Policy brief on behavioral threat assessment and access control for island hospitals and healthcare systems.
Policy brief on behavioral threat assessment and access control for island hospitals and healthcare systems. Free under Creative Commons Attribution 4.0 — no registration required.
Summary of the paper
"Insider Threat in Island Healthcare Systems" is an ISPI policy brief on patient safety, data security and workforce integrity in geographically isolated hospitals and clinics.
Its central point is the sole provider constraint. A continental hospital can act on concerning staff behavior knowing replacements can be found. An island hospital may depend on a handful of qualified clinicians, so removing one can create a clinical capacity crisis. The brief argues island healthcare needs graduated responses that manage insider risk while preserving care the community cannot lose.
What the paper finds
- Workforce dependency changes the response. Because island facilities are often the only medical resource for their population, standard personnel actions can be operationally severe.
- Community density creates privacy risk. Overlapping personal and professional relationships produce HIPAA compliance and patient safety risks, including staff accessing records of people they know, that continental frameworks do not address.
- Familiar risks present differently. Drug diversion, patient data access and supply chain fraud take different forms where community relationships overlay every professional interaction.
- Audit capacity competes with operations. Where the same small IT staff run clinical systems and review access alerts, keeping systems running can take priority over reviewing flags.
What it recommends
- Develop island healthcare insider threat frameworks with graduated response protocols that avoid creating clinical capacity crises.
- Establish shared health IT security audit services for small island hospitals.
- Commission research on relationship-based patient record access in island healthcare to build targeted detection and prevention protocols.
Who it's for
Hospital executives, compliance and privacy officers, health IT and security staff, state and territorial health departments, and healthcare regulators.
This research connects to the 39 Small Island Developing States worldwide through the Samoa Pathway and BPOA+30 framework. Every ISPI research product carries a mandatory SIDS global bridge per the ISPI Research Architecture.
Further reading
Cite as
Pulley, Warren (2026). Insider Threat in Island Healthcare Systems: Patient Safety, Data Security, and Workforce Integrity in Geographically Isolated Medical Environments (ISPI PB-09). Island Security Policy Institute, Honolulu. https://ispiglobal.com/papers-landing/pb09-insider-threat-healthcare https://doi.org/10.5281/zenodo.23450003
BibTeX
@techreport{ispipb092026,
author = {Pulley, Warren},
title = {Insider Threat in Island Healthcare Systems: Patient Safety, Data Security, and Workforce Integrity in Geographically Isolated Medical Environments},
institution = {Island Security Policy Institute},
address = {Honolulu, HI},
number = {ISPI PB-09},
year = {2026},
url = {https://ispiglobal.com/papers-landing/pb09-insider-threat-healthcare},
doi = {10.5281/zenodo.23450003}
}Related analysis
AnalysisInsider Threat in Island Communities — Why Standard Frameworks Fail Worldwide →AnalysisHow to Implement an Insider Threat Program in a Small Island Organization →AnalysisBehavioral Threat Assessment in Island Communities — Why Cultural Calibration Changes Everything →PaperPB-08 — Insider Threat in Pacific Government Agencies →PaperPB-10 — Continuity of Operations Planning for Island Government Agencies →GuideInsider Threat in Island Communities: Research and FAQ →Pulley, Warren. "Insider Threat in Island Healthcare Organizations." Island Security Policy Institute, 2026. https://ispiglobal.com/papers-landing/pb09-insider-threat-healthcare
