Table 2.

Gaps and improvements identified by the assessors during the exercises

	Gaps identified during exercises		Improvements observed in the second exercises	Additional improvements suggested by the assessors
	First	Second
Disaster standard operating procedures (SOPs)	●Only one pharmacy had SOPs ●Hospital management’s difficulties in informing the pharmacy of hospital SOPs (except for the pharmacy with SOP) ●Lack of hierarchical disaster management structure	●Lack of enough tested informational and situational dashboards	●Presence of SOPs in every pharmacy ●SOPs consulted early ●Easier, more comprehensive triggering of SOPs ●Use of dashboards	●Train staff to use SOPs and dashboards
Allocation of roles	●No clear disaster management leader ●Spontaneous but uncoordinated allocation of tasks ●Lack of work delegation ●Lack of anticipation ●Only one pharmacy had action card, resulting in disorganized task attribution	●Only one pharmacy had actions cards ●Lack of delegation of specific tasks ●Difficulty designating or identifying a manager for each process/department ●Poor optimization of human resources	●Leader more clearly identifiable	●Create actions cards
Management	●In pharmacies without SOPs, management committees were set up slowly or not at all ●Pharmacy heads’s mix of management roles and operational tasks ●Lack of knowledge about the concept of disaster management, and no SOPs ●Lack of organization and rhythm in disaster management (no meeting points, …) ●Tendency to include too many people in the disaster management team ●No feedback requested on the evolution of the tasks delegated	●Inability to maintain overall situational awareness of the pharmacy ●Inability to manage and distribute tasks and collect feedback	●Management teams established rapidly	●Organize a rhythm to management via regular, scheduled meeting points
Responses by different hospital pharmacy units	●Poor redistribution of human resources ●No identification of leaders for the most affected processes or departments ●Lack of overall coordination and management ●Lack of separation between disaster-related and routine work flows	●No identification of leaders for the most affected processes or departments	●Improved separation of flow of disaster and routine requests to the pharmacy	●Identify leaders for each of the most affected processes or departments
Communication	●No structured communication (no reformulation) ●Lack of pharmacy feedback on actions requested by other hospital departments ●Poor, unstructured communication both up and down the hierarchy, between management and staff and between different pharmacy departments ●Under-utilization of the means of communication available	●Insufficient targeted communication with staff ●No acknowledgement of messages received (reformulation to demonstrate comprehension)	●Improved general communication ●Improved communication of SOPs to all employees	●Train and practice structured communication in routine practice (especially restating reformulating requests for action to demonstrate comprehension) ●Make sure to have regular status meeting points with a representative from each pharmacy department