Artificial intelligence (AI) is reshaping health care, offering opportunities to enhance capacity, improve outcomes, and ensure equitable, efficient care. As Ontario faces demographic and capacity pressures as well as rising costs, responsible AI adoption has become a strategic necessity.
Across the province, hospitals are leading by example, embedding AI into strategy, governance, and operations. While the path ahead is promising, the full potential of AI will only be realized through coordinated policy, investment, and strong ethical leadership.
Despite spending about 12 percent of its GDP, or more than C$330 billion each year, Canada continues to struggle with rising health care costs and uneven outcomes. Studies suggest AI could cut health care spending by 4.5–8 per cent each year, which would mean billions of dollars in savings1. Recognizing this potential, hospital leaders are turning to AI to improve efficiency, lower costs, and enhance patient care.
After initial caution towards AI adoption, recent breakthroughs in generative AI, proven successes with machine learning in health care, and growing public confidence have sparked new interest across the sector. At the same time, hospitals are recognizing that the sharp rise in digital health data, from electronic records, wearable devices, and mobile apps, offers even more opportunity to deliver care that is more personalized, efficient, and connected.
The emerging consensus among hospital executives is that AI should augment, not replace, human expertise and serve as a “powerful accelerator of insight". To avoid falling behind in innovation, hospitals need clear vision, strong leadership, and governance from the top.
This involves three interconnected leadership priorities:
1. Strategic integration of AI into planning and operations.
From reducing administrative burdens with AI “scribes" to optimizing staff scheduling and logistics, hospitals are using AI to help relieve system pressures and ensure resources are allocated where they are needed most.
Beyond operations, AI is also transforming care delivery and safety. A strong example is St. Michael's Hospital's CHARTWatch system in Toronto, which uses AI to predict patient deterioration within 48 hours. By alerting staff to intervene earlier, this AI tool has helped reduce unexpected ward deaths by 26 per cent, significantly improving patient outcomes.
2. Ethical guardrails and governance to maintain trust, safety, and alignment with values.
In Ontario's publicly funded health system, ethical deployment is the key to sustainable AI adoption and maintaining public trust and confidence. National consistency will be required to align standards, safeguard public confidence and ensure that innovation strengthens the values that define Ontario's health care.
Hospitals across the province are establishing AI governance committees and ethical frameworks to guide fair, transparent, and accountable implementation. For example, The Hospital for Sick Children (SickKids) in Toronto set up an executive-led AI steering committee that applies principles to help ensure the ethical and effective development, adoption and deployment of AI systems within SickKids.
Hospitals are also developing AI usage policies that typically address: data privacy and security requirements, validation and testing standards for AI tools, criteria for selecting AI vendors, and rules around human oversight. Examples such Unity Health Toronto's transparency-focused guidelines illustrate how clear ethical frameworks can guide responsible adoption.
Leaders across the sector are also focused on fairness and inclusion. Many organizations now conduct equity impact assessments and engage diverse stakeholders in AI development, while growing attention is being paid to Indigenous data governance and honouring principles like OCAP (Ownership, Control, Access, and Possession). Equity impact assessments and inclusion of diverse voices, including Indigenous data governance, are critical.
To build and maintain trust in AI, hospitals are also emphasizing transparency and accountability. This includes using AI tools with explainability, keeping detailed audit logs of AI-driven decisions, and clearly communicating to staff and patients how these technologies are being used and governed. Hospitals are treating AI systems like ongoing clinical trials, logging any errors or near-misses to improve safety and reliability over time.
Rather than acting as barriers, strong governance frameworks and transparent communication are becoming the foundation that builds trust in AI and makes its adoption impactful. As hospitals embrace innovation, leaders are ensuring that technological progress does not come at the expense of the public's trust or the values that define Ontario's health care.
3. Change management and culture shifts to get buy-in from staff and stakeholders.
Successful AI adoption in Ontario's health care system depends on people as much as technology. By strengthening AI literacy and leadership among clinicians, managers, policymakers, and the public, we can build the trust and support needed to integrate AI into care delivery.
Programs such as the OHA's and University of Waterloo's Ontario Hospital Executive Program in Artificial Intelligence: Building a Blueprint to Harness AI in Health Care and AMS-Fitzgerald Fellowship in Artificial Intelligence (AI) and Human-Centred Leadership illustrate how education can build trust and equip leaders to guide responsible implementation. Hospitals like Unity Health Toronto are also advancing this work through the Health AI Academy, a national training initiative developed with KPMG and Signal 1, that equips health professionals with the knowledge and skills to apply AI and advanced analytics ethically and effectively.
AI will inevitably transform professional roles and workflows. Transparent communication, supports, and engagement with clinicians and patients are vital to maintaining confidence and ensuring AI complements, rather than replaces, the expertise and compassion of the health care workforce.
As hospitals embrace AI, one thing is clear: leadership, grounded in strategy, ethics, and people, makes all the difference. It is about more than simply adopting the latest tools or chasing technological trends.
When CEOs and executives foster innovation and safeguard ethics and equity, trust builds among staff and patients, ensuring that sustainable progress can happen. Ontario's hospitals recognize this and are shaping a future where AI enhances the health system's capacity to deliver better, more equitable care while empowering the workforce to adapt and lead.
To strengthen safety and confidence, Canada and Ontario should create regulatory sandboxes for testing and validating AI tools in partnership with Health Canada and provincial regulators. Strategic investment in high-impact demonstration projects, such as digital scribes, predictive analytics, and AI-enabled resource management, can accelerate adoption while building evidence of effectiveness.
Proven applications like CHARTWatch at St. Michael's Hospital, which reduced ward deaths by 26 per cent, show how AI can save lives and improve efficiency. These solutions should be treated as core digital infrastructure, supported through coordinated national funding and knowledge sharing.
Although Ontario's health AI ecosystem is rich with talent and innovation, it is fragmented highlighting the need for a Pan-Canadian Health AI Strategy aligning data standards, governance, and implementation frameworks. This strategy should fund interdisciplinary hubs linking research, policy, and clinical practice, and establish federal-provincial mechanisms for harmonized oversight. By coordinating efforts, Ontario can move from pilot projects to scalable, trusted, and impactful transformation across the health system.
AI offers a once-in-a-generation opportunity to strengthen our health system. With the right balance of innovation, governance, and people-centered leadership, Ontario can become a global leader in ethical, effective, and sustainable health AI, enhancing care for every Ontarian.
1. Source: McKinsey and Company.