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The Q2 Governance Problem: When AI Goes Live Without a Safety Net · The Clinical Realist

• 0:00
  SPEAKER_00: Welcome back to the Clinical Realist.
• 0:01
  SPEAKER_00: I'm Dr.
• 0:02
  SPEAKER_00: Sarah Matt.
• 0:03
  SPEAKER_00: It's late April.
• 0:04
  SPEAKER_00: And right about now, if your health system deployed a clinical AI tool in Q1, you're starting to notice something.
• 0:10
  SPEAKER_00: The pilot worked.
• 0:11
  SPEAKER_00: The go live went pretty reasonably well.
• 0:14
  SPEAKER_00: And the vendor support team has been very responsive.
• 0:17
  SPEAKER_00: Clinicians are using the tool less.
• 0:21
  SPEAKER_00: But something's off.
• 0:22
  SPEAKER_00: Not catastrophically off, just off enough that you are spending more time and conversations about the tool than you expected at this point.
• 0:31
  SPEAKER_00: Clinicians are asking questions you don't have clean answers to, and the data is coming in, but nobody is sure what to do with it.
• 0:39
  SPEAKER_00: The vendors, of course, still engage, but you're starting to realize that their support model was built for GoLive and not for the six-month steady state.
• 0:47
  SPEAKER_00: If that description sounds familiar, what your experience is a governance gap, not a technology gap, a governance gap.
• 0:55
  SPEAKER_00: And the good news is it's fixable.
• 0:58
  SPEAKER_00: The bad news is that the longer you wait, the more expensive it gets.
• 1:06
  SPEAKER_00: Clinical AI implementations have a predictable pattern after GoLive.
• 1:10
  SPEAKER_00: The first four weeks are usually the honeymoon phase.
• 1:12
  SPEAKER_00: Things are new, people are engaged, the vendor is attentive.
• 1:18
  SPEAKER_00: Issues get resolved fast, and the data looks better than expected because the early adopters are doing the heavy lifting.
• 1:24
  SPEAKER_00: Then weeks four through eight happen.
• 1:27
  SPEAKER_00: The early adopters are no longer carrying the teen.
• 1:30
  SPEAKER_00: The full clinical population is using the tool now, or supposed to be.
• 1:34
  SPEAKER_00: The vendor support team has deprioritized your account because GoLive is behind them.
• 1:40
  SPEAKER_00: The implementation team has moved to the next project.
• 1:44
  SPEAKER_00: And the first real data is coming in, not pilot data, not the first week's novelty data, actual production data from actual clinical operations.
• 1:55
  SPEAKER_00: And it's raising questions.
• 1:57
  SPEAKER_00: Why is the tool flagging this class of patients at a different rate than the pilot suggested?
• 2:03
  SPEAKER_00: Why are these three clinicians using the tool in a way that was not in the training protocol?
• 2:09
  SPEAKER_00: And why is the recommendation workflow generating pushback from the afternoon shift that the morning shift isn't experiencing?
• 2:16
  SPEAKER_00: These are not technical questions, they're governance questions.
• 2:20
  SPEAKER_00: And they require someone in the organization who has the absolute authority to look at them and look at the data, make a judgment about what it means, and decide what needs to be changed.
• 2:31
  SPEAKER_00: If you built a governance structure before Go Live, you should have that person already, which is great.
• 2:35
  SPEAKER_00: And that person has been looking at the production data since day one.
• 2:38
  SPEAKER_00: They have a 30-day review built into the calendar, and they know exactly what they're seeing and what it means.
• 2:45
  SPEAKER_00: If you didn't build that structure, you're probably improvising.
• 2:48
  SPEAKER_00: And the questions are real.
• 2:50
  SPEAKER_00: The data's real.
• 2:51
  SPEAKER_00: But the person who's supposed to answer them doesn't have a clear mandate.
• 2:55
  SPEAKER_00: The data review meaning is not on the calendar.
• 2:58
  SPEAKER_00: And the question of why this is not working looks like it has never been formally defined.
