U.S. Hospitals Underfund AI Governance as Adoption Accelerates
Black Book Survey of 182 Hospitals Finds Only 22% Confident in Producing a 30-Day AI Audit Trail; Median 4.2% of 2026 IT + Quality/Safety Budgets Devoted to AI Oversight
NEW YORK, November 12, 2025 (Newswire.com) - A new Black Book Research survey of 182 U.S. hospital leaders reveals widespread underinvestment in AI governance, safety, and compliance heading into 2026. Although artificial intelligence continues to expand across clinical and operational workflows, the median 2026 budget share for AI governance and safety is just 4.2%, and only 22% of hospitals report high confidence that they could deliver a complete, auditable AI explanation within 30 days to regulators or payers.
Segment Breakdown (n = 182)
Segment | n | Median % of 2026 | IQR* | High Confidence | Low Confidence | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Small Hospitals (1-2 facilities) | 74 | 2.3% | 1.0%-4.0% | 15% | 54% | |||||||||
Community Systems (3-9 facilities) | 71 | 4.5% | 2.5%-6.5% | 21% | 43% | |||||||||
Large Medical Centers/Systems (10 + facilities or academic) | 37 | 6.8% | 4.5%-9.0% | 34% | 28% | |||||||||
Overall | 182 | 4.2% | 2.0%-6.8% | 22% | 44% |
( * IQR stands for Interquartile Range, a statistical measure that describes the spread or variability of the middle 50% of data points in a dataset.)
Key Findings
Despite higher spending among large systems, confidence in audit readiness remains low across all hospital types.
Policy maturity: Only 29% have implemented and enforced AI policies covering model inventory, lineage, and sign-offs; 48% are still drafting policies.
Vendor transparency: 41% cite limited explainability artifacts from vendors (e.g., model cards, drift reports) as their top audit barrier.
Data provenance: 37% report incomplete tracking of data inputs and model versions.
Ownership ambiguity: 33% say unclear internal ownership between IT, Quality/Safety, and Compliance slows governance progress.
Budget trajectory: 26% plan to increase governance/safety funding by ≥2 points in 2026; 18% plan no increase.
"Underinvestment is the quiet risk in hospital AI programs," said Doug Brown, founder of Black Book Research. "Even among large medical centers, governance budgets remain single-digit shares. Hospitals need audit trails, not just pilots, to prepare for 2026 scrutiny. Smaller facilities are one incident away from major disruption. Shifting even two to three percentage points of 2026 budgets toward AI governance could drastically improve readiness."
Recommended Q1 2026 Board Actions
Fund a full AI governance stack: model registry, lineage, monitoring, and override logs.
Contract for audit rights in all vendor agreements, ensuring explainability artifacts are delivered.
Clarify ownership (RACI) across IT, Quality/Safety, and Compliance, with quarterly board reporting.
Conduct a 30-day AI audit drill in Q1 2026 and remediate identified gaps.
About the Study
Black Book surveyed 182 hospital leaders (for-profit and non-profit) between Oct. 15 and Nov. 8, 2025. Respondents were grouped by size: Small Hospitals (1-2), Community Systems (3-9), and Large Medical Centers/Systems (10+). Data are reported at a 95% confidence level with medians and interquartile ranges (IQR).
About Black Book™
Black Book Market Research LLC is an independent healthcare research and advisory firm known for comprehensive, crowdsourced vendor and buyer perception studies. Since 2002, Black Book has delivered unbiased insights that help healthcare organizations benchmark technology strategy, vendor performance, and operational risk. Industry stakeholders are invited to download the free research guide, Governing Hospitals AI: 2026 Board to Bedside Accountability Guide at https://blackbookmarketresearch.com/governing-hospitals-ai-2026-board-to-bedside-accountability-guide and other industry research at www.blackbookmarketresearch.com. Media Contact: research@blackbookmarketresearch.com
Source: Black Book Research
