Fowler Zachary, Rahimi Amina, Cantu Aldana Alejandra, Uribe-Leitz Tarsicio, Carrillo-Villaseñor Fernando, Roa Lina, Hill Sarah K, Macias Valeria, Castillo-Angeles Manuel, Reich Amanda J
Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, United States.
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States.
PLoS One. 2025 Apr 29;20(4):e0321969. doi: 10.1371/journal.pone.0321969. eCollection 2025.
Chiapas is a state in southern Mexico that faces significant challenges in healthcare delivery. Strengthening the surgical system requires a comprehensive understanding of all health system domains and the contextual factors that influence care delivery. This study used qualitative methods to identify factors related to both gaps and successes in surgical care in Chiapas, Mexico. Semi-structured interviews were conducted with 23 participants at 15 public and private hospitals. Participants consisted of nurses, physicians, surgeons, and hospital administrators. Interviews were transcribed, and a codebook was developed and applied to all interviews. Recurring themes were identified and described using thematic analysis. Four themes characterizing the challenging context through which care is delivered were identified: referral system challenges, workforce shortages, insufficiencies in perioperative and nonoperative care, and waste and mismanagement of resources. Three themes related to innovations and workarounds were identified: efforts to maximize resources and reduce waste, strategies to reduce language barriers, and planning to account for clinical needs in situations of limited access and emergencies. Gaps and challenges within the surgical system of Chiapas lead to challenges in care delivery across all domains of the health system. However, several solutions have emerged among local providers. Insight into these factors can be used in planning efforts to improve access to safe and effective surgical care.
恰帕斯州是墨西哥南部的一个州，在医疗服务提供方面面临重大挑战。加强手术系统需要全面了解所有卫生系统领域以及影响护理提供的背景因素。本研究采用定性方法来确定与墨西哥恰帕斯州手术护理中的差距和成功相关的因素。在15家公立和私立医院对23名参与者进行了半结构化访谈。参与者包括护士、医生、外科医生和医院管理人员。访谈内容被转录，并制定了一本编码手册并应用于所有访谈。通过主题分析确定并描述了反复出现的主题。确定了四个表征护理提供所面临的具有挑战性背景的主题：转诊系统挑战、劳动力短缺、围手术期和非手术期护理不足以及资源浪费和管理不善。确定了三个与创新和变通方法相关的主题：努力最大限度地利用资源并减少浪费、减少语言障碍的策略以及在获取有限和紧急情况下考虑临床需求的规划。恰帕斯州手术系统中的差距和挑战导致卫生系统所有领域的护理提供面临挑战。然而，当地提供者已经出现了一些解决方案。深入了解这些因素可用于规划工作，以改善获得安全有效的手术护理的机会。
