{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T20:41:31Z","timestamp":1786308091313,"version":"build-2736575974"},"reference-count":60,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp;amp; Management"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Unsafe anaesthesia practices in Mexico have contributed to repeated outbreaks of fatal fungal meningitis, exposing broader health system vulnerabilities. This study aimed to analyse how structural weaknesses in perioperative care, spanning governance, workforce, and institutional practices, reflect deep gaps in health planning, regulation, clinical oversight and hospital management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We applied a participatory, role\u2010based systems mapping approach. A two\u2010phase design method combined a survey to identify perceived system failures with structured, guided interprofessional, participatory reflection sessions. Participants from diverse professional groups refined key themes and assessed their impacts on patient safety, workforce practice, and institutional integrity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four core themes emerged: resource management and operational efficiency; quality control and safety standards; regulatory compliance and institutional integrity; and personnel commitment and professional conduct. Beyond resource and regulatory gaps, the findings highlighted weak institutions, fragmented communication, and improvised workarounds normalised across professional groups. These patterns underscore system\u2010wide deficiencies in national policy and system strategy implementation, health workforce planning, operational management, and organizational accountability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Catastrophic fungal, fatal meningitis outbreaks in Mexico arose from failures of governance, learning, oversight, culture, supply chains, and frontline practice\u2014and prevention requires coordinated action across the entire sociotechnical system. By situating perioperative safety failures within the broader context of health\u2010system governance, this study demonstrates the value of participatory systems inquiry for linking frontline clinician experiences to policy and organizational priorities. The findings provide a foundation for strategies to strengthen health planning, regulatory oversight, and organizational readiness in complex health systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hpm.70125","type":"journal-article","created":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T19:50:43Z","timestamp":1786305043000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mapping System Vulnerabilities in Anaesthesia Safety: A Role\u2010Based Inquiry in Response to Fatal Fungal Meningitis Outbreaks in Mexico"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0205-6844","authenticated-orcid":false,"given":"Jonathan Mat\u00edas","family":"Chejfec\u2010Ciociano","sequence":"first","affiliation":[{"name":"Federacion Mexicana de Colegios de Anestesiologia  Ciudad de M\u00e9xico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5866-8111","authenticated-orcid":false,"given":"Adrian Orozco","family":"Guridi","sequence":"additional","affiliation":[{"name":"Federacion Mexicana de Colegios de Anestesiologia  Ciudad de M\u00e9xico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo Prieto","family":"Hurtado","sequence":"additional","affiliation":[{"name":"Federacion Mexicana de Colegios de Anestesiologia  Ciudad de M\u00e9xico Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2766-5582","authenticated-orcid":false,"given":"Maryam","family":"Tabibzadeh","sequence":"additional","affiliation":[{"name":"Manufacturing Systems Engineering &amp; Management Department California State University  Northridge California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1836-6831","authenticated-orcid":false,"given":"Andr\u00e9","family":"van Zundert","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine Royal Brisbane and Women's Hospital  Brisbane Queensland Australia"},{"name":"The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7004-4410","authenticated-orcid":false,"given":"Adrian W.","family":"Gelb","sequence":"additional","affiliation":[{"name":"Department of Anesthesia &amp; Perioperative Care Center for Health Equity in Surgery &amp; Anesthesia (CHESA) University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7906-698X","authenticated-orcid":false,"given":"Paul","family":"Barach","sequence":"additional","affiliation":[{"name":"College of Population Health Thomas Jefferson University  Philadelphia Pennsylvania USA"},{"name":"Department of Surgery Imperial College London  London UK"},{"name":"Sheps Center for Health Services Research University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1807\u201059322009001000011"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(16)30003\u20101"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)30001\u20101"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(24)00558\u20108"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002927"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad570"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2308192"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad690"},{"issue":"1","key":"e_1_2_11_10_1","first-page":"53","article-title":"Perioperative Surgical Home, Fixing a Fragmented Process to Improve Quality of Care","volume":"116","author":"Duncan M. 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