Healthcare’s Incident Response Confidence Problem
A recent survey revealed a striking statistic: only 6% of healthcare cybersecurity leaders feel fully confident in their organization’s security program. For anyone in this industry, while that number stings, it doesn’t surprise.
Confidence in cybersecurity is not a meaningless metric. It reflects whether leaders believe they have the people, processes, and technology in place to detect, contain, and recover from a cyber incident before it costs them data, time, operational downtime, or, at worst, patients.
When many healthcare security leaders lack that confidence, something structural is causing it.
Why Confidence Remains Low
Cybersecurity practitioners are, by nature, skeptical. Paranoia isn’t a character flaw in this field; it’s a professional asset that keeps teams from becoming complacent. Some level of healthy doubt is baked into the culture so we should never expect too high of a high level of confidence from cybersecurity professionals around their incident response.
But the 6% figure points to something beyond healthy skepticism. Healthcare cybersecurity teams face a compounding problem: every new defense they deploy requires manpower to manage, monitor, implement, and refine. As programs grow in complexity, teams spread thinner, and the sense that something important is slipping through the cracks grows louder.
More Tools, Less Confidence
There’s a counterintuitive reality at the center of many healthcare security programs: adding more tools can reduce confidence rather than increase it. More tools means more consoles, more data, and more alerts for an already stretched team.
This is the human part of the confidence problem. Under the label of risk and efficiency, it’s often easier for teams to get budget approval for new tools. It can be much more challenging to get a budget for staff. This then creates an unbalanced department where tool demands outweigh staff availability, and sometimes even the expertise.
Every integration point between these tools also creates a seam, and seams are risk. When platform A doesn’t communicate cleanly with platform B and the team has to manually pass information between systems this slows response time. It also increases workload on the staff, creating the need to prioritize more, which then increases the chance that the wrong thing will be deprioritized and events will fall through the gaps. Coverage like this looks complete on paper but it carries blind spots in practice.
Even with complete integration, the seam where data flows between tools is a new attack surface for threat actors. The more tools in the stack, the more seams, and the larger the organization’s attack surface becomes.
This is the tool rationalization part of the confidence problem. A team identifies a gap, purchases a solution, and moves on. That feels effective, but if a tool is running at 60% coverage, it’s not. Instead, it’s creating a false sense of security while adding to the management burden.
Without proper rationalization and staffing, tool volume doesn’t sharpen visibility. It creates noise, and noise is where threats hide.
Small Changes, Big Blind Spots
It doesn’t take a significant change to make a threat significantly harder to find. I have seen the same threat group, in multiple cases simultaneously, make subtle variations from one engagement to the next. A slightly different technique, a modified payload, a new entry path. Those small changes are often enough to slip past detection that was calibrated for the last iteration of the attack.
There is a seemingly endless amount of small tweaks that attackers can make. The threat landscape is genuinely a game of cat and mouse, and the adversary has time and their singular focus working to their advantage. That’s not a reason for fatalism. It is another factor that makes high confidence in any program difficult to sustain, and a reason for continuous validation of your cyber program.
Building Confidence In Your Program
Organizations that report confidence share one trait: they have prioritized well. They have taken the time to understand what their program actually looks like, validated their controls, mapped their gaps, and built the institutional processes and knowledge that lets them sleep at night.
Tabletop exercises are incredible tools for this because they surface gaps in people, process, and technology in a controlled environment so that gaps can be prioritized before an actual incident forces your hand. In a well-designed tabletop, IT isn’t the only team at the table so it also creates cross-departmental coordination that no audit can replicate.
But preparation doesn’t have to start with a full-scale tabletop. It can start with a working lunch. A CIO asking the team things like, “What keeps you up at night?” and the conversation that follows can do more to build program confidence than most tool deployments. That is, if there’s open communication.
Communication as a Confidence Driver
One of the most underutilized assets in any healthcare cybersecurity program isn’t technology. It’s the conversation between the engineer at the keyboard and the executive in the executive suite. Or, more often, it’s the conversation that isn’t happening.
The technicians and engineers on the front lines know where things are broken. They see the gaps in coverage, the tools that are partially deployed, and the processes that exist on paper but not in practice. The question is whether the culture exists for them to say so.
Effective communication in a security program must be bidirectional. That means inviting the people on the frontlines to speak up and making sure they feel comfortable doing so.
What Leaders Should Do in the Next Six Months
If there is one concrete action to prioritize, it’s this: document your processes in detail, then use that process as a diagnostic.
Bring together your technology owners and ask each to produce a step-by-step playbook for their area of responsibility in the event of an incident. Strive for the kind of documentation a new help desk technician could follow on their first day during an active incident without asking questions, down to the command-line arguments and button presses.
That exercise will reveal two things. First, where documentation is missing, which is itself a gap. Second, capability limitations that may not be visible at the leadership level. When a systems administrator tells you their recovery tool can only handle 500 endpoints in a 10,000-device environment, that is not a complaint. It is the data you need to plan around or to make the case to your board for a better solution. A solution that the team can be more confident in.
Prioritization, Not Perfection
Cybersecurity in healthcare will always carry uncertainty. Threat actors evolve. Teams are stretched. Budgets and technology lag behind risk. But confidence is not the same as certainty.
The gap between the 6% who are confident in their incident response and the rest isn’t technology or even budget. It’s prioritization, communication, and preparation, and all three are within reach.
About T.J. Ramsey
T.J. Ramsey is Senior Director, Threat Operations at Fortified Health Security in Brentwood, Tennessee. He served as a U.S. Army Military Intelligence Analyst for the Department of Defense and held security roles at Obsidian Solutions Group and SAIC/Leidos.
