Background and objective:
The COVID-19 pandemic clearly highlighted the limited capacities in health systems including hospitals. This study collates experience and insights on challenges and strategies in secondary care management during the pandemic. The gained knowledge should help to facilitate pandemic preparedness in hospital care.

Methods:
52 semi-structured interviews with managers and executive staff of hospitals in Denmark, France, Germany, Hungary and Italy were conducted in Summer 2022 and were analysed by researchers in the respective countries. Subsequently, an overarching analysis was conducted to identify key themes and derive recommendations for improved preparedness.

Results:
Despite marked differences between their national health systems, the investigated countries encountered similar problems. Concerning prerequisites, experts from most countries noted lack of up-to-date or sufficiently tested pandemic plans, too scarce resources dedicated to information transfer, including insufficient availability or usability of IT systems within and across organisations. Pandemic responses worked best in case of pre-existing cooperations and due to highly motivated staff. Often, in-house solutions for emerging problems were developed before support from authorities arrived. Keeping staff motivated and healthy got increasingly difficult due to the duration of the crisis, burden of work, diminishing societal support, poor governance regarding administrative burdens and (monetary) recognition of work.

Conclusion:
The pandemic intensified pre-existing problems in the hospital sector – most notably, staff shortages and information management deficits – and accelerated developments that had begun already pre-pandemic. Experts from all five countries agreed that better equipped and integrated primary care and more suitable e-health solutions could take strain off hospitals. Professional managerial support for health organizations could improve processes. Regular practical tests of pandemic plans would point out needs for updates as well as trainings and other resources, thus enabling providers to concentrate on their core tasks in times of crisis.