Organizational Readiness for Generative AI Integration in Healthcare Operations: Comparative Management Capabilities Between the U.S. and Low- and Middle-Income Countries

The rapid evolution of generative artificial intelligence (GenAI) is reshaping healthcare operations by expanding capabilities in clinical documentation, predictive analytics, workflow automation, and strategic planning. However, the successful integration of these technologies depends not solely on technological advancement but on the degree of organizational readiness and managerial sophistication within healthcare institutions. This study critically explores the preparedness required to embed GenAI into healthcare systems, adopting a comparative lens that examines structural and managerial differences between the United States and Low- and Middle-Income Countries (LMICs). It conceptualizes readiness as a multidimensional construct shaped by governance structures, financial resilience, digital infrastructure, workforce capability, and ethical oversight. Using a structured analytical review methodology, the study synthesizes interdisciplinary scholarship spanning digital transformation, cybersecurity governance, infrastructure modernization, financial modelling, and global health policy. A comparative framework is developed to assess institutional readiness across dimensions including strategic leadership, interoperability, cloud-native integration, compliance maturity, sustainability alignment, and human capital development. The analysis identifies clear asymmetries in readiness levels. Healthcare institutions in the United States benefit from advanced digital ecosystems, predictive analytics infrastructures, and established regulatory mechanisms that support scalable GenAI deployment. In contrast, LMIC health systems often encounter fiscal and infrastructural constraints, yet demonstrate adaptive strengths through modular innovation strategies, cost-conscious governance models, and emerging digital reform initiatives. Across both contexts, robust data governance, ethical accountability, cybersecurity preparedness, and inclusive stakeholder engagement are essential for sustainable integration. The study concludes that institutional coherence and governance maturity are decisive determinants of GenAI readiness. It recommends standardized readiness assessment tools, targeted investment in digital and workforce infrastructure, strengthened cybersecurity frameworks, and collaborative regulatory harmonization to promote equitable and responsible implementation worldwide.