Healthcare Implementation Crisis
2025-12-04
Scenario: Healthcare Implementation Crisis Difficulty: ⭐⭐ Tier 1 (Beginner) - Perfect for new teams Time: 75-140 minutes
Essential Prep (5 min):
This scenario teaches: Social engineering during deadline pressure, behavioral analysis, stakeholder management, balancing security with business needs
Key facilitation: Let business pressure create real tension. No perfect solution exists - team must choose trade-offs.
It’s Friday afternoon at MedTech Solutions, and the mood should be celebratory—your biggest implementation ever goes live Monday morning at Riverside General Hospital. This $2M annual contract represents years of business development and will showcase your electronic medical records platform to the entire regional healthcare market.
But instead of champagne, there’s growing concern. Multiple staff members are reporting computer slowdowns, and the help desk has received several calls about unexpected pop-ups. Yesterday evening, during the final push to meet Monday’s deadline, several IT staff received what appeared to be critical security updates from trusted software vendors.
With everything riding on Monday’s go-live, you need to investigate what’s happening—without derailing the most important implementation in company history.
Type: Healthcare technology consulting and implementation Size: 200 employees across 4 offices Implementation Team: 25 staff working on Riverside General
Key Assets:
Contract Value: $2M annual recurring revenue Strategic Importance: Reference case for regional healthcare market expansion Executive Involvement: CEO personally invested in hospital leadership relationship Regulatory Environment: HIPAA, SOC 2, healthcare vendor security requirements
Timeline: Monday 8am go-live (72 hours away)
What you’re seeing Friday afternoon:
Performance Issues: Computers running 30% slower since yesterday afternoon during final implementation push
Help Desk Reports: 5 calls about unexpected pop-ups appearing on workstations
Staff Mentions: IT team received “urgent security update” emails Thursday evening from apparent software vendors
Application Slowdowns: Some applications taking longer to start than usual, affecting implementation timeline
Connection Issues: One workstation exhibiting intermittent connection issues to hospital’s test environment
The Question: Is this just implementation stress on the systems, or something more serious?
IT Director, MedTech Solutions
Public Role: IT Director responsible for infrastructure and implementation project technical success
Demeanor: Extremely competent but currently stressed, detail-oriented under normal circumstances but cutting corners under deadline pressure
What She Says: “We need to figure out what’s going on without derailing Monday’s go-live. This contract is everything.”
Head Nurse, Riverside General
Public Role: Head Nurse representing clinical staff perspective and operational readiness
Demeanor: Patient-focused, practical, frustrated with technical delays, direct communicator
What He Says: “Our nursing staff completed EMR training last week. They’re prepared for Monday. Any delay means rescheduling training for 200 nurses.”
Chief Information Officer, Riverside General
Public Role: Hospital CIO, client decision-maker with contract authority
Demeanor: Business-focused, impatient, expects professionalism, references contract terms
What He Says: “I need confirmation by end of day Friday: Is Monday’s go-live happening or not? The hospital board is expecting an announcement.”
Chief Operating Officer, MedTech Solutions
Public Role: COO responsible for operational excellence and client satisfaction
Demeanor: Results-oriented, impatient with excuses, focused on metrics and outcomes
What She Says: “Quarterly earnings call is next week. I need a positive announcement about this major contract success.”
IM Only - NPC Secrets & Pressure Points
Hidden Agenda: Wants to solve security incident without delaying Monday go-live or jeopardizing client relationship. Needs to protect team from blame while acknowledging mistakes were made.
What She Knows (But Won’t Volunteer):
Pressure Point: Her career advancement depends on successful go-live. Fears being held responsible for security incident.
IM Portrayal: Speak quickly when anxious. Initially defensive about decisions but becomes collaborative when treated as partner rather than blamed. Will admit mistakes if team creates safe space.
Hidden Agenda: Needs Monday go-live to proceed on schedule for patient care continuity. Concerned about staff training timing. Wants assurance systems will work reliably.
What He Knows:
Pressure Point: Any delay requires rescheduling training and affects patient care continuity. Doesn’t understand IT security concerns but focuses relentlessly on patient impact.
IM Portrayal: Ask “how does this affect patient care?” frequently. Express frustration with technical jargon. Respond positively to explanations that prioritize patient safety.
Hidden Agenda: Demands go-live proceeds on schedule or wants to know about contract penalty compensation. Concerned about hospital reputation and operational continuity.
