School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
Int J Health Plann Manage. 2021 Sep;36(5):1758-1771. doi: 10.1002/hpm.3258. Epub 2021 Jun 6.
After-Action Reviews (AARs) are management tools used to evaluate the response to public health emergencies at the national and subnational level. Aim of this study is to apply available AAR models to assess and critically appraise COVID-19 response of San Raffaele Scientific Institute, a large university hospital in Milan, Italy.
We designed an AAR based on the key-informant interview format, following the methodology proposed by the 2019 World Health Organization Guidance for AAR. After systematic assessment of the hospital reorganization, we conducted 36 semi-structured interviews to professionals with executive, clinical, technical and administrative roles. We designed an ad-hoc questionnaire exploring four areas: (i) staff management; (ii) logistics and supplies; (iii) COVID-19 diagnosis and clinical management; (iv) communication.
Overall, the hospital response was evaluated as effective and sufficiently prompt. Participants stressed the relevance of: (i) strong governance and coordination; (ii) readiness and availability of healthcare personnel; (iii) definition of a model of care based on a multidisciplinary approach. Challenges were reported for communication management and staff training.
This study is one of the first applications of the AAR to the COVID-19 response in hospital settings, which can be successfully adapted or scaled up to other settings in order to implement preparedness strategies for future public health emergencies.
事后评估（AAR）是用于评估国家和次国家一级应对公共卫生紧急情况的管理工具。本研究旨在应用现有的 AAR 模型来评估和批判性地评价意大利米兰大型大学医院圣拉斐尔科学研究所的 COVID-19 应对措施。
我们根据关键知情人访谈格式设计了一个 AAR，遵循 2019 年世界卫生组织 AAR 指南中提出的方法。在对医院重组进行系统评估后，我们对具有行政、临床、技术和行政职务的专业人员进行了 36 次半结构化访谈。我们设计了一个专门的问卷，探讨了四个领域：（i）员工管理；（ii）后勤和物资供应；（iii）COVID-19 诊断和临床管理；（iv）沟通。
总体而言，医院的反应被评估为有效且足够迅速。参与者强调了以下方面的重要性：（i）强有力的治理和协调；（ii）医疗人员的准备和可用性；（iii）基于多学科方法的护理模式的定义。在沟通管理和员工培训方面存在挑战。
本研究是 AAR 在医院 COVID-19 应对措施中的首次应用之一，可以成功地适应或扩展到其他环境，以实施未来公共卫生紧急情况的准备策略。
