Cyberattacks. Extreme weather events. Pandemics. Threats to health system operations seem to be increasing in frequency and severity, prompting leaders to raise emergency preparedness to a higher level.
At Hartford Healthcare, Chief Clinical Officer Ajay Kumar, MD, is responsible for making sure the seven-hospital system is ready for anything.
“I consider emergency preparedness, business continuity, and incident management to be a part of quality,” he says. “If we don’t do these right, we are not going to be able to provide high-quality care to the patients, access to patients, and support to the patients.”
Evidence from recent catastrophes supports him. The Change Healthcare cyberattack, which reverberated across thousands of hospitals, didn’t just disrupt cash flow. In the midst of the calamity, about 1,000 hospitals responded to an American Hospital Association survey about its impact, and 74% of respondents said direct patient care had been affected.(1)
When the COVID-19 pandemic threw standard hospital practices sideways, the disruption took a heavy toll. A survey of hospital leaders in late 2020 and early 2021, as reported in the Journal of General Internal Medicine, found that about half of respondents believed non-COVID inpatients received worse quality or outcomes during peak COVID surges than they would have otherwise; nearly two-thirds said outpatient non-COVID patients received worse quality or outcomes than normal.(2)
Hurricane Helene devastated western North Carolina in 2024, and hospitals were not spared. One nurse, speaking to Healthcare Dive several days after the hurricane hit, said some procedures at her hospital were delayed by a lack of clean, sterile equipment. Another nurse said patients waiting for open-heart surgery were delayed because there was no running water.(3)
Jeffrey Flaks, Hartford Healthcare’s president and CEO, said the $7 billion system, delivering care through more than 500 sites, has had emergency preparedness efforts for certain situations for many years. But the approach Kumar leads is entirely different.
“This is really overarching and it looks at much more global-type issues,” he says.
The project includes response and recovery strategies for information technology (IT) disasters/cyber incidents; emergency response to save lives and protect assets; a crisis management framework to guide leaders during an event; crisis communications plans; and business continuity support to ensure patient care does not suffer during a disruptive event.
“These things are imaginable, and the time to think about them isn’t after an event occurs, but in advance,” Flaks says. “We have resourced this because, to me, it goes into the category of being able to sleep at night.”
Kumar spoke with PLJ about the health system’s business continuity project.
Q: How does business continuity fit into your job as chief clinical officer?
In my role as chief clinical officer, business continuity isn’t just an operational concern, it’s [also] a clinical imperative. My focus is on ensuring our patients continue to receive safe and effective care, no matter the disruption.
My team, ranging from quality and safety to pharmacy to academic affairs to our patient transfer center, and more, is responsible for much of this work to ensure that clinical services are prioritized, our teams are trained, and our protocols are ready to activate at a moment’s notice.
Ultimately, this work is about building a system that is resilient under pressure because patient trust depends on our ability to deliver, even in the most challenging circumstances.
Q: How did business continuity come to your plate?
I’ve always had a strong interest in how operations function across the system. As a hospitalist, I quickly learned how critical it is, especially on the acute-care side, to manage throughput and respond to volume surges effectively. Early in my career, I found myself deeply involved in those kinds of operational challenges.
During the COVID-19 pandemic, our CEO served as the incident commander, and I played a key leadership role in managing clinical operations, capacity, and elements of the supply chain across the system. That experience really opened the door for me to step into broader crisis management roles.
I’ve also always paid close attention to how health systems around the country respond during major crises — what happened in North Carolina during the hurricane, or in Hawaii during the fires on New Year’s Eve. I kept asking myself: If that were us, would we be ready?
That curiosity evolved into a focused interest in business continuity. With my CEO’s support, I was assigned to lead the development of a systemwide continuity plan, grounded in clinical realities and operational readiness.
Q. How does your business continuity approach compare with standard emergency preparedness common in health systems?
Most health systems have some form of emergency preparedness, usually centered around an incident command structure that activates during specific events. While that’s essential, business continuity goes beyond that.
What we’ve built at Hartford HealthCare takes a broader, more integrated view. It’s not just about clinical operations, it’s [also] about ensuring every segment of the organization can function during a crisis: IT, revenue cycle, human resources, supply chain, transportation, communications, all of it. Our approach focuses on continuity across the board, so we are not just reacting to an emergency, we are proactively preserving operations and services in a coordinated, sustainable way.
Q. How are you developing a business continuity plan?
We are taking a comprehensive, ground-up approach by assessing every single business unit across the system: clinical, non-clinical, support services, ancillary services, and more. We are meeting with senior leaders in each area to understand their current state of preparedness, identify gaps, and guide them in building escalation plans for various types of disruptions. That includes scenarios like natural disasters, cyberattacks, communication failures, and even active-shooter situations.
Each unit must be able to answer key questions: How long can they sustain operations during a disruption? What does their downtime procedure look like? At what point do they escalate to system leadership? We are designating individuals in each unit who understand the full scope of their business operations and who are empowered to manage through disruption.