What He Knows:
Pressure Point: Hospital board expects Monday go-live announcement. Has alternative vendors ready if MedTech fails. Represents make-or-break contract decision.
IM Portrayal: Call hourly for updates using formal business language. Reference contract terms and penalty clauses. Soften if team demonstrates competence and transparency. Email with legal team CC’d escalates pressure.
Hidden Agenda: Protect company reputation, ensure client retention, minimize revenue impact. Company financial dependence on this contract.
What She Knows:
Pressure Point: Quarterly earnings announcement, company reputation in healthcare market, operational metrics.
IM Portrayal: Demand action plans with timelines. Focus on business impact metrics. Initially resistant to anything delaying go-live. One-line emails: “Decision needed within 1 hour.”
IM Only - What’s Really Happening
Thursday Evening (6pm-8pm): During overtime implementation work session
Friday Morning (Discovery):
Friday Afternoon (Critical Timeline):
Technical Risk:
Business Risk:
Root Cause:
IM Only - Session State Tracking
Email Analysis: Identified phishing emails with spoofed security vendor domains
File System: Found suspicious executables in %TEMP% directories with legitimate-sounding names
Process Analysis: Detected process injection into svchost.exe and explorer.exe
Network Monitoring: Identified C2 communication patterns and suspicious geolocations
Malmon Identification: Confirmed GaboonGrabber (Trojan/Stealth) through behavioral patterns
Hospital Exposure: Discovered 3 infected machines had VPN to hospital test environment
Timeline Critical: Identified approaching 24-hour threshold for Multi-Payload Deployment
Cultural Factors: Uncovered organizational culture of bypassing security during deadlines
Secondary Payloads: Detected staging of Snake Keylogger, AgentTesla, Redline
Track team decisions, NPC interactions, creative solutions…
IM Only - Combat & Response Guide
Type Strengths - What Makes This Threat Dangerous:
Type Weaknesses - Most Effective Approaches:
SUPER EFFECTIVE (+3 bonus):
MODERATELY EFFECTIVE (+1 bonus):
WEAK/INEFFECTIVE (-2 penalty):
IM Only - Facilitation Guide
“It’s Friday afternoon at MedTech Solutions. The implementation team has been working nonstop for weeks, and the Riverside General Hospital EMR go-live is just 72 hours away. The energy should be celebratory—this $2M contract represents the biggest success in company history. But instead, there’s tension in the air.
Sarah Chen, the IT Director, has just called an emergency meeting. Multiple team members are reporting computer issues: slowdowns, unexpected pop-ups, applications taking longer to start. Yesterday evening, during the final implementation push, several IT staff received what appeared to be critical security updates from trusted software vendors. Everyone was working late, clicking through warnings to maintain momentum toward Monday’s deadline.
Now Sarah needs answers. And as she explains the situation, her phone rings—it’s David Kim, the CIO of Riverside General Hospital, calling for his daily status update. She lets it go to voicemail. You can see the stress in her face as she says, ‘We need to figure out what’s going on without derailing Monday’s go-live. This contract is everything.’
What do you do?”
Detective examining email logs:
Protector analyzing running processes:
Tracker investigating network traffic:
Communicator interviewing staff:
Crisis Manager assessing scope:
Threat Hunter proactive findings:
Guide synthesis: “You’ve found process injection, memory-resident operation, sophisticated social engineering, and C2 infrastructure. The behavioral patterns—especially hiding within legitimate processes and using convincing fake software updates—point to a specific type of threat. What kind of Malmon combines stealth, social engineering mastery, and fileless techniques?”
When team identifies Trojan characteristics: “Your threat intelligence matches this to GaboonGrabber, a Trojan-type Malmon known for Perfect Mimicry and Fileless Deployment. But there’s something in your research that’s concerning—GaboonGrabber has a hidden ability called Multi-Payload Deployment that activates after 24 hours. You’re approaching that threshold.”
“As Round 1 ends, you’ve identified GaboonGrabber and understand the basic attack. But Sarah’s phone is ringing again—it’s David Kim calling for the third time today. In the background, you hear Jennifer Park, the COO, talking loudly about quarterly earnings and client retention. And your timeline analysis shows you’re 2 hours away from the 24-hour mark where GaboonGrabber typically deploys secondary payloads.
You understand what happened. Now you need to understand how bad this could get—and fast.”
