The board signed it.
The governance broke anyway.
Not at the vote.
After the room moved on.
The policy gets written.
The committee nods.
The board signs.
Then the institution keeps deploying.
Through urgency.
Through vendor confidence.
Through whoever argues hardest.
The missing piece was never a better policy.
Accountability has to be something the team can point to.
Something that runs every deployment through it.
Before go-live. Not after.
Six shifts turn a binder into accountability.
↳ Start with the decision. Not the deployment.
↳ Name the two seats before go-live.
↳ Build the map. Owner to owner to the handoff.
↳ Pin it where the board can see it.
↳ Run every deployment through it. No name, no launch.
↳ Anchor every governance meeting to the map.
The core idea is simple.
Make the accountability visible.
As a living map.
Governance Owner.
Decision Owner.
The Handoff between them.
The Accountability Gap™ (TAG™)
does not close with a policy.
It closes with a map
the institution actually runs every deployment through.
You already know which deployments went live
with no name on the call.
The only question is whether the map exists
before the next one does.
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