In September 2024, Dr. Mark van Buchem, head of the radiology department at Leiden University Medical Center (LUMC) in the Netherlands, was tasked with presenting at LUMC’s strategic meeting. The focus was on his department’s pioneering efforts in integrating artificial intelligence (AI) into the clinical workflow, a project that had begun in 2018. Over six years, various AI initiatives were launched, many of which had been successfully integrated into the radiology department’s daily operations. At this point, LUMC sought to leverage these successes to develop a comprehensive AI strategy that could scale across the entire hospital. This case explores the challenges and opportunities associated with scaling AI-driven health care transformation in a complex academic and medical setting.