Most healthcare organizations that run downtime drills come away feeling reasonably good about their preparedness. The workstations came on. Staff accessed the system. The census was visible. The drill ended, the EHR came back online, and the team moved on. The problem is that most downtime drills are designed to demonstrate that the technology works, not to find out what actually breaks when clinical and administrative teams are under real pressure. That is a very different exercise, and it is the one that matters.
A downtime drill that only tests whether the system turns on is not a preparedness exercise. It is a technology check. A drill that actually tests your real gaps requires deliberately introducing the conditions, constraints, and ambiguities that staff will face during an actual event. It requires observing what staff do rather than what they say they would do, and it requires being willing to document findings that are uncomfortable to share because they reveal how much distance exists between the written policy and actual practice.
The Most Common Reasons Downtime Drills Fail to Find Real Gaps
Understanding why typical drills miss the mark is the starting point for designing a better one. The most common failure modes are:
- The drill is announced too far in advance, giving staff time to review procedures they have not looked at in months, which masks the gap in day-to-day familiarity
- Only the staff who are most familiar with the downtime system are involved, rather than a representative cross-section that includes newer hires and agency staff
- The drill focuses on a single workflow, such as accessing the patient census, rather than the full sequence of tasks staff would actually need to complete during a real event
- There is no observer documenting what staff actually do, so the debrief relies on self-report rather than observed behavior
- The drill is conducted on a low-volume shift where the pressure of managing a real patient load alongside downtime procedures is absent
- The post-drill debrief focuses on what went well rather than what revealed genuine uncertainty or inconsistency
Each of these factors produces a drill that confirms the organization’s existing beliefs about its preparedness rather than challenging them. The result is a false sense of readiness that surfaces painfully during an actual event.
Designing a Drill That Finds Real Gaps
A drill designed to surface real gaps looks different from a standard technology check. Key design elements include:
- Give minimal advance notice to the departments being drilled. A same-day notification that the drill will occur at some point during the shift is closer to the reality of an unplanned outage than a two-week advance announcement
- Include staff who joined the organization within the past six months, agency or travel staff working that shift, and any department where turnover has been high, because these are the staff most likely to have gaps in downtime familiarity
- Require staff to complete the full workflow sequence, not just access the system. That means registering a simulated new patient, printing a wristband, completing a relevant form, and documenting the steps as they would during a real event
- Assign observers to watch and document what actually happens rather than relying on staff self-report. What an observer sees during a drill is almost always more revealing than what staff describe in a debrief
- Run the drill during a shift with a real patient volume so that staff experience the actual tension of managing patient care responsibilities alongside downtime procedures
- Include a scenario element that the drill design team knows will expose a specific suspected gap, such as asking staff to access a form that was recently updated in the eForms library or requiring them to register a patient type that the downtime system handles differently
Using Planned Maintenance Windows as Drill Conditions
The most realistic downtime drill conditions available to any healthcare organization are planned EHR maintenance windows. When the EHR is taken offline for a scheduled upgrade or maintenance event, the downtime is real, the patient volume is real, and the pressure to manage both is real. Using these windows as structured drills rather than unobserved operational events produces far more valuable preparedness data than any simulation.
To get the most from a planned maintenance window as a drill:
- Brief department leads in advance that the window will be treated as a formal drill with observers and documentation requirements
- Assign a drill coordinator for each participating department who is responsible for observing staff behavior and documenting findings
- Run the full registration and documentation workflow in dbtech’s downtime system rather than defaulting to paper for any part of the process
- Track the time it takes for each department to activate downtime procedures from the moment the EHR goes offline, because delays in activation are one of the most common gaps that only surface under real conditions
- Document any moment where staff expressed uncertainty, asked where something was, or reached for a paper form rather than using the downtime workstation
Running the Debrief to Capture Actionable Findings
The debrief is where the value of the drill is either realized or lost. A debrief that focuses on reassurance and confirmation produces no useful output. A debrief structured to capture specific, actionable findings produces a gap list that can be directly translated into program improvements. Effective debrief structure includes:
- Start with the observers’ documented findings rather than staff self-report, which establishes the debrief as a fact-based review rather than a satisfaction conversation
- For each gap identified, ask three questions: What did staff actually do? What should they have done? What needs to change to close the gap?
- Assign a specific owner and deadline to each gap identified, rather than noting it as an area for general improvement
- Distinguish between gaps that require technology changes, such as a form that needs to be added to the eForms library or a workstation that needs to be relocated, and gaps that require training or procedure updates
- Review whether the gaps identified were predictable based on known weaknesses in the program, and if so, ask why they had not been addressed before the drill
What Good Drill Documentation Looks Like
The documentation produced by a well-run downtime drill serves multiple purposes. It satisfies the Joint Commission and CMS requirement for evidence of downtime testing. It creates an evidence trail that demonstrates the organization is actively managing its downtime preparedness program. And it provides the baseline data for evaluating whether the gaps identified in one drill have been addressed before the next one.
Good drill documentation includes:
- The date, time, duration, and participating departments
- The drill scenario and any specific workflows that were tested
- Observer notes documenting specific staff behaviors, confusion points, and workflow deviations
- A gap list with specific findings, assigned owners, and remediation deadlines
- Confirmation that gaps from the previous drill have been addressed, or an explanation of why they have not
- Sign-off from the downtime program owner and the relevant department leaders
dbtech’s Downtime Audit Assessment can be used in combination with a drill program to provide an objective third-party evaluation of the gaps the organization’s own drills may be missing. To learn how dbtech supports downtime preparedness testing and program development, visit our Downtime Solutions page or request a demo.