We are also evaluating the structural design of each area in terms of how well their operations can adapt and the competency and readiness of the teams involved. Drills and scenario-based exercises help us assess escalation pathways, communication protocols, and overall sustainability.
The goal is to embed a readiness mindset so that when a systemwide crisis occurs, each unit knows how to respond effectively, allowing leadership to focus on coordinating the bigger picture.
Ultimately, it comes down to this: Are we prepared to sustain our mission of delivering high-quality, patient-centered care, no matter what comes our way?
Q. What is the status of this work?
We are a little more than halfway through the assessment phase. The goal is not just to complete the initial evaluation, but [also] to build a cycle of periodic assessments and drills that keep us prepared over time.
The environment we operate in now provides no shortage of real-world scenarios to test our readiness, and these events act as natural drills, constantly challenging us and revealing where we need to refine our processes.
The work continues to evolve, and the plan will keep maturing because the pressure to stay ready is already built into the system we are living in.
Q: What did you learn about Hartford Healthcare’s preparedness during COVID?
COVID was an incredibly challenging time, but we also saw the strength of our system come through. We had a great incident command structure across the system, and we quickly built multiple teams to address emerging problems. That agility allowed us to respond to community needs with speed and clarity.
One example I’m particularly proud of is the call center we launched just 24 hours after the idea was proposed. We quickly had staff in place answering thousands of calls from anxious individuals, not just from Connecticut but from across the country. At one point, we were handling up to 8,000 calls a day.
We also led the way in mobile testing and vaccine deployment, being the first in the state to do both. We asked ourselves: What does the community need, and how can we provide a pathway that others can follow? That mindset of speed, focus, agility, and discipline became core strengths for us, and that is what we are carrying forward into our business continuity planning. COVID reinforced that these strengths are not optional but foundational.
Q. How are your colleagues being trained?
We rely heavily on scenario-based learning to prepare our leaders and teams. For example, imagine a situation where the revenue cycle department, with its 1,000 employees and several layers of leadership, is hit with three simultaneous disruptions: a network outage affecting staff productivity, a heat issue at one office location, and a violent threat at another.
On their own, each event is manageable. But if the leaders do not respond quickly and effectively, those issues can compound and ripple across the entire system, including clinical operations.
In our training, we simulate scenarios like this and focus on decision-making, communication, and command structure. Leaders learn how to triage and direct their teams, communicate clearly through established channels, and request support from other parts of the organization. They also learn to reprioritize on the fly, recognizing that resources like IT or facilities support may be stretched across multiple emergencies.
A key skill we emphasize is knowing when and how to escalate. If every department treats its own crisis as the top priority, the system can become overwhelmed. Part of the training is understanding how to evaluate the severity of the issue, follow the chain of command, and escalate to the system incident commander when broader coordination is needed. It’s not just about reacting; it’s about responding with discipline, agility, and clarity.
Q. How does a clinical leader engage non-clinical staff members to work on this?
Our focus is on minimizing downtime, reducing financial losses, and ensuring regulatory compliance, but above all, we are committed to delivering high-quality care.
When we discuss business continuity, we always start with the fundamental question: “If we don’t get this right, what’s at stake for our patients?” That shared purpose quickly brings everyone onto the same page.
Regardless of their role, colleagues recognize that patient care is the core of everything we do. This common ground fosters strong collaboration and meaningful conversations across departments, making it easier to engage non-clinical staff in these critical efforts.
Q. What advice can you share with chief medical officers who are concerned about business continuity?
The most critical foundation for successful business continuity is aligned leadership. Without a genuine, committed partnership across the executive team, especially between the CMO, COO, and CEO, it’s nearly impossible to navigate the complexity involved.
Understanding that business continuity touches every part of the organization and requires sustained focus is essential before any meaningful progress can be made. At Hartford HealthCare, we are fortunate to have a CEO deeply dedicated to quality, safety, and community around the clock. That kind of leadership commitment creates the momentum and resources necessary to build resilience and truly prepare for any situation.
References
American Hospital Association. AHA Survey: Change Healthcare Cyberattack Having Significant Disruptions on Patient Care, Hospitals’ Finances. AHA News. March 15, 2024. https://www.aha.org/news/news/2024-03-15-aha-survey-change-healthcare-cyberattack-having-significant-disruptions-patient-care-hospitals-finances .
Huggins A, Husaini M, Wang F, Waken RJ, Epstein AM, Gray EJ, Maddox KEJ. Care Disruption During COVID-19: A National Survey of Hospital Leaders. J Gen Intern Med. 2023; 38(5): 232–1238. https://doi.org/10.1007/s11606-022-08002-5 .
Vogel S. HCA’s Mission Hospital in North Carolina Still Without Running Water Days After Hurricane Helene Hits. Healthcare Dive, Oct. 2, 2024.https://www.healthcaredive.com/news/hca-mission-hurricane-helene-recovery-north-carolina/728653/ .