Development of an Integrated Model for Enhancing Surgical Capacity in Community Hospitals: A Case Study of Laplae Hospital

Objective: To pilot-evaluate an integrated model for enhancing surgical capacity at Laplae Hospital (Uttaradit Province) under Thailand’s “One Province One Hospital” policy. Materials and Methods: A mixed-methods pilot study with a predominantly quantitative, one-group pretest-posttest quasi-experimental design was conducted between October 2024 and March 2025. The intervention comprised personnel development, infrastructure and technology enhancement, and surgical service system development. Data comprised satisfaction scores (baseline to six months), SF-36 (baseline and one month), clinical and administrative records, and interviews with 12 stakeholders. Analyses used paired t-tests, repeated measures ANOVA, Fisher’s exact test, and content analysis. The 45 patients were the complete census of eligible patients, so findings are preliminary. Results: Forty-seven procedures were performed in 45 patients. Monthly case volume rose 4.5-fold (2 to 9). One day surgery reached 100% of eligible cases by March 2025. One minor complication occurred (2.1%); there were no major complications, unplanned readmissions, or unplanned referrals. Satisfaction improved from 3.1±0.7 to 4.1±0.5 (p<0.001). SF-36 physical domains improved significantly at one month (Bodily pain +21.6, Role limitations-physical +19.4, Physical functioning +16.3, p<0.001). Referrals to Uttaradit Hospital fell from 23 to 7, significantly only for hernia (11 to 3, p=0.011). Key success factors were leadership, provincial hospital collaboration, and progressive implementation; the main barrier was limited perioperative nursing staff. Conclusion: The integrated model appears feasible for strengthening surgical capacity in a community hospital. Given the small, single-site, uncontrolled design, findings are hypothesis-generating and require confirmation in adequately powered multi-site studies.