Modern surgical ecosystems: Models for surgical care in limited-resource settings

Background: Surgery is an irreplaceable health intervention that can be thought of as an ecosystem, with distinct infrastructure, personnel, and supply chain needs. Challenges inherent to providing surgical care include the need for skilled professionals and specialized sterilization equipment and processes. Surgical centers in the developed world possess a wealth of knowledge that can benefit those seeking to establish or improve surgical care in the developing world, though the cost of sophisticated systems can be prohibitive in low resource settings. Methods: Interviews were conducted with key surgical services personnel at 7 hospitals in Salt Lake City, Utah. Participants were asked to discuss their professional roles, the daily tasks associated with their roles, and perspectives of how their roles fit into the overall system of surgical services as well as the wider context of health care. Participants included surgeons, anesthesiologists, nurses, clinical engineers, administrators, and sterile processing technicians. Results: Participants illuminated the myriad processes that must function in synchrony to provide advanced surgical care. They described an intricate, dynamic environment driven by dedication to quality and patient safety. They also highlighted the essential role of effective communication, education, and participation in professional communities. Recurrent themes emerged that underscored common features of well-functioning surgical centers. Conclusions: In developed settings, surgical care benefits from abundant resources, advanced technology and human expertise. While such luxuries cannot be guaranteed in global developing settings, lessons learned from analysis of more privileged surgical systems can be applied to raise the standard of surgical care for all.