A policy-and-operations-focused perspective argues that healthcare leaders won’t get value from autonomous AI if they avoid redesigning how clinical decisions are measured, governed, and audited. The piece frames AI risk as governance and implementation rather than model capability, emphasizing that clinical trust hinges on decision accountability. The message for the sector is practical: organizations need operational frameworks that specify how AI outputs connect to clinical action, including measurement of performance and clear oversight pathways for clinicians and compliance teams.