IM Only - Facilitation Guide
“It’s Friday evening, several hours into your investigation. The office is mostly empty except for your incident response team, Sarah Chen nervously checking her phone, and the sound of Jennifer Park on a conference call in the next room discussing ‘the IT situation.’
Your deeper investigation has revealed troubling details: Three of the infected workstations had active VPN connections to Riverside General’s test environment when the malware was installed. Your behavioral analysis confirms this is GaboonGrabber, and you’re now 90 minutes away from the 24-hour threshold.
Sarah just got off the phone with David Kim. His exact words: ‘I have the hospital board expecting a Monday go-live announcement. I have alternative vendors ready if MedTech can’t deliver. I need a yes or no by morning: Is Monday’s go-live happening or not?’
The question now is: How bad is this, and what are we going to do about it?”
Time Pressure (Hour 1):
Sarah reveals: “I should probably tell you… we temporarily disabled certain security controls last week to ‘streamline’ the implementation process. Antivirus real-time scanning was slowing down our testing environment, so we… turned it off. Just temporarily.”
How does this change your assessment?
Stakeholder Pressure (Hour 2):
Mike Rodriguez calls from the hospital: “Our nursing staff completed EMR training last week. They’re prepared for Monday. If we delay, we have to reschedule training for 200 nurses during flu season when we’re already short-staffed. How does that affect patient care continuity?”
How do you explain technical security concerns to clinical stakeholders?
Business Pressure (Hour 3):
Jennifer Park demands explanation via terse email: “I have a quarterly earnings call next week. I need to announce this major contract success. Why are IT problems preventing us from meeting client commitments? Decision needed within 1 hour: Are we go for Monday launch?”
How do you communicate security risks to business executives focused on financial metrics?
Technical Complication (Hour 4):
Your monitoring detects GaboonGrabber attempting to download secondary payloads—you’re seeing the beginning of Multi-Payload Deployment in real-time. Staging files detected: indicators of Snake Keylogger (credential theft), AgentTesla (remote access), and Redline (data exfiltration).
The threat is evolving. What’s your immediate containment strategy?
Detective Investigation:
Protector System Analysis:
Tracker Network Investigation:
Communicator Stakeholder Developments:
Crisis Manager Coordination:
Threat Hunter Proactive:
“Your investigation has painted a clear picture—and it’s worse than you initially thought. GaboonGrabber has hospital network exposure, is preparing to deploy secondary payloads, and you’ve discovered the infection is more widespread than initial reports suggested.
But you’ve also discovered something important: This happened because of organizational culture and deadline pressure, not just technical vulnerabilities. The IT team bypassed security controls, management prioritized speed over safety, and everyone was conditioned to click through warnings during implementation crunch time.
David Kim’s email just arrived. The hospital’s legal team is CC’d. The subject line: ‘Re: Contract Penalty Clauses for Delayed Implementation.’
It’s time to make decisions. What’s your response strategy?”
IM Only - Facilitation Guide
“It’s late Friday night. You’ve got all the information you’re going to get before decisions must be made. The technical picture is clear: GaboonGrabber is confirmed, secondary payload deployment is imminent, hospital network exposure is real, and thorough cleanup will take 36-48 hours minimum—well past Monday’s deadline.
The business picture is equally clear: $2M contract with penalty clauses, client relationship at breaking point, company reputation in healthcare market at stake, quarterly earnings announcement depending on this success.
Sarah Chen looks exhausted but determined: ‘Tell me what you need. I’ll support whatever decision protects our client and makes this right, even if it costs me my job.’
David Kim’s assistant just called to schedule a 7am Saturday morning call with hospital executives.
Jennifer Park sent a one-line email: ‘Decision needed within 1 hour: Are we go for Monday launch?’
What do you do?”
Option A: Comprehensive Cleanup (Delay Go-Live)
Team chooses thorough remediation, recommends delaying Monday go-live to Wednesday.
IM Narration: “You make the difficult call: Thorough cleanup is necessary, Monday go-live must be delayed. Sarah supports your decision and personally calls David Kim to explain.
The conversation is tense. David’s initial reaction: ‘This is exactly what I was afraid of. I have vendors who could have this system live by Monday. Why should I wait for MedTech?’
But then Sarah does something important. She doesn’t make excuses. She explains exactly what happened, what the team discovered, why patient data protection requires thorough response, and how quickly MedTech identified and is containing a sophisticated threat that many organizations wouldn’t even detect.