• 3:06
  SPEAKER_00: The six to eight week window is when that improvisation becomes visible.
• 3:11
  SPEAKER_00: Not because the tool failed, because the absence of governance becomes apparent in the data.
• 3:17
  SPEAKER_00: Let me describe what a governance gap actually looks like in a live clinical environment, because it does not announce itself dramatically.
• 3:24
  SPEAKER_00: It looks like this.
• 3:48
  SPEAKER_00: And the clinical champion sends an email to the physician population asking, is anyone having issues with the tool?
• 3:54
  SPEAKER_00: So then three responses come back.
• 3:57
  SPEAKER_00: Two are vague, and one is from the department chief who says, We talked about this in last month's meeting.
• 4:02
  SPEAKER_00: So no one knows what meeting that was, and nobody is following up.
• 4:06
  SPEAKER_00: So one month later, the utilization number is lower, and the same loop repeats.
• 4:12
  SPEAKER_00: This isn't negligence.
• 4:14
  SPEAKER_00: Everyone in this loop is a competent professional doing their job the best they can.
• 4:18
  SPEAKER_00: The problem is structural.
• 4:20
  SPEAKER_00: There's no designated owner, there's no decision framework, and there's no defined threshold that triggers an actual formal review.
• 4:28
  SPEAKER_00: There's no meeting with authority to even make a change.
• 4:33
  SPEAKER_00: The governance gap is not a gap in talent, it's a gap in structure.
• 4:38
  SPEAKER_00: Now let's contrast this with what a health system with pre-built governance looks like at the same moment.
• 4:45
  SPEAKER_00: The monthly data report comes in and the physician steward reviews it against the predefined performance benchmarks established at GoLife.
• 4:52
  SPEAKER_00: Utilization is below benchmark.
• 4:54
  SPEAKER_00: The steward calls a 45-minute governance review with three prenamed participants.
• 4:59
  SPEAKER_00: And at that meeting, they use a standard protocol to determine whether the utilization gap is adoption-related, workflow-related, or tool related.
• 5:07
  SPEAKER_00: They assign an action to the responsible party within a two-week resolution timeline.
• 5:12
  SPEAKER_00: And the governance record is updated.
• 5:15
  SPEAKER_00: Same data, completely different response.
• 5:18
  SPEAKER_00: Because the structure was built before the tool went live.
• 5:22
  SPEAKER_00: Now here's the economics question I get asked most often in this conversation.
• 5:27
  SPEAKER_00: Is it worth building the governance structure after the fact?
• 5:31
  SPEAKER_00: We're already live.
• 5:32
  SPEAKER_00: Can we retrofit?
• 5:34
  SPEAKER_00: Yes.
• 5:35
  SPEAKER_00: Yes, yes, yes, you can retrofit.
• 5:37
  SPEAKER_00: But retrofitting governance onto a live clinical AI tool, it's much harder than building it before go live.
• 5:43
  SPEAKER_00: And it's a lot more expensive.
• 5:45
  SPEAKER_00: And here's why.
• 5:46
  SPEAKER_00: When you build governance before go live, you're building from a blank slate.
• 5:50
  SPEAKER_00: You define what looks good before you have data.
• 5:54
  SPEAKER_00: You name the steward before there's a crisis.
• 5:57
  SPEAKER_00: And you establish the review cadence before there's a backlog.
• 6:00
  SPEAKER_00: So the structure's clean.
• 6:03
  SPEAKER_00: Now, you can retrofit, but when you retrofit, you're building governance while the tool is alive, which means every structural decision you make immediately generates a question about the existing data.
• 6:13
  SPEAKER_00: So what do we do with the last six weeks of utilization data that nobody reviewed?
• 6:17
  SPEAKER_00: Do we apply the new governance framework retroactively?
• 6:20
  SPEAKER_00: And who owns the backlog of unresolved clinical questions?
• 6:24
  SPEAKER_00: You're building the safety net while people are already falling.
• 6:29
  SPEAKER_00: It's still worth doing.
