You Passed the Audit. Are You Ready for the Incident?

The practice passed its audit two months before the incident.

That detail comes up early in every post-incident conversation, usually with a mix of confusion and disbelief. The documentation was solid. The boxes were checked. Everyone felt confident.

And yet, when systems went down, that confidence evaporated in minutes.

Because audits don’t measure how an organization behaves under pressure. They measure how well it prepared for inspection.

Those are not the same thing.

What leadership thought the audit meant

For most SME healthcare leaders, an audit passing signals closure.

HIPAA? Covered.
Security program? Documented.
Risk? Managed.

It’s not an unreasonable assumption. Audits are expensive, time-consuming, and disruptive. When you pass one, it feels like you’ve earned a pause.

But audits validate evidence, not capability.

They confirm that policies exist. That controls are described. That responsibilities are assigned on paper.

They don’t test whether those controls work at 5:47 a.m. when phones are down and patients are already noticing.

What actually happened when things broke

When the incident hit, leadership wasn’t asking about compliance.

They were asking:

• Who’s making the call right now?
• How long will this realistically last?
• What do we tell patients, partners, and staff?
• At what point does this become a business problem, not an IT problem?

None of those questions are on an audit checklist.

The organization wasn’t careless. It wasn’t negligent. It simply hadn’t practiced operating without its systems.

And that gap is where disruption turns into crisis.

Why this hits SMEs harder than large enterprises

Large health systems can absorb confusion. SMEs can’t.

There’s less redundancy. Fewer decision layers. Smaller margins for error. When a system goes down, it’s not an inconvenience—it’s an operational threat.

In that environment, resilience isn’t about perfect security.

It’s about:

• Clarity over who decides what
• Practiced communication paths
• Realistic recovery expectations
• Knowing which operations matter first when everything can’t be restored at once

None of that shows up in an audit report.

Compliance isn’t the problem. Overconfidence is.

This isn’t an argument against audits or compliance. Those are necessary.

The danger is treating compliance as the finish line instead of the baseline.

Cyber-resilient organizations assume something will fail and plan accordingly. They don’t rely on documentation to carry them through a real-world incident.

They rely on rehearsed decisions.

The question every leader should ask

If this happened tomorrow, would your organization be relying on what’s written down—or on what’s been tested?



Because when the incident starts, the audit is already over.