Management of hospital care during the COVID-19 pandemic: Lessons learnt from five European countries

Background: The COVID-19 pandemic required major adaptations in the organisation of health care systems, particularly within hospitals. The aims of this article are to gather evidence on challenges in hospital care from a management perspective during the pandemic. The lessons learned will help to improve pandemic preparedness and resilience.

Methods: The management of hospital care during the pandemic in five European countries (Denmark, France, Germany, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 57 interviews were conducted with senior hospital staff in management roles in spring and summer 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies, gaps and failures in hospital pandemic management.

Results: The surge in COVID-19 patients overwhelmed hospital capacities, forcing hospitals to balance the care of COVID-19 and non-COVID-19 patients. In response, many hospitals converted regular wards into COVID-19 units and postponed elective surgeries, thus compromising care of chronically ill and non-urgent patients. Telemedicine played an important role in maintaining care during this period, but also posed challenges such as acceptance by elderly patients and physicians. The effectiveness of segregated pathways to prevent additional infections depended on the hospital’s existing infrastructure. Moreover, the overall response was hampered by widespread staff shortages and high workloads, which affected patient care and staff wellbeing. In addition to human resource constraints, hospitals faced shortages of personal protective equipment and medical supplies, leading to a reevaluation of logistics, including the establishment of dedicated pandemic warehouses. Finally, many hospitals found government-issued guidelines and pandemic plans inadequate or inapplicable. As a result, they set up internal task forces to coordinate the pandemic response and respond quickly to rapidly changing circumstances.

Conclusion: The COVID-19 pandemic highlighted shortcomings in hospitals’ preparedness and the need for improved resilience in case of crisis. Strategies to improve pandemic resilience, such as better working conditions, would also improve health system performance in “normal times”. Pandemic-specific measures, such as postponement of elective surgeries, are necessary but need to be carefully managed to minimise the negative impact on patient care.