David is silent for a long moment. Then: ‘Let me call you back.’
Thirty minutes later, he does. ‘I talked to our CISO. He said most vendors would have tried to hide this or rush through cleanup. He convinced the board that your transparency and security competence is exactly what we want in a healthcare technology partner. We’re delaying go-live to Wednesday. Get this done right.’”
Outcome: Delayed go-live, but relationship strengthened through transparency and security competence demonstration.
Option B: Balanced Approach (Enhanced Monitoring + Phased Remediation)
Team proposes hybrid strategy: immediate containment, enhanced behavioral monitoring, network microsegmentation, proceed with go-live under increased vigilance, schedule complete cleanup post-implementation.
IM Narration: “You propose a hybrid strategy: Immediate containment of infected systems, enhanced behavioral monitoring to prevent secondary payload deployment, network microsegmentation to isolate hospital connectivity through monitored channels, and Monday go-live proceeds with increased security vigilance and post-implementation complete cleanup scheduled.
Sarah presents this to David Kim with transparent risk communication: ‘Here’s what we know, here’s the immediate threat we’re containing, here’s the long-term cleanup plan, here’s how we’re protecting patient data throughout.’
David asks hard questions. Mike Rodriguez asks about patient safety. Your team answers honestly, demonstrating both technical competence and business understanding.
The decision: Go-live proceeds Monday with security team on-site throughout, enhanced monitoring active, and contractual agreement for phase 2 cleanup the following week. The incident actually strengthens the relationship—Riverside General’s security team becomes partners in the response.”
Outcome: Go-live proceeds on schedule with risk mitigation. Partnership strengthened through collaboration.
Option C: Inadequate Response (Minimize Incident)
Team downplays incident, proceeds normally without significant remediation.
IM Narration: “You decide to downplay the incident and proceed with Monday go-live without significant remediation. ‘We’ve removed the malware, everything’s fine,’ Sarah tells David Kim.
Monday morning, during go-live, your enhanced monitoring (which you did implement, at least) detects a catastrophic event: GaboonGrabber’s secondary payload deploys ransomware across the hospital’s test environment, which isn’t as isolated from production as anyone thought.
Patient care isn’t directly affected, but the incident makes regional news. HIPAA breach notifications are required. David Kim’s email is brief: ‘Contract terminated effective immediately. Legal team will be in touch regarding penalties and damages.’
The lesson is painful but clear: Security shortcuts during high-pressure projects don’t just create technical debt—they destroy business relationships and reputations.”
Outcome: Contract failure, reputation damage, painful lesson about security shortcuts.
Hybrid isolation approaches:
Transparent risk communication:
Phased remediation strategies:
Collaborative hospital security integration:
“Honeypot” monitoring:
Contract amendment approach:
Third-party IR assistance:
“[Adapt based on their response strategy, emphasizing how their decisions played out and what they learned]
As the incident winds down and you prepare for Monday—whether that’s go-live day or cleanup continuation—Sarah Chen pulls the team aside. ‘I learned something important,’ she says. ‘We created a culture where deadline pressure made clicking through security warnings normal. That culture made us vulnerable. This incident happened because of how we work, not just because of technical factors. We’re changing that.’
And David Kim sends one final email: [Adapt message based on outcome - either praising transparency and competence, or expressing disappointment in handling]
The Riverside General implementation will proceed—your decisions determined whether it happens as a partnership strengthened by security cooperation, or as a lesson learned through painful consequences.”
IM Only - Post-Game Discussion Guide
Technical Concepts:
Collaboration Skills:
Scenario-Specific:
Real-World Connections:
Encourage teams to document:
Sample MalDex Entry:
Malmon: GaboonGrabber Context: Healthcare technology implementation during critical client go-live deadline Key Discovery: Behavioral analysis of process injection patterns enabled identification despite fileless deployment Effective Response: Hybrid approach using network microsegmentation + enhanced monitoring allowed go-live while containing threat Team Innovation: Transparent risk communication turned potential contract failure into partnership Lesson Learned: Organizational culture that prioritizes deadline pressure over security controls creates exploitable vulnerabilities
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Handbook References:
MITRE ATT&CK Techniques:
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Remember: Security is as much about people and culture as it is about technology. Every incident is an opportunity to learn and improve.