Buzz the tower.
Spill the coffee.
Nobody was watching anyway.
That is what clinical AI deployment
looks like inside most health systems.
The plane comes in fast.
The tower shakes.
The commander looks down at his uniform.
Nobody was holding the board
when it happened.
Most institutions name the technology.
Most charters name the committee.
Most clinical AI deployments
never name who holds the sky.
That is not a workflow problem.
That is an empty tower.
The Governance Owner holds the sky.
↳ Charters what the agent is authorized to do.
↳ Commissions the deployment.
↳ Covers the institution when it goes wrong.
The Decision Owner holds the call.
↳ Decides when the recommendation arrives.
↳ Documents what the chart will carry.
↳ Defends the call when it is questioned.
The Handoff between them
is the moment the sky stays governed
or goes dark.
The Accountability Gap™ (TAG™)
does not live in the recommendation.
It lives in the empty tower.
You already know which clinical AI deployment
in your institution
just buzzed your tower.
Nobody spilled coffee.
Because nobody was there to spill it.
Name who holds the sky.
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