Someone else wrote it.
The board approved it.
Wolters Kluwer put it plainly.
2026 is the year of governance.
Health system C-suites are playing catch-up
to clinicians who already adopted the tools.
Here is what that catch-up looks like from the inside.
Boards approving AI strategies
they did not build.
Boards approving AI strategies
they cannot explain.
Most are losing that race.
Most do not know it yet.
Not maliciously.
Not carelessly.
The vendor deck was confident.
The peers were moving.
The conference validated the direction.
So the board approved what it was shown.
Five signs it is happening right now.
↳ The roadmap has a three year horizon.
No one can name the problem it solves.
↳ The pilots are running.
No one can say what value they produce.
↳ The governance committee meets monthly.
No one can name who owns each deployment.
↳ The CMIO championed it.
The board approved it.
No one can explain it to a regulator.
↳ The confidence in the room
matches the confidence in the vendor deck.
One of them wrote the strategy.
The peers perform it.
The vendors count on it.
The conferences reinforce it.
And quarter after quarter
the distance widens
between what leadership says it knows
and what it actually knows.
The executives who close that distance
do not know more technical vocabulary.
They know which questions
the vocabulary was built to avoid.
The strategy exists.
The ownership does not.
↳ The Governance Owner
names what the agent is authorized to do.
↳ The Decision Owner
holds the clinical call.
↳ The Handoff between them
is where the accountability trail builds.
The Accountability Gap™ (TAG™)
does not open because the board was careless.
It opens because the strategy arrived
with no seat attached.
You already know which sign
you recognized in your last board meeting.
The only question left
is whether you name the seat
before the next approval.
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