The First Hour: Critical Steps for Healthcare Leaders When Systems Fail

When healthcare systems fail, the clock starts ticking. Whether caused by a ransomware attack, network outage, or internal system crash, the first 60 minutes of an IT disruption are the most critical for patient safety, operational stability, and staff coordination.

How a hospital responds in that first hour can determine the difference between a well-managed downtime and a full-blown crisis.

Yet many healthcare leaders feel unsure of what to do in those pivotal early moments. Who should be notified? What systems need to be secured? How do you keep clinical operations moving when communication, documentation, and ordering platforms go dark? This article outlines the key leadership actions to take in the first hour of an IT failure—actions that can contain the disruption, support clinical teams, and preserve trust across the organization.

Why the First Hour Is So Critical

In the early phase of an outage, uncertainty is high and information is scarce. Staff are looking for direction. Systems may be partially functional or entirely inaccessible. And while IT teams begin root cause analysis, clinical operations can’t wait.

Without immediate, coordinated leadership, the result is predictable:

• Confusion about documentation and workflow expectations

• Delays in patient care

• Increased safety risks

• Poor communication between departments

• Frustration among frontline staff

By acting decisively in the first hour, leaders can stabilize the situation, maintain patient flow, and reduce the impact of the outage.

What Healthcare Leaders Must Do in the First Hour of a System Failure

1. Activate the Downtime Response Plan Immediately

Don’t wait to confirm the root cause—move quickly.

• Initiate the facility’s IT downtime protocol.

• Notify clinical leaders, IT command, and emergency management teams.

• Assign clear roles and responsibilities

  
  

Early activation gives departments permission to shift to manual workflows without hesitation.

2. Initiate Hospital-Wide Communication and Containment

Clear, organization-wide messaging is essential—even if details are still emerging.

• Announce the outage and confirm the shift to downtime workflows using alternative communication channels if primary is down.

• Provide guidance on documentation, ordering, and communication expectations.

• Instruct staff to move to downtime records, logs, or manual entries based on which systems are down.

• Ensure that executive leadership is briefed with accurate, time-stamped updates.

  
  

Transparency reduces confusion and keeps everyone aligned in the absence of digital systems.

3. Support the Clinical Front Lines

Ensure that frontline teams are supported with:

• Downtime toolkits and paper forms with clear instructions

• Backup medication and allergy lists, preference cards

• Verbal handoff guidance and task delegation protocols

• Runner systems or radios for communication

  
  

Assign clinical leads in each unit to monitor safety risks and report upward.

4. Begin Coordinated Decision-Making for Patient Management

Work with operations and clinical teams to:

• Decide whether elective surgeries or admissions need to pause.

• Communicate clearly with downstream departments, outpatient clinics, or transfer partners.

• Inventory affected devices and systems in the OR, ED, and ICU

• Switch to alternative workflows for vital monitors, ventilators, and medication pumps if network dependent

  
  

Protecting continuity means anticipating where bottlenecks will emerge—and responding before they escalate. If key services are affected, prepare to triage and reprioritize procedures.

Leadership in the First Hour: A Mindset Shift

Effective first-hour response is not just about following a checklist—it’s about leading with calm coordination and clinical focus in the midst of uncertainty.

The first hour sets the tone for the entire event—and can dramatically reduce the long-term impact. The best first-hour response is one that has been rehearsed, documented, and internalized long before a real outage occurs. Leadership teams should regularly review downtime protocols, run live scenarios, and assess where decision-making bottlenecks exist.

Because when digital systems fail, hospitals don’t have time to figure it out—they need to act.

Is Your Leadership Team Ready for the First Hour?

At Stone Risk Consulting, we help hospitals design real-time response playbooks for IT outages that empower leadership to act decisively in the most critical moments. Contact us to assess your leadership readiness and strengthen your first-hour response strategy.