Ethical AI in Healthcare: PPTO Governance Playbook

Hospitals are deploying AI faster than governance can keep up. Sepsis prediction algorithms, diagnostic imaging tools, clinical decision support systems, and operational AI are entering clinical workflows with limited oversight, inconsistent equity monitoring, and no standardized review process.

This book provides the missing system.

Most hospitals have AI tools in production with no formal governance structure. The risks are concrete: biased algorithms producing different recommendations by race, clinical tools trained on unrepresentative data, no process to pause a system that's underperforming, and no one clearly accountable when something goes wrong.

The gap between AI deployment and AI governance is where patient safety, equity, and institutional liability risks concentrate.

The book is built on the PPTO Framework (People, Process, Technology, Operations), a peer-reviewed governance model I developed and published in the Open Journal of Business and Management (Grant & Levasseur, 2026).

Each pillar addresses a different dimension of governance:

People — Who governs? Governance committee structure, cross-functional membership, clinical and technical ownership, training, and accountability

Process — How do we evaluate and monitor? Pre-deployment review, ongoing performance monitoring, equity thresholds, and decommissioning procedures

Technology — What standards do we require? Data representativeness, explainability requirements, audit logging, vendor documentation, and failover procedures

Operations — How do we sustain this? Executive sponsorship, dedicated budget, change management, feedback loops, regulatory monitoring, and maturity tracking

This is not a theory book. It's an implementation manual. Hospital leaders can start building governance infrastructure the week they finish reading it.

The book includes:

A complete AI governance committee charter template

A RACI accountability matrix for governance activities across all four pillars

A pre-deployment review checklist (6 sections, 30+ checkpoint items)

A 5-dimension risk-tiering rubric for classifying AI systems by risk level

An equity metrics dashboard template with the 10-percentage-point disparity threshold

A 90-day implementation timeline from zero governance to operational program

Change management frameworks for AI deployments

Vendor evaluation criteria and contract provisions

One of the framework's most concrete contributions: if any AI system's performance differs by more than 10 percentage points between any demographic subgroup (disaggregated by race, ethnicity, age, sex, and insurance status), it triggers mandatory governance review.

This threshold turns a vague commitment to equity into a measurable, actionable standard.

Hospital and health system executives (CMO, CIO, CNO, CEO)

Compliance officers and legal counsel

Health equity officers

Quality improvement leaders

AI governance committee members

Data scientists and clinical informatics teams

Healthcare consultants advising on AI adoption

This book is the practitioner translation of peer-reviewed research. The journal article established the evidence base. The book translates it into tools hospital leaders can use on Monday morning.

Available on Amazon: Get the book