An After-Action Review at Municipal Level in the Public Health Service - Lessons Learned at the Corona Unit of the Duesseldorf Public Health Authority after the end of the Covid-19 Pandemic, March 2023

Abstract

After-Action Reviews (AARs) represent structured, qualitative evaluations of crisis interventions. Here, we describe the implementation of an AAR to assess the Corona Unit of the Duesseldorf Health Department. We employed an after-action review (AAR) using the working group format supplemented by structured interviews with key personnel. Our approach was guided by the guidelines for AARs provided by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC). Participants identified nine relevant challenges with potential for improvement in three categories: (I) challenges in recruiting requested personnel, (II) overarching coordination issues, and (III) frequent relocations. Participants proposed solutions for these challenges: (I) 1. Routine cross-agency inquiries for voluntarily available personnel, 2. consideration of resources from municipal subsidiaries and involvement of personnel with leadership experience from other departments, 3. Better coordination of deployment and onboarding, 4. proposal for early communication regarding different compensation regulations, (II) 5. establishment of an overarching coordination authority for the crisis unit, 6. clearer delineation of responsibilities within the crisis unit with explicit job profiles, 7. establishment of a shared working platform, and 8. creation of a central dashboard for generating all situation reports. Additionally, they identified (III) 9. a facility for housing a crisis unit in case of an emergency. This study represents one of the first applications of an AAR for evaluating crisis structures at the level of a local Public Health Authority (LPHA) in the context of the COVID-19 pandemic. While some of the identified challenges are specific to Duesseldorf, many municipalities faced personnel recruitment and coordination challenges during the COVID-19 pandemic. Municipal crisis plans can be reviewed and adjusted concerning the identified challenges. Sharing evaluation results among LPHA stakeholders can contribute to strengthening crisis structures in the long term.