Table 4.

Selected illustrative quotations from the focus groups.

Theme and subthemes	Illustrative quotations
Fear of getting Covid, fear of relatives getting Covid
Fear of getting Covid	• At the beginning, I was afraid, I did not feel safe when consulting patients (FGD). • At the beginning, the fear and lack of information led to panic. The mass media had an important role on this (FGA). • Pandemic has been an experience that I would not have liked to have in my career, really anxiogenic. However, we have been able to help many people; it was a battle we won (FGN).
Fear of relatives getting Covid	• When you have a professional activity that requires being in close contact with infected people, you are afraid of bringing it back to your family (FGN).
Workload, work complexity, shortage of staff
Workload	• We had different types of workload: one was to organise the response to the pandemic, two to continue with the normal work, third the work related to explanation and communication, and fourth the extra psychosocial burdens, an extra load for the medical team (FGD). • All new tasks were done with last-minute training (FGD). • We carried out many tasks: contact tracing, phoning to positive cases, giving them advice, contacting close contacts. There were days we did this until ten o'clock at night (FGN).
Work complexity	• We needed to respond to the new situation very quickly, preparing group sessions, preparing information, preparing interviews: that was stressful (GFPS). • There was a period when the guidelines changed a lot. We constantly updated our guidelines, checking the reliability of the information, to make sure the information was still accurate. This was a very time-consuming and complex activity (FGN).
Shortage of staff	• We cannot do this again with minimum staffing that has been the case in this pandemic (FGD). • There is an evident link between workload and shortage of staff. Our social work was overload with demands of sick people, isolated at home, mainly alone, far from their country, from family members. For these people we had an extra charge of work (FGA). • In terms of human resources, we need replacements. In addition, the workload - strangely enough - it does not come with any compensatory period. I am not even saying extra leave, I am saying about a period, which we can fit our jobs into 40 h per week, rather than more than this, as was often the case.
Teamwork during the pandemic
	• The group cohesion was really good (FGD). • The workload has allowed us to be closer, to communicate, and to try to help each other, because we all know that we all need support at one time or another (FGN). • D: The crisis was a jump in a black whole, with great uncertainty. The team spirit helped to increase resilience (FGPS). • In the medical service, the management of the complexity improved thanks to the fact that we strongly collaborated among ourselves. The pandemic improved the collaboration and the communication among colleagues (FGA).
Teleworking
Benefit of remote working	• Having a long period with extremely long working days, being able to do most of the work at home helped a lot. I do not know if I would have been able to manage the workload without (FGD). • To stay at home, prepare my agenda, my administrative work, gave me the opportunity to be more focused, more concentrated, saving time, with less stress related to the fear of becoming infected (FGPS). • Keeping some teleworking days per week gives you the opportunity to adapt much more easily in a crisis situation. Maintaining teleworking days can be thought also as a preventive measure in case of a new crisis situation (FGA).
Challenges	• Teleworking for me was difficult [ …] It was just at the level of the organisation of the family life. The working environment at home was not suitable for teleworking. Teleworking put more pressure on me: when I went back to the office, I was more relaxed (FGN). • A lot of staff […] have done their best and have delivered a lot of good work during very difficult times with a lot of teleworking. If administration now revert and say tasks can only be done in office, they do not recognize the efforts, they do not recognize the fact that a lot of work was done at home. So I would advocate for continued recognition for the type of tasks that can be done by teleworking. Our jobs come with many tasks, some of which are perfectly done in telework (FGD).
How to manage future health crises
Institutional collaborations	• It was interesting and useful to build up a collaboration with the local health authorities (FGD). • Local health authorities have been supportive. I never met them in person but we rely on them, jus by telephone, by a virtual conference, we got very useful, important information (FGD). • During the crisis, we had exchanges with other institutions: I discovered procedures that had been adopted by the other institutions. It was great to share new ideas. We learnt things that we put in place: it is important to know how other institutions work (FGN). • More interinstitutional communication between medical services at operational level is crucial (FGA).
Harmonising rules and procedures	• It is important to write clear procedures and guidelines that could be valid for different kinds of health emergencies, pandemics or other problems, to establish clear communication channels, to know how to communicate (FGN). • What we missed were clear procedures: in the future, general procedures and rules would help a lot. It could be useful to put together the experience we have lived in medical services, creating common procedures (FGA). • Clear procedures regarding a crisis could help in the future, both with mobilising personnel and with resources, in order to make human resources and necessary materials quickly available (FGA).
Improving decision-making process	• The information should be shared with lower levels and not only between managers. It could be interesting to understand also how things are going on at upper levels during a crisis (FGA).
Others	• After such a long crisis, you need recovery, to be better prepared for the next crisis. Our administrations are not learning the importance of the recovery (FGD). • [ …] flexibility is important, because we may have different challenges in the future and the institution has to be prepared with specific teams/units of reference dealing with crisis management and preparedness (FGPS). • A key factor is training We know what happened and I think there is room for improvement (FGPS).
Other comments
Communication and misinformation	• Concerning the communication, the explanation we provided, I think we were not sufficiently prepared for that. We were not prepared to deal with misinformation, with the infodemic, and with all the negativity related with the implemented measures (GFD). • We had different sources information: we had rules from our institution that were not consistent with those of the country where our institution was based. People did not understand why different rules occurred between the local health authorities and our institution (FGN).
Interinstitutional medical board (IMB)	• In my institution, I was the single doctor making all decisions. As a doctor, I am so grateful that we had the European network to get the alignment (FGD). • The IMB was also important in strengthening ourselves, feeling supported, and building our own resilience (FGD).

Note: FGD=Focus group doctors; FGN=Focus group nurses; FGPS=Focus group psychologists and social workers; FGA=Focus group administrative personnel.