Strengthening Pandemic Preparedness: A Thematic Analysis of Frontline Healthcare Workers' Perspectives During the First Wave of the COVID-19 Pandemic in Aotearoa New Zealand: A Reflexive Thematic Analysis.

Background and Aims: The COVID-19 pandemic exposed critical gaps in healthcare preparedness globally, including in Aotearoa New Zealand (NZ). This study explored healthcare workers' experiences during the initial COVID-19 wave, identifying key areas to inform future policies and practices. Methods: Frontline HCWs at Christchurch Hospital, NZ, who participated in an online survey on COVID-19 awareness and preparedness, were invited to answer an open-ended question about improving pandemic preparedness and response. Responses were analyzed using reflexive thematic analysis. Results: Six major themes were identified, encompassing communication and information dissemination, training and preparation, resource availability, clear protocols and planning, staff engagement and support, and consistency and standardization. Participants highlighted the importance of transparent, regular updates through both email and face-to-face meetings, alongside simulations and standardized online modules to strengthen infection-control training. They also emphasized the need for adequate resources such as PPE, negative pressure rooms, and ICU capacity, supported by clear guidelines for PPE use and patient management. Furthermore, healthcare workers underscored the value of inclusive decision-making to enhance morale, as well as the need for uniform practices across regions and departments to ensure a cohesive and coordinated pandemic response. Conclusion: The findings highlight the need for robust communication, comprehensive training, resource allocation, and inclusive planning to strengthen healthcare resilience. Addressing these areas can improve pandemic preparedness and response, protect HCWs, and ensure better patient outcomes.