governance structure before we trust it.
↳ We still do not know what it stands for.
↳ We are comparing it to the last one.
↳ We are watching to see if it protects us.
↳ The unnamed seat creates an information vacuum.
Your clinicians are not withholding.
They are protecting themselves
from a structure
they have not yet ruled out.
When your board last reviewed
the deployment,
were the clinicians using it
in the room.
You already know the answer.
The version approved
and the version the floor is living with
are not the same deployment.
Mo Johnson, MD MBA is a cardiothoracic surgeon and the founder of GPe Research. Field Notes are short dispatches from the clinical AI accountability frontier, published alongside the MedicoVigilance™ newsletter at medicovigilance.org.
Follow the work on LinkedIn: linkedin.com/in/mo-johnson