Grant Thornton found
that 46 percent of leaders
name governance and compliance
as the top reason clinical AI fails.
Nearly half.
And most of them saw it coming.
Every leader who has deployed clinical AI
knows this ride.
↳ The vendor demo looked like transformation.
↳ Go live looked nothing like the pilot.
↳ Pilot metrics climbed. Leadership was happy.
↳ Legal asked for the audit trail.
↳ Talk of pausing. The old workflow had less liability.
↳ The board presentation went well. The dashboard looked good.
↳ The vendor pushed an update. The decision logic changed.
↳ There is a diagnostic for this.
↳ Nine blocks. One score. The gap has a name.
The accountability rollercoaster.
It does not stop
because the technology improves.
It stops when named decision authority
stops disappearing.
Clinical AI entered the workflow.
Nobody chartered the governance.
Nobody owned the decision
at the point of care.
The Accountability Gap™ opened on go live day.
It has been running the ride ever since.
It closes the moment two seats are filled.
↳ A Governance Owner who holds the charter, the commission, and the cover.
↳ A Decision Owner who decides, documents, and defends.
Empty those two seats,
and every deployment feels ungoverned.
Fill them,
and the ride has a name, a score, and a way off.
You recognized at least one moment on that list.
You already know which deployment it was.
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