Voices From the Frontline: A Reflexive Thematic Analysis Illuminating Perioperative Practice Realities in Southern Ethiopian Teaching Hospitals

Despite national efforts, gaps persist in Ethiopian perioperative care. This reflexive thematic analysis aimed to investigate the contextual challenges faced in delivering perioperative care. In-depth interviews were conducted with 20 healthcare professionals, including anesthetists, nurses, and surgeons, to gain a frontline perspective of perioperative practice realities. The analysis revealed eight interconnected themes: systemic infrastructure vulnerabilities, workforce expansion uncertainties, workforce demoralization, fragile perioperative safety culture, hierarchical structures and communication barriers, financial barriers to care, fragmented information systems, and fragile governance with sociopolitical instability. Local deficiencies in resources and equipment were amplified by global challenges, creating a precarious care environment. While workforce numbers increased, concerns persisted about competency and training quality. Systemic pressures and unmet professional needs contributed to staff demoralization. Inconsistent safety practices and top-down quality improvement initiatives hindered sustainable progress. Rigid hierarchies and departmental silos impeded effective teamwork and resource coordination. Financial constraints created significant barriers to care access and ethical dilemmas for providers. Incomplete digitalization and inconsistent documentation practices compromised continuity of care and data-driven improvements. Overarching sociopolitical instability and weak governance cascaded into healthcare system disruptions. The findings underscore the need for a multifaceted approach to strengthen perioperative care, including improving infrastructure, enhancing workforce development, fostering a culture of safety, breaking down hierarchical barriers, addressing financial accessibility, implementing robust information systems, and building resilient governance structures amidst adversity.