Generative AI is rapidly finding its way into clinical and operational workflows, often outside formal oversight. These unsanctioned “shadow AI” tools introduce real challenges for governance, trust, and compliance, but they also reveal where innovation is outpacing traditional frameworks. This panel brings together health system leaders and AI experts to explore how organizations can transform hidden adoption into structured enterprise strategy. At the center of this conversation is evidence-driven governance and expert-in-the-loop as non-negotiable principles for AI in care. Panelists will share practical approaches for identifying shadow AI, embedding oversight without slowing progress, and aligning innovation with evidence-based medicine to deliver measurable value across the enterprise.