Evolving Perceptions and Attitudes to Adopting Generative AI in Professional Settings: Multicenter Longitudinal Qualitative Study of Senior Chinese Hospital Leaders.

Background: The rapid evolution of generative artificial intelligence (GenAI) is transforming health care globally. In China, hospitals are rapidly embracing digital transformation. Senior leaders are pivotal in influencing and deciding the adoption of GenAI technologies in professional settings. However, evidence on their perceptions and attitudes and how they evolve over time is lacking. Objective: This study aims to investigate senior Chinese hospital leaders' perceptions relating to GenAI and their attitudes toward adopting GenAI technologies in professional settings and to document how their perspectives evolve. Methods: A longitudinal, descriptive qualitative study was conducted using a phenomenological approach. Senior leaders, including hospital directors/deputies and department heads/deputies, from 3 tertiary hospitals across the Hebei, Guangdong, and Sichuan provinces were purposively sampled. Data were collected through semistructured telephone interviews at two time points (baseline and 6 months later). Interview transcriptions were analyzed using Colaizzi's method to extract themes related to knowledge acquisition, attitudinal shifts, and evolving barriers and facilitators to GenAI adoption. Results: A total of 32 participants were interviewed in August 2024 and February 2025, including 11 (34.4%) participants from Hebei, 12 (37.5%) from Sichuan, and 9 (28.1%) from Guangdong. Their roles included 8 (25%) hospital directors/deputies and 24 (75%) department heads/deputies. The analysis of the interview transcriptions revealed three primary themes. First, participants' understanding of GenAI improved markedly over time as they engaged with diverse information sources and gained practical experience. Second, despite widespread support for personal use, senior leaders shifted from initial reluctance to formal institutional adoption. Third, initial obstacles, such as limited technical literacy and resource constraint concerns, diminished over time, while new drivers, including peer influence and technological breakthroughs such as DeepSeek, emerged to catalyze adoption. Conclusions: Senior Chinese hospital leaders' perceptions and attitudes toward GenAI have evolved significantly over time. Improved knowledge through diverse information channels has enhanced their comprehension and shifted their stance from cautious personal experimentation toward formal institutional adoption. The dynamic interplay between diminishing obstacles and emerging catalysts, notably the influence of peer practices and technological breakthroughs such as DeepSeek, underscores the potential for transformative change in health care management. Targeted educational initiatives, pilot projects, and robust policy frameworks are needed to facilitate GenAI integration.