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Many countries were under-prepared for the arrival of an emergency such as the COVID-19 pandemic. An intra-action review allows countries, systems and services to reflect on their preparedness and response to date, and revise their policies and approaches as needed. We describe the approach to undertaking an intra-action review of Ireland’s Health Protection COVID-19 response during 2021. A project team within National Health Protection developed a project plan, identified key stakeholders, trained facilitators and designed workshop programmes, employing integrated collaborative web tools. Multidisciplinary representatives participated in three half-day, independently facilitated workshops on challenges and solutions within specific response areas: communication, governance and cross-cutting themes such as staff well-being. An all-stakeholder survey sought further in-depth detail. Participants reviewed the ongoing pandemic response in terms of good practice and challenges and recommended implementable solutions. We customised our mixed-methods approach using existing ECDC/WHO guidance, producing consensus recommendations during Ireland’s fourth wave of COVID-19, with particular focus on pathways to implementation. Our adaptations may help others in formulating and customising methodological approaches. During an emergency, identifying and reflecting on good practices to retain, and areas for strengthening, with a clear action plan of implementing recommendations, will enhance preparedness now, and for future emergencies.


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  1. Mayigane LN, de Vázquez CC, Vente C, Charles D, Copper FA, Bell A, et al. The necessity for intra-action reviews during the COVID-19 pandemic. Lancet Glob Health. 2020;8(12):e1451-2.  https://doi.org/10.1016/S2214-109X(20)30414-9  PMID: 33038949 
  2. World Health Organization (WHO). Emergency Response Reviews. Geneva: WHO. [Accessed: 2 Dec 2022]. Available from: https://www.who.int/emergencies/operations/emergency-response-reviews
  3. Riccardo F, Bolici F, Fafangel M, Jovanovic V, Socan M, Klepac P, et al. West Nile virus in Europe: after action reviews of preparedness and response to the 2018 transmission season in Italy, Slovenia, Serbia and Greece. Global Health. 2020;16(1):47.  https://doi.org/10.1186/s12992-020-00568-1  PMID: 32423479 
  4. European Centre for Disease Prevention and Control (ECDC). Conducting in-action and after-action reviews of the public health response to COVID-19. Stockholm: ECDC; 4 Jun 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/conducting-action-and-after-action-reviews-public-health-response-covid-19
  5. World Health Organization (WHO). Guidance for conducting a country COVID-19 intra-action review (IAR). Geneva: WHO; 23 Jul 2020. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Country_IAR-2020.1
  6. European Centre for Disease Prevention and Control (ECDC). One-day in-action review (IAR) protocol in the context of COVID-19. Stockholm: ECDC; Mar 2021. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/One-day-in-action-review-protocol.pdf
  7. SHARP Joint Action (JA). Strengthened International Health Regulations and Preparedness in the EU (SHARP). About SHARP joint action. [Accessed: 2 Dec 2022]. Available from: https://sharpja.eu/
  8. Centre for Effective Services (CES). Stakeholder Engagement Tool. Dublin: CES; 2017. Available from: https://d1j85byv4fcann.cloudfront.net/cesdownloads/3.-Stakeholder-Engagement-Tool.pdf?mtime=20210210184008&focal=none
  9. World Health Organization (WHO). Tool 5. Trigger question database - 28 April 2021. Geneva: WHO; 28 Apr 2021. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Country-IAR-templates-trigger-questions-2021.1
  10. Health Service Executive (HSE). Report of the review of the application of the Framework for Improving Quality in our Health services: Learning to guide future approaches. Dublin: HSE; Sep 2018. Available from: https://www.hse.ie/eng/about/who/qid/framework-for-quality-improvement/executive-summary-review-of-the-framework-for-improving-quality.pdf
  11. Clarke V, Braun V. Thematic analysis. J Posit Psychol. 2017;12(3):297-8.  https://doi.org/10.1080/17439760.2016.1262613 
  12. Damayanthi S. Thematic Analysis of Interview Data in the Context of Management Controls Research. London: Sage Research Methods; 2019.
