For healthcare leaders, there’s no good time for a cyberattack, but they’re especially aggravating when they hit while you’re on vacation. That’s what happened to Katrina Brown, chief nursing officer of Providence Hospital in Mobile, Alabama, when the EMR system and other software went down while she was in Hawaii.
The Response Strategy: Taking Quick Action
Brown immediately began monitoring the situation remotely. “I was very, very grateful that I had a strong leadership team, because you can’t always be there for every situation.”
Upon her return, Brown expected chaos. Instead, she found a capable staff following pre-established downtime procedures. “We had a really strong policy,” she says. “I don’t think we understood the importance of it until we were right in the middle of that downtime.”
However, the transition wasn’t seamless. Lab reports and radiology scans had to be delivered manually, leading to inefficiencies. The hospital even had to find an off-site transcription company to handle reports. When patient call lights went out, nurses distributed cowbells, which created confusion about which rooms the sound was coming from. “You really don’t understand the inefficiency of a cowbell ringing until you’re right there in the moment,” she says.
Despite these challenges, Brown proudly notes that even after nearly 30 days of downtime, the hospital experienced no serious patient safety issues.
What Worked
Adaptive Staffing and Patient Census Management
With the extra work that paper charting required, the hospital decided to add nurses and reduce the patient census for safety purposes, as well as to minimize the burden on staff. “We didn’t want to pressure our staff in an already stressful environment to work mandatory overtime or additional hours,” says Brown. Some departments, like the ICU, were minimally affected due to already low nurse-to-patient ratios, while others, like med-surg, added another nurse per unit.
She also added an additional nurse on each floor just to assist with paper charting—something most of the younger nurses weren’t familiar with. “We’re very fortunate at Providence Hospital to have a lot of experienced nurses—that really, really worked in our favor.”
Safety-First Organizational Culture
Brown credits hospital leadership for making patient safety a priority during the crisis and standing by the decision to increase staffing levels, despite the costs. “When we’re saying we’re over-staffing and we’re reducing the census, none of that works to your financial benefit,” she points out.
Interestingly, when patients heard about the attack, they stopped coming to the ER, which helped keep the census down. When systems were restored, the hospital made a point of communicating the safety guidelines it had implemented to restore trust and encourage patients to return—which they did.
Empathetic but Firm Leadership
Brown’s leadership style fostered an environment where staff felt comfortable expressing their concerns. Many staff members told her how uncomfortable they were without the digital tools they were accustomed to using. “My answer to them was, ‘Good. I don’t want you to feel comfortable right now,'” she says. Instead, she emphasized using that discomfort as motivation to focus closely on patients and their safety.
Even just acknowledging the staff’s concerns was validating, she notes: “I think they understood, ‘okay, it’s okay for me not to feel comfortable with this situation.'”
Gaps That Complicated Recovery
Failure to Align Digital and Paper Processes
One significant failure Brown acknowledges was not keeping physician order sets updated. These standardized, pre-defined groups of evidence-based medical orders guide the treatment of specific conditions and procedures, helping to streamline care, improve efficiency, and reduce errors.
A year before the attack, Brown and other nursing leaders had discussed maintaining paper order sets with physicians, who decided they wouldn’t be needed. As a result, during the crisis, the need to hand-write every single order created additional inefficiencies and delays—and caused doctors to complain about their hands cramping.
Generational Skills Gap and Technology Dependence
As previously noted, many nurses were unfamiliar with paper charting. But Brown is also concerned that over-reliance on technology is eroding nurses’ critical thinking skills and increasing their fear of making errors without digital safety nets.
Another unexpected complication arose with the handwritten physician orders: younger nurses couldn’t read cursive, having never been taught the skill in school. Brown had to request that physicians print their orders instead.
Three Takeaways for Healthcare Leaders
- Maintain backup systems even when they seem unnecessary. Some processes may seem burdensome, but when an attack hits, they can make a significant difference in efficiency.
- Invest in leadership development across all employee levels. Leaders go on vacation, get sick, or may be otherwise unavailable. Ensuring there’s a pipeline of people with the skills and expertise to step in can help prevent confusion and delays that impact patient safety.
- Consider infrastructure dependencies beyond primary EMR systems. Components like call buttons and transcription services may require creative solutions during extended downtime.
A Holistic Approach to Crisis Response
Brown’s experience shows that while healthcare’s digital transformation has dramatically improved patient safety and operational efficiency, organizations must be prepared to return to analog processes during crisis response. The keys to successful incident management include strong leadership development, comprehensive planning, and a culture that prioritizes patient safety above all else.
Ultimately, healthcare organizations that view cybersecurity as an operational resilience challenge—rather than simply a technology problem—will be best positioned to maintain patient care and safety when digital systems inevitably fail.
To hear Brown’s full discussion, you can watch her Cyber Survivor episode here.
