Stop Telling Community Hospitals That They're Doomed to Fall Behind

By: Aaron Neinstein, MD, Chief Medical Officer @ Notable and Jae Zayed, Vice President, Chief Digital & Information Officer @ Southwest General

Almost every panel I've been on about AI the last few years (ok, I guess that's every panel), an inevitable question that comes up is, "What about the smaller hospitals? Aren't they going to fall even further behind with AI?" The moderator gets serious. The audience nods. And the implication is clear - the well-resourced hospitals will inevitably pull away, adding more and more AI capabilities, while community hospitals, rural hospitals, and FQHCs fall deeply behind.

I've heard it at ViVE. At HIMSS. At Becker's. Name an event. It has come up. People keep saying it, and act like it's a foregone conclusion.

I think it's wrong. And rather than argue the point myself, I'm going to let someone prove it.

Southwest General Hospital is a 350-bed community hospital in Middleburg Heights, Ohio. Jae Zayed is their VP, CDIO. I asked him to tell this story himself, because he's living it.

Jae

When people hear "350-bed community hospital," they have a picture in their head.

It doesn't include 50 AI workflows running in production with another 50 targeted on the roadmap. 

But that's where we are.

We cut radiology authorization processing time by 80%. We launched AI-powered pre-registration with 96% patient satisfaction and a 2.2% opt-out rate — below industry benchmark. We've given back over 13,000 hours to registration staff and operations. Our clinical documentation agents cut physician documentation time by 20%. 

We're using AI voice agents to schedule radiology appointments. We're deploying post-ED discharge follow-up calls. We're launching orders and coding agents inside our EHR this month. We built HOPE — our branded AI assistant — and she has her own TikTok.

When we present to our Board, we are able to show them a continuous AI-powered patient journey from pre-registration through post-discharge. Staff are telling me "oh wow, that was so easy." People who were skeptical six months ago are asking what we can automate next. We are reaching out to close care gaps at a higher scale than ever before. 

What makes this possible? We don't have mountains of red tape. We have strong partnerships. There's a need, leadership makes a decision, we move.

We're not falling behind. We're knocking at the door — pushing the big boys.

The freedom of constraints

Aaron

David Epstein's new book Inside the Box makes the case that constraints actually drive increased creativity and better results. Limits force you to clarify your priorities ruthlessly and experiment in productive ways. As Epstein puts it, total freedom can be paralyzing, and unlimited resources don't necessarily lead to the biggest breakthroughs.

I keep thinking about that in the context of what Jae is doing at Southwest General.

Southwest General doesn't have an innovation lab, nor a 40-person data science team. They don't have 18 months to build a governance framework before deploying anything. And those constraints - the ones everyone assumes are disadvantages - are exactly why they're moving faster than health systems ten times their size.

Because Southwest General knows their mission, they know what their business needs, they know what their community needs. When you have clear pains - prior auth taking days, registration burning thousands of hours, patients missing follow-up appointments - you don't need a team of management consultants to create an AI strategy. You just need to solve your problems.

What I wish more people realized

The barrier to adopting AI is neither budget, nor headcount, nor hospital size. It's strategic clarity.

If you know where you're going and you know what's important to your patients and your staff, the tools exist, and AI will do what you need it to do.

The failure mode is treating AI as a separate thing. Standing up AI committees, running AI initiatives and then going looking for problems it can solve. Ironically, it's the well-resourced organizations that are most likely to fall into that trap, because they can afford to.

Community hospitals can't afford to waste time on AI for AI's sake. They have specific problems, specific constraints, specific patients who need specific things. So they skip the deliberation and just start building.

What the narrative actually does

The digital divide talking point is inaccurate, but it bothers me more because it's harmful.

When we keep telling community hospitals and FQHCs that they're doomed to fall behind, we reinforce this idea again and again, and give them permission to believe it.

Jae told me something - there's a sense of pride forming at Southwest General - among the board, the staff, the community - about how they're personalizing care for their patients. As he put it: "You're not going to miss your appointments. You're going to be notified. We're listening. We're knocking at the door. We're pulling you back in."

That's a system that knows exactly who it serves and what they need. That's a system that knows where it's going.

Flip the question

So next time you're on a panel and someone asks, "How will small hospitals keep up?" - flip it.

What can large systems learn from community hospitals moving faster than they are?

The divide isn't between big and small hospitals. It's between those who know what they're building for and the ones still talking about AI.