Your closing question is worth pushing one step further downstream, into a case where healthcare actually did say yes. The LungIMPACT RCT tracked 93,326 chest X-rays and found AI triage cut radiologist reporting time from 47 to 34 hours, but time to lung cancer diagnosis barely moved: 44 versus 46 days, not significant. Your epilepsy scanner is stuck before any gatekeeper approves it. This trial shows what happens after every gatekeeper approves: the metric inside one department's control moves, but nothing downstream restructures around it, because no single authority owns the pathway from image to diagnosis the way the Royal Navy owns the decision to put a clock on Excalibur.
That reframes your tradeoff. Distributed authority doesn't just slow the yes, it caps what the yes is worth once you get it.
Your closing question is worth pushing one step further downstream, into a case where healthcare actually did say yes. The LungIMPACT RCT tracked 93,326 chest X-rays and found AI triage cut radiologist reporting time from 47 to 34 hours, but time to lung cancer diagnosis barely moved: 44 versus 46 days, not significant. Your epilepsy scanner is stuck before any gatekeeper approves it. This trial shows what happens after every gatekeeper approves: the metric inside one department's control moves, but nothing downstream restructures around it, because no single authority owns the pathway from image to diagnosis the way the Royal Navy owns the decision to put a clock on Excalibur.
That reframes your tradeoff. Distributed authority doesn't just slow the yes, it caps what the yes is worth once you get it.