Every minute of unplanned IT downtime can risk patient safety, hospital operations, and organizational reputation. Keeping digital infrastructure stable is essential for health systems to prevent service disruptions and guard against cyber threats.
In a recent discussion hosted by Becker’s Healthcare, leaders from Rapid City, S.D.-based Monument Health and Wausau, Wis.-based Aspirus Health shared their organizations’ comprehensive approach to navigating clinical and operational disruptions.
They outlined an operations-first playbook that prioritizes patient safety, speed, and accountability.
Key themes from the discussion are summarized below.
1. Operational ownership builds resilience
Patrick Woodard, MD, CIO at Monument Health, emphasized that IT alone cannot manage downtime planning.
Even experienced IT professionals may not know the intricate workflows specific to departments like nursing, lab, or pharmacy during outages. Realizing this gap, leaders began engaging operational teams directly, asking what they would do during a downtime. These conversations revealed that a one-size-fits-all, IT-led approach doesn’t work when entire organizations are affected. Instead, each department must understand and take responsibility for its own downtime procedures.
“I think there is a much better understanding today of, I own my operations and that means whether our EMR is working or whether it’s not,” Dr. Woodard said. “Giving teams the opportunity to step out of their normal day to day and think about what will I do if the systems are dark, will help them answer the question for themselves.”
This cultural shift highlights the importance of combining a centralized governance model with decentralized accountability, ensuring each service line has clear and practical response plans tailored to specific roles while aligning with enterprise-wide standards.
2. Practice creates redundancy
Both Monument Health and Aspirus Health rely on tabletops to surface workflow vulnerabilities and test assumptions. Aspirus ran five regional tabletop drills, revealing that many team members had never practiced with paper documentation.
“We quickly found out that we needed to go old school and have duplicate and triplicate forms,” Lisa K. Rowe-Peplinski, DNP, RN, vice president of system nursing operations at Aspirus Health said. “Those pieces of paper now needed to march through the system and get processed so that we could deliver care, and a single sheet of paper wasn’t going to cut it.”
Dr. Woodard noted that these tabletops often break well-intentioned but untested plans. To him, the main focus of downtime tabletop exercises is effective internal communication. While external communication with cyber insurance providers, security vendors and EHR partners like Epic or Cerner is critical during actual downtime scenarios, the priority during these exercises is ensuring internal teams know how to collaborate. These exercises help identify how key players will coordinate, whether remotely or on-site during prolonged events.
“At the end of the day, there are patients that are sitting there waiting to be cared for,” Dr. Woodard said. “An IT vendor is critical to getting things back up and running, but the real focus of the tabletop or an actual downtime event is how do we continue operations? Make sure that you have the people who are actually doing the work.”
3. Training matters
The shift away from paper has created a generation gap in downtime readiness. Dr. Rowe-Peplinski said her teams found that newer clinicians often lacked basic analog skills such as chart checking or paper order documentation.
Aspirus is addressing this with job aids, annual competencies, and incorporating downtime workflows into clinical orientation.
“My preceptor does electronic documentation while I do paper documentation and I get to test those skills,” Dr. Rowe-Peplinski said. “Then we might flip that. So my preceptor gets to do some paper documentation while I do the electronic documentation, keeping everyone up to speed with their downtime skills.”
These training exercises not only build confidence but also allow health systems to monitor staff readiness through regular evaluations, closing skill gaps before they become risks.
4. Why collaboration beats isolated planning
Effective internal communication was a recurring theme. During downtime, standard digital channels often fail. Both health systems are exploring emergency communication platforms that function off-network, ensuring continuity regardless of the disruption type.
“You can have a backup plan, but if you haven’t communicated with some of the technical folks, perhaps that backup plan is not viable,” Dr. Woodard said. “You can have backup plans that you create in a silo all day, but in the absence of a partnership, it may not be as reliable as you think.”
Ideally, technical savvy combined with communication will help organizations weather the storm and bounce back quickly. Both leaders stressed the importance of department-specific recovery plans, agility among teams, and confidence in trained responses.
“Over half, about 55% of our gaps really lived in the operational space and not in the IT space,” Dr. Rowe-Peplinski said. “It really is thinking about how we are going to do our work differently during this time and really thinking about our workflows.”
Strong communication, clear recovery plans, and team readiness help organizations respond and recover when systems go down.
5. In Conclusion
When systems fail, recovery depends on more than just IT. It requires coordinated, organization-wide readiness. Monument Health and Aspirus Health show that operational resilience is built by equipping departments with role-specific plans, conducting realistic practice exercises, and strengthening internal collaboration. By combining centralized governance with clear accountability across teams, they ensure that every part of the organization knows how to respond. Their approach serves as a practical guide for health systems working to safeguard patient care and maintain stability during prolonged disruptions.
