"Is it governed?"
A nod.
Black Book asked 182 hospital leaders
what slows their AI governance.
One in three said the same thing.
No clear owner.
Not between IT.
Not quality.
Not compliance.
No one has to sign a name
to nod yes.
So the committee agrees.
The board signs.
Everyone looks covered.
Three weeks later
the recommendation reaches a patient.
No one owns the call.
Ask the question harder.
Still a nod.
Ask a different question.
Get a name.
Stop asking if the AI was approved.
Start asking what a nod cannot survive.
↳ Who owns the call at the bedside?
No nod answers that without a person.
↳ Where is the Decision Owner in the charter?
Not written is not owned.
↳ Who signs before go-live?
Not after the harm.
↳ Which deployment has no owner?
Name it.
A nod hides the architecture.
A name exposes it.
↳ The Governance Owner names what the agent can do.
↳ The Decision Owner holds the call.
↳ The Handoff is where the trail builds.
The Accountability Gap™ (TAG™)
does not close with a sharper question.
It closes with a name.
Before the recommendation reaches the bed.
You already know the deployment
that got a nod instead of an owner.
The only question left.
Do you ask
before the next one goes live?
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