Health Care Analytics Challenges: A 3-Pillar Framework Connecting Analytics Maturity, Workforce Agility, and Technical Enablement.

Health care organizations face a "triple threat" of low analytics maturity, high workforce instability, and semantic technical barriers that together produce a crisis of "institutional amnesia." Leadership turnover, workforce shortages, and widespread intent to leave among informatics specialists systematically erase the tacit knowledge required to navigate complex clinical data schemas, trapping organizations in a cycle where knowledge loss outpaces knowledge capture. Viewed through the socialization, externalization, combination, and internalization model of knowledge creation by Nonaka, the root cause is a "socialization failure": high turnover fractures the social networks required for mentorship, rendering the traditional apprenticeship model of informatics unsustainable. To address this failure, we used a design science research approach synthesizing evidence from health care informatics, knowledge management, and natural language processing to develop a sociotechnical framework: human-in-the-loop knowledge governance (HITL-KG). HITL-KG is designed to shift the locus of organizational knowledge from volatile human memory to durable semantic artifacts called "validated query triples," each comprising a natural language intent, executable SQL, and rationale metadata. By embedding knowledge capture into the daily query workflow, the framework aims to convert ephemeral analytics into permanent institutional assets. The accompanying 3-pillar assessment rubric enables organizations to identify compounding vulnerabilities across analytics maturity, workforce agility, and technical enablement. The "validator paradox" (who validates the AI when experts leave?) is addressed by reframing validation through lean "standard work": each validated query establishes the current known standard rather than eternal truth, functioning as a "knowledge ratchet" that prevents regression. Decoupling analytical capability from individual tenure lets analytics maturity advance even as the workforce evolves. This paper proposes and theoretically motivates the framework; empirical validation is deferred to a companion study.