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From Pilot Trap to Institutional Capacity: A Governance Framework for Sustainable Clinical AI Implementation in
Jin Tian1, Zengren Zhao1, Longmei Tang2,3
1Hospital Management Innovation Center, The First Hospital of Hebei Medical University, 89 Donggang Street, Shijiazhuang, Hebei, 050000, China, +86 311 87156084.
Journal of Medical Internet Research
|May 7, 2026
Summary
Clinical artificial intelligence (AI) applications often fail to integrate into routine care due to insufficient governance. A new framework, developed from a Chinese AI platform implementation, addresses this by building capacity during deployment.
Area of Science:
- Health Informatics
- Artificial Intelligence in Medicine
- Clinical Governance
Background:
- Clinical artificial intelligence (AI) applications frequently stall in pilot phases, failing to integrate into routine healthcare.
- This 'pilot trap' stems from technical, regulatory, and critically, insufficient organizational governance capacity.
Purpose of the Study:
- To address the gap in clinical AI implementation by developing a practical governance framework.
- To understand how governance capacity evolves during real-world AI platform deployment.
Main Methods:
- Analysis of an 18-month implementation of a provincial clinical AI platform in China.
- Development of a 6-module governance framework based on observed implementation dynamics.
Main Results:
- The 6-module framework includes institutional carrier formation, infrastructure, regulatory/ethical, interdisciplinary coordination, scaling, and lifecycle oversight.
- Governance capacity is built iteratively during implementation, not pre-emptively.
- The concept of functional transferability was introduced.
Conclusions:
- Sustained clinical AI integration requires developing institutional capacity through implementation, not just pre-deployment planning.
- The proposed framework complements existing standards by focusing on building functional capacity.
- Advancing clinical AI relies on health systems' ability to foster and maintain the necessary institutional capacity for routine use.
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