Roughly 80% of healthcare AI projects fail to scale beyond the pilot phase. Seventy percent never reach production at all. The median time from pilot approval to quiet shutdown is fourteen months. (healthtechdigital.com)

The point of decision infrastructure isn’t to create a better annual plan. It’s to create a repeatable decision rhythm that keeps the portfolio current without turning every week into a re-ranking exercise. Done well, it reduces chaos without pretending uncertainty disappears. It gives leaders a way to update decisions with discipline instead of improvisation.

Raw beats polished because a rough, decision-ready artifact is more useful than a beautiful system that still can’t produce something a leader can approve. Infrastructure beats UI because the method has to work before you wrap it in an interface. Inputs beat opinions because governance doesn’t need more arguments — it needs a consistent way to evaluate trade-offs under constraints.