A growing number of hospitals are adopting AI, but most remain underprepared to govern its use, according to a Nov. 11 survey from Black Book Research.
Black Book surveyed 182 hospital leaders between Oct. 15 and Nov. 8, 2025. Respondents represented for-profit and nonprofit hospitals of varying sizes, including small hospitals, community systems and large medical centers or academic systems.
Here are five key findings from the report:
- The median share of 2026 IT and quality or safety budgets allocated to AI governance and safety is 4.2%. Large systems dedicate a median of 6.8%, compared with 2.3% among small hospitals.
- Only 22% of hospitals said they are highly confident they could produce a complete AI audit trail within 30 days for regulators or payers. Confidence is lowest among small hospitals, where only 15% expressed high confidence.
- Just 29% of hospitals reported having implemented and enforced policies covering AI model inventory, lineage and sign-offs. Nearly half, 48%, are still drafting such policies.
- Forty-one percent of hospitals cited limited documentation from AI vendors, such as model cards and drift reports, as their top audit barrier. Another 33% said unclear ownership among IT, quality and safety, and compliance teams impedes governance efforts.
- Only 26% of hospitals said they plan to raise AI governance and safety budgets by two or more percentage points in 2026, while 18% plan no increase.
