A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland
Abstract Background In May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstateme...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-10076-8 |
| _version_ | 1797577238754885632 |
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| author | Gemma Moore Zuneera Khurshid Thérèse McDonnell Lisa Rogers Orla Healy |
| author_facet | Gemma Moore Zuneera Khurshid Thérèse McDonnell Lisa Rogers Orla Healy |
| author_sort | Gemma Moore |
| collection | DOAJ |
| description | Abstract Background In May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems, and the risk mitigation measures introduced to safely continue health services. The resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care is explored. Methods To gain an in-depth understanding of staff experiences of the cyber-attack, eight focus groups (n = 36) were conducted. Participants from a diverse range of health services were recruited, including staff from radiology, pathology/laboratories, radiotherapy, maternity, primary care dental services, health and wellbeing, COVID testing, older person’s care, and disability services. Thematic Analysis was applied to the data to identify key themes. Results The impact of the cyber-attack varied across services depending on the type of care being offered, the reliance on IT systems, and the extent of local IT support. Staff stepped-up to the challenges and quickly developed and implemented innovative solutions, exhibiting great resilience, teamwork and adaptability, with a sharp focus on ensuring patient safety. The cyber-attack resulted in a flattening of the healthcare hierarchy, with shared decision-making at local levels leading to an empowered frontline workforce. However, participants in this study felt the stress placed on staff by the attack was more severe than the cumulative effect of the COVID-19 pandemic. Conclusions Limited contingencies within the health system IT infrastructure - what we call a lack of system resilience - was compensated for by a resilient workforce. Within the context of the prevailing COVID-19 pandemic, this was an enormous burden on a dedicated workforce. The adverse impact of this attack may have long-term and far-reaching consequences for staff wellbeing. Design and investment in a resilient health system must be prioritised. |
| first_indexed | 2024-03-10T22:05:24Z |
| format | Article |
| id | doaj.art-626df5fd05cc470db10b1213a8160561 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-10T22:05:24Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-626df5fd05cc470db10b1213a81605612023-11-19T12:48:29ZengBMCBMC Health Services Research1472-69632023-10-012311910.1186/s12913-023-10076-8A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in IrelandGemma Moore0Zuneera Khurshid1Thérèse McDonnell2Lisa Rogers3Orla Healy4Health Service Executive, National Quality and Patient Safety DirectorateUCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College DublinUCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College DublinUCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College DublinHealth Service Executive, National Quality and Patient Safety DirectorateAbstract Background In May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems, and the risk mitigation measures introduced to safely continue health services. The resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care is explored. Methods To gain an in-depth understanding of staff experiences of the cyber-attack, eight focus groups (n = 36) were conducted. Participants from a diverse range of health services were recruited, including staff from radiology, pathology/laboratories, radiotherapy, maternity, primary care dental services, health and wellbeing, COVID testing, older person’s care, and disability services. Thematic Analysis was applied to the data to identify key themes. Results The impact of the cyber-attack varied across services depending on the type of care being offered, the reliance on IT systems, and the extent of local IT support. Staff stepped-up to the challenges and quickly developed and implemented innovative solutions, exhibiting great resilience, teamwork and adaptability, with a sharp focus on ensuring patient safety. The cyber-attack resulted in a flattening of the healthcare hierarchy, with shared decision-making at local levels leading to an empowered frontline workforce. However, participants in this study felt the stress placed on staff by the attack was more severe than the cumulative effect of the COVID-19 pandemic. Conclusions Limited contingencies within the health system IT infrastructure - what we call a lack of system resilience - was compensated for by a resilient workforce. Within the context of the prevailing COVID-19 pandemic, this was an enormous burden on a dedicated workforce. The adverse impact of this attack may have long-term and far-reaching consequences for staff wellbeing. Design and investment in a resilient health system must be prioritised.https://doi.org/10.1186/s12913-023-10076-8ResilienceHealth systemsHealth service staffCyber-attackPatient safety |
| spellingShingle | Gemma Moore Zuneera Khurshid Thérèse McDonnell Lisa Rogers Orla Healy A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland BMC Health Services Research Resilience Health systems Health service staff Cyber-attack Patient safety |
| title | A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland |
| title_full | A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland |
| title_fullStr | A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland |
| title_full_unstemmed | A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland |
| title_short | A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland |
| title_sort | resilient workforce patient safety and the workforce response to a cyber attack on the ict systems of the national health service in ireland |
| topic | Resilience Health systems Health service staff Cyber-attack Patient safety |
| url | https://doi.org/10.1186/s12913-023-10076-8 |
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