AI-led policy redesign and a broader definition of return on investment are reshaping how Nirav Shah, MD, Associate CMIO, AI & Innovation, Endeavor Health, approaches digital transformation across the nine-hospital Chicago-area system.

Endeavor Health, which operates roughly 300 sites of care and accounts for about one-third of Illinois’ population in its catchment area, built its reputation as an early Epic and enterprise data warehouse adopter. In his role, Shah practices infectious diseases, participates in innovation and IT governance, reports to the chief clinical officer, and leads research tied to AI and new care models, positioning him at the intersection of technology, operations and clinical practice.

Building a Matrix Role for AI Leadership

In describing his day, Shah outlines a schedule that can swing from meetings with venture investors to research design sessions, IT discussions on predictive analytics and vendor evaluations—all before lunch. The structure is decidedly matrixed, with multiple leaders expecting input and shared accountability for outcomes. That configuration, he said, is becoming essential as health systems seek to apply AI across strategy, governance, development and deployment.

The central responsibility is to serve as a connector among innovation teams, informatics, operational leaders and front-line clinicians, seeing new ideas from inception through implementation and evaluation. That includes helping the organization think through when a promising pilot should scale, what metrics define success, and how insights are translated into white papers or multicenter studies that influence responsible AI adoption across the sector.



The breadth of this charge comes with a cognitive tax, as context switching is constant. Shah leans on a research team to go deep on literature reviews, measurement frameworks and outcomes analysis so that his own attention can remain on cross-functional design, prioritization and decision-making.

Protecting Time and Culture in a Burnout Era

Meeting discipline has become a core leadership tool. Shah favors 30-minute sessions, or even 15 minutes when the agenda is narrow, and is quick to remove people from email threads when their attention is not required. “Time is probably the most valuable thing our health systems have, like the time of our workers,” adding that leaders should treat meeting invitations the way they treat capital requests: as scarce, carefully allocated resources.

He regularly evaluates his own calendar the same way. When he realized there were enough experts to handle detailed Epic consolidation work without him, he requested to be removed from a recurring meeting series, freeing an hour a week over the course of a year. That kind of “successful dismount” allows executive time to be redeployed toward higher-impact work without slowing projects.

Shah links these habits directly to burnout. The cumulative effect of unnecessary meetings, long email distributions and inefficient workflows contributes to the sense that clinicians and staff are losing control of their days. He sees ambient documentation as one promising lever, especially when leaders position it as a tool for reducing after-hours charting, improving patient and provider experience, and supporting recruitment and retention. He points to emerging multicenter research with Sutter Health and UChicago Medicine that associates frequent use of ambient tools with gains in patient experience scores.

Rebalancing ROI for AI Investments

Conversations about ambient documentation lead quickly to a broader debate about ROI. Shah observes that different stakeholders value different outcomes: innovation leaders may focus on whether a pilot justified a grant; clinicians may emphasize burnout, quality and experience; and finance leaders look for budget relief. To make sense of this, he frames AI investments in two buckets—financial ...