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Freshwater systems are under increasing global stress, yet healthcare sustainability strategies rarely address water governance. This article examines water as a planetary boundary risk and explores how healthcare supply chains and infrastructure depend on stable freshwater systems.
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Artificial intelligence is often presented as a transformative solution. In practice, AI frequently acts as a stress test for organisational systems. When deployed in complex environments such as healthcare, AI exposes weaknesses in data integrity, workflows, governance, and system readiness.
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Small plastic items such as soy sauce containers expose a structural weakness in waste systems. This paper examines targeted bans as upstream governance controls that eliminate predictable failure points and restore alignment between product design and environmental system capacity.
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Healthcare increasingly adopts recycled-content materials in the name of sustainability. But recycled inputs do not guarantee circular outcomes. Clinical safety, contamination risks, regulation, and waste pathways often reshape the lifecycle reality.
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Digital modernisation is often treated as an operational upgrade. In reality, it transforms how organisational risk behaves. This paper examines why boards of traditionally structured organisations now inherit technology-grade exposure across cybersecurity, data, vendors, and AI.
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Mentoring is often framed as goodwill, yet it functions more like infrastructure. When designed well, it strengthens judgement and learning. When left to intention alone, it can narrow thinking, create dependence, and quietly amplify organisational risk.
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Net zero is often framed as an endpoint. In reality, residual emissions, harms, and uncertainties persist. ISI introduces the Residual Risk Budget — a systems integrity lens that makes remaining exposure visible, owned, and governable across boards, regulators, and institutions.
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Governance failures rarely stem from illegality. More often, they arise from lawful, compliant decisions that prove strategically or ethically unsound. This ISI paper explores why boards must move beyond “Can we?” and institutionalise the discipline of asking “Should we?”.
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Healthcare AI, sustainability, and net zero are not technical challenges with tidy solutions. They are wicked problems—complex, evolving, and resistant to linear control. This paper sets out an integrity-based governance architecture for holding risk, accountability, and adaptation under pressure.
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AI governance does not fail at approval. It fails when drift, workload, and accountability pressures appear after deployment. This paper outlines a practical integrity architecture for governing AI in real clinical systems.
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Dr Alwin Tan, MBBS, FRACS, EMBA (University of Melbourne), AI in Healthcare (Harvard Medical School) Senior Surgeon | Governance Leader | HealthTech Co-founder |Harvard Medical School — AI in Healthcare | Australian Institute of Company Directors — GAICD candidate University of Oxford — Sustainable Enterprise Institute for Systems Integrity (ISI) Abstract Healthcare AI governance has entered
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This paper examines why systems resist change under pressure and how structurally protected variables shape governance behaviour and outcomes.