• 6:30
  SPEAKER_00: And if you're, you know, in this position right now, the answer is not to wait until Q3 and start fresh.
• 6:35
  SPEAKER_00: No, don't do that.
• 6:37
  SPEAKER_00: The answer is to build the structure as fast as possible and apply it from today forward.
• 6:42
  SPEAKER_00: But the organizations that are not in this position spend a fraction of the retrofit cost building governance before go live.
• 6:49
  SPEAKER_00: That's the strategic investment that looks expensive before implementation, but very obvious afterwards.
• 6:58
  SPEAKER_00: So if you're listening to this episode and your organization is currently in the governance gap, here's the fastest way forward.
• 7:06
  SPEAKER_00: Step one, name the steward today, not tomorrow, today.
• 7:11
  SPEAKER_00: Not a committee, one person, a clinician who has the clinical credibility, the organizational standing, and the time to function as the governance owner for this tool.
• 7:21
  SPEAKER_00: A nurse, a doctor, a pharmacist, I don't care who it is, one person.
• 7:24
  SPEAKER_00: Then give them the title and the authority in the same conversation.
• 7:29
  SPEAKER_00: Step two, schedule the darn governance review, the first one this week, and use the production data you have to find the review questions in advance.
• 7:40
  SPEAKER_00: What are we seeing in utilization?
• 7:42
  SPEAKER_00: What are the edge cases that have come up in the last six weeks?
• 7:45
  SPEAKER_00: What are the open clinical questions that nobody has actually answered?
• 7:49
  SPEAKER_00: One meeting, two hours max, document the outputs.
• 7:54
  SPEAKER_00: And step three, build the forward governance calendar.
• 7:58
  SPEAKER_00: 30-day reviews, quarterly deep dives, an escalation protocol for the scenarios that trigger a pause.
• 8:04
  SPEAKER_00: Put it on the calendar today.
• 8:06
  SPEAKER_00: Not tomorrow, today.
• 8:08
  SPEAKER_00: Not when you have time to do it.
• 8:10
  SPEAKER_00: I mean, you gotta do it now.
• 8:12
  SPEAKER_00: Like do it now.
• 8:13
  SPEAKER_00: Do it yesterday.
• 8:14
  SPEAKER_00: And then step four, define this is not working and what that looks like.
• 8:20
  SPEAKER_00: This is the hardest conversation and probably the most important one.
• 8:23
  SPEAKER_00: What performance threshold triggers an actual formal pause for assessment?
• 8:27
  SPEAKER_00: What clinical outcome triggers immediate escalation?
• 8:31
  SPEAKER_00: And what utilization floor represents a truly failed implementation?
• 8:36
  SPEAKER_00: Define these thresholds before you get to them.
• 8:39
  SPEAKER_00: It's much harder to find them after.
• 8:41
  SPEAKER_00: Four steps.
• 8:43
  SPEAKER_00: You can have a functional governance structure running within two weeks from today.
• 8:47
  SPEAKER_00: That's right.
• 8:47
  SPEAKER_00: Two weeks from today.
• 8:49
  SPEAKER_00: The Q2 governance problem is predictable.
• 8:51
  SPEAKER_00: It happens to most organizations that deployed clinical AI and Q1 without a pre-built governance structure.
• 8:56
  SPEAKER_00: It's not a reflection of bad intent or bad tech.
• 8:59
  SPEAKER_00: It's a structural gap that becomes visible at a specific moment in the implementation lifecycle.
• 9:05
  SPEAKER_00: If your organization is in that gap right now, the fastest path out is a direct conversation about what the governance structure needs to look like for your specific situation.
• 9:14
  SPEAKER_00: That's the work I do.
• 9:15
  SPEAKER_00: Discovering Clarity Sessions at the link below.
• 9:18
  SPEAKER_00: I'm Dr.
• 9:19
  SPEAKER_00: Sarah Matt.
• 9:20
  SPEAKER_00: This is the Clinical Realist, and I'll see you next week.