Today, few health system boards have established an oversight accountability framework that clarifies the role of the board, senior leaders, and clinicians in the governance of AI.
For many organizations, “AI governance” is a function of the IT team, with the CIO or CTO responsible and the CISO playing a significant role. This structure is an important and necessary component. However, it does not take the place of the board’s appropriate engagement in AI strategy, guiding principles, investment rationale, security and privacy assurance, leadership structure and decision-making processes, enterprise and regulatory risk analysis, accountability for patient harm and regulatory exposure, and the need for ongoing monitoring as AI tools are updated and their capabilities evolve.
Health care boards must treat effective governance of AI as a fiduciary duty. It is not something the board can effectively oversee through occasional updates from IT and other senior leaders, because AI will impact everything in the organization. Most importantly, AI in health systems is constantly changing, which raises the need for robust oversight and increases the complexity of the oversight process.
In particular, AI impacts mission, strategy, and workforce in the governance realm.
Mission
AI opens up new questions about organizational identity – how it changes the organization’s culture, future vision, and role in and relationship with its communities. Boards must prepare for human-centric conversations and decisions, including how to safeguard critical human aspects valued by the organization and its stakeholders and communicate the ways in which the organization is protecting those human and cultural priorities.
Strategy
AI will profoundly affect strategic partnerships as well as bring new opportunities for collaboration. Strategic partners need to be aligned with AI-related priorities and concerns. Vendors’ use of AI must be scrutinized according to the organization’s risk profile, and contracts may need to be reconsidered or updated. Potential new AI partners and strategic opportunities should be reviewed against the organization’s guiding principles as they emerge. Strategic plans should indicate how and where AI will be involved across plan implementation, in addition to the organizational strategy regarding AI itself.
Workforce
As AI changes roles, it will require training and upskilling, redesigned workflows and processes, and careful consideration of how communication channels and future workforce needs may shift. Because this has the potential to lower trust and morale and increase change fatigue and burnout, the board has a fundamental obligation to monitor the impacts of AI-related decisions that carry the risk of significant employee displacement.
New skills criteria, incentives, and performance metrics may be needed for key leadership positions. Ongoing collaboration between the board, C-suite, legal counsel, and clinical and department leaders regarding the opportunities and risks of AI’s impact on the workforce and its use in patient-facing settings will be essential.
The Board’s Role
If there are not yet guardrails, policies, or processes established for the proper use of current AI tools, these must be developed and implemented with clear accountability for who is responsible for implementation across the organization. The board should review and approve these policies. Then, the mission, strategy, and workforce considerations outlined above can be used to inform a framework for corporate governance of AI in health systems.
A board-level AI governance framework should help clarify several areas of enterprise responsibility:
AI is not just an “IT issue”
Given AI’s enterprise-wide impacts, this is not something the board can effectively oversee through occasional updates from IT and other senior leaders.
As AI expands, so will its costs
The CFO and finance/investment committee of the board must develop clarity on where and to what degree the organization should invest in AI and determine how to measure its impacts on budget, ROI, margin, debt, and bond rating. AI-related cost assumptions should be challenged and rigorously tested. More broadly, the cost-benefit analysis should be integrated into the organization’s guiding principles for whether, when, and how to adopt AI tools across the enterprise.
Compliance, legal/regulatory, and enterprise risk concerns must be considered
As part of its oversight and accountability mechanism, the board should receive regular updates and advice from legal counsel, the compliance committee, and the enterprise risk committee as AI use expands and broadens the organization’s risk profile. Consider the need to address AI-specific trust and reliability issues, which are separate and distinct from traditional compliance issues.
Conclusion
Boards and senior leaders must never lose sight of their charitable mission amidst the fast pace of change AI brings to health care. Health systems are and will remain run by people, for people. The incorporation of AI brings questions regarding how such innovation changes the organization’s mission, culture, future vision, and the health system’s role in and relationship with its communities.
Being prepared to guide human-centered conversations and decisions is critical. This includes how the organization will protect the human and cultural priorities valued by patients, clinicians, employees, and other stakeholders. Board should also consider how those commitments are communicated as AI becomes more embedded in the organization’s strategy, operations, workforce, and care delivery.
References:
Shai Ganu, “AI is a fiduciary duty, not an agenda item,” August 7, 2026.
Layla Alabdulkarim, Ph.D., “Five keys to governing the convergence of AI, cybersecurity, and clinical risk,” AHA Trustee Services.
Michael Peregrine, “Board human capital committees face new AI-driven challenges,” Becker’s Health IT, August 17, 2026.