  13. Boland M, Morrissey M, O’Connor E, Dever N, O’Mahony C, Romanowski S, et al. Intra-Action Review of the HSE Health Protection response to the COVID-19 pandemic during 2021. Final Report and Recommendations. Dublin: Health Service Executive (HSE).; Apr 2022. Available from: http://hdl.handle.net/10147/632023
  14. Health Service Executive (HSE). Health Protection Strategy 2022-2027. Dublin: HSE. [Accessed: 15 Mar 2023]. Available from: www.hpsc.ie/HPStrategy
  15. Ward C, Ihlo T, Morgan W. Hexagon tool. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute; Dec 2019. Available from: https://fpg.unc.edu/publications/hexagon-tool
  16. Burke K, Morris K, McGarrigle L. An introductory guide to implementation: terms, concepts and frameworks. Dublin: Centre for Effective Services (CES); 2012. Available from: http://hdl.handle.net/10147/306846
  17. Government of Ireland. Department of Health. Ministers for Health establish the Public Health Reform Expert Advisory Group. [Accessed: 13 Dec 2022]. Available from: https://www.gov.ie/en/press-release/8beb5-ministers-for-health-establish-the-public-health-reform-expert-advisory-group/
  18. Stoto MA, Nelson C, Piltch-Loeb R, Mayigane LN, Copper F, Chungong S. Getting the most from after action reviews to improve global health security. Global Health. 2019;15(1):58.  https://doi.org/10.1186/s12992-019-0500-z  PMID: 31601233 
  19. Pimentel CB, Snow AL, Carnes SL, Shah NR, Loup JR, Vallejo-Luces TM, et al. Huddles and their effectiveness at the frontlines of clinical care: a scoping review. J Gen Intern Med. 2021;36(9):2772-83.  https://doi.org/10.1007/s11606-021-06632-9  PMID: 33559062 
  20. Jin Y, Austin L, Vijaykumar S, Jun H, Nowak G. Communicating about infectious disease threats: Insights from public health information officers. Public Relat Rev. 2019;45(1):167-77.  https://doi.org/10.1016/j.pubrev.2018.12.003 
  21. Mheidly N, Fares J. Leveraging media and health communication strategies to overcome the COVID-19 infodemic. J Public Health Policy. 2020;41(4):410-20.  https://doi.org/10.1057/s41271-020-00247-w  PMID: 32826935 
  22. Parajuli RR, Mishra B, Banstola A, Ghimire BR, Poudel S, Sharma K, et al. Multidisciplinary approach to COVID-19 risk communication: a framework and tool for individual and regional risk assessment. Sci Rep. 2020;10(1):21650.  https://doi.org/10.1038/s41598-020-78779-0  PMID: 33303910 
  23. Ní Shé É, O’Donnell D, O’Shea M, Stokes D. New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19. Int J Environ Res Public Health. 2020;17(18):6442.  https://doi.org/10.3390/ijerph17186442  PMID: 32899652 
  24. Cowper A. Covid-19: are we getting the communications right? BMJ. 2020;368:m919.  https://doi.org/10.1136/bmj.m919  PMID: 32144115 
  25. Riccardo F, Monaco F, Bella A, Savini G, Russo F, Cagarelli R, et al. An early start of West Nile virus seasonal transmission: the added value of One Heath surveillance in detecting early circulation and triggering timely response in Italy, June to July 2018. Euro Surveill. 2018;23(32):1800427.  https://doi.org/10.2807/1560-7917.ES.2018.23.32.1800427  PMID: 30107870 
  26. Powell BJ, Mettert KD, Dorsey CN, Weiner BJ, Stanick CF, Lengnick-Hall R, et al. Measures of organizational culture, organizational climate, and implementation climate in behavioral health: A systematic review. Implement Res Pract. 2021;2:263348952110188.  https://doi.org/10.1177/26334895211018862 
  27. van Daalen KR, Bajnoczki C, Chowdhury M, Dada S, Khorsand P, Socha A, et al. Symptoms of a broken system: the gender gaps in COVID-19 decision-making. BMJ Glob Health. 2020;5(10):e003549.  https://doi.org/10.1136/bmjgh-2020-003549  PMID: 33004348 

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