Summary of the Dissertation: Managing the quality of medical examination and treatment at public hospital in Viet Nam

The thesis is completed:

MINISTRY OF EDUCATION AND TRAINING

MINISTRY OF HOME AFFAIRS

National Academy of Public Administration
Proposed supervisor:
1. Assoc. Prof. PhD. Le Thi Van Hanh

NATIONAL ACADEMY OF PUBLIC ADMINISTRATION

2. Prof. PhD. Nguyen Cong Khan

Reviewer 1: ……………………………………………………………

CAO HUNG THAI
Reviewer 2:………………………………..……………………………

Reviewer 3: ……………………………………………………………

MANAGING THE QUALITY OF
MEDICAL EXAMINATION AND TREATMENT
AT PUBLIC HOSPITAL IN VIET NAM

The thesis will be presented to the Evaluation council at National
Academy of public administration

Major: Public Administration Management

Place: Room…..……, National Academy of public administration. No: 77 –

Nguyen Chi Thanh road – Dong Da district – Ha Noi

Major code: 62 34 82 01

Time: ………….. …….………

The thesis can be found at the National Library of Vietnam or the library of
National Academy of Public Administration.

SUMMARY OF THE DISSERTATION


INTRODUCTION
1. The urgency of the research
When it comes to the quality of human life, health issues are often
mentioned. Health is a state of entire physical, mental and social comfort, not
merely a condition of suffering no disease or injury. Having good health is one
of the basic human rights in any race, religion, politics or any socio-economic
condition.
Therefore, health care is one of important goals in the development
process and is placed in a high position: "Health is the most precious human
resource, one of the basic requirements for people to live happily, and an
important factor in economic, cultural, social and country-defense
development”.
Human health is influenced by many factors such as the natural
environment (soil, water, air, climate), social environment (culture, education,
labor, studying), biological condition and genetics; individuals’ awareness of
taking care of their own health (physical training, personal hygiene, diet and
living habits) and, especially, medical activities. In order to have good health, it
is crucial to prevent disease proactively and positively, practice food hygiene

and safety projects, enforce labor, school, and environmental sanitation,
periodic health examination, expanded program on Immunization, quarantine,
disease prevention, and only sick people and accident victims will come to
health agencies to get first aid, medical examination, treatment, and functional
rehabilitation depending on their health status and injuries. It can be said that
health and medicine have a close and organic relationship.
In the development process, depending on political institutions and
socio-economic condition, each government has its own direction to develop
national health, such as issuing strategies, policies and using government
management tools to intervene, regulate, support medical activities as well as
control health service quality, so as to ensure the effectiveness and efficiency of
government management and the rational use of the budget invested in health.
Also, it is essential to help citizens easily access good quality health services,
meeting the increasing health care needs, in order to contribute to social equity
and security.
In developed countries such as Northern Europe countries (welfare
state), United States of America, England, France, Japan, Korea, etc., health
service provision, in general, and medical examination and treatment services,

in particular, are noticed to invest for development. The government
management of providing health care services is quite complete, from the legal
framework to the government management apparatus, to the support, inspection
and supervision tools, ensuring health care services provided in compliance
with the law and quality assurance. New quality management methods are
continuously applied by hospitals, such as comprehensive quality management,
ISO quality management, JCI hospital quality assessment, etc., therefore the
quality and effectiveness of medical examination and treatment are maintained
and constantly improved, satisfying the patients.
In the past 20 years, Asian countries such as Singapore, Thailand,
Malaysia have had policies to manage the health care services quality through

legal instruments and national quality improvement programs; the application
of ISO and JCI quality management has also been implemented and promoted
by health facilities. Numerous hospitals have built and maintained the "good
quality hospital" services admitted by the region and the world, meeting the
demand and attracting citizens to seek medical treatment.
In our country, during the Renovation period, especially since the Law
on Examination and Treatment was issued and took effect from January 1,
2011, it made a significant milestone in management activities as well as in
health care services supply. With the goals of placing patients at the center of
health care, ensuring the safety of patients, implementing medical examination
and treatment publicly, fairly and effectively, encouraging the application of
hospital quality management standards in health facilities; Health care, in
general, and medical treatment, in particular, have experienced a huge
innovation and amelioration. The system of policies and laws on medical
examination and treatment continues to be improved; The government hospital
system is concerned to invest to upgrade both facilities, equipment, and quality
of human resources; The health care expertise of hospitals has been gradually
strengthened, contributing to the health care service quality development,
satisfying the patients.
However, the work of medical examination and treatment in the past has
suffered from shortcomings and backwardness, facing difficulties and
challenges:
First, whilst the health care service demand of citizens is rising both in
quantity and quality, the capacity to provide medical examination and treatment
services of health facilities is still limited, not yet met the service scope and
quality. Currently, disease patterns in Vietnam are increasingly diverse and


complex: non-infectious diseases gradually increase, infectious diseases are
more complicated, numerous new epidemics emerged and so on. On the other

hand, the socio-economic condition improved, incomes of citizens accelerated,
transportation was also more convenient. This leads to increasing demand for
medical examination and treatment, although hospitals have not been invested
to upgrade in time, a huge number of facilities and equipment have been
deteriorated, and the competence of medical staff is still limited. Hospital
overload has occurred at Central hospitals and upper-level hospital in Hanoi
and Ho Chi Minh City.
Second, the context of globalization and world integration leads to rapid
changes in medical technology, especially Information Technology. Therefore,
it is crucial for technology and management system of Vietnamese hospital to
be promptly transformed in order to provide good quality and safe health care
services. In other words, the quality of health care services in Vietnamese
hospital must meet a minimum quality standard and be constantly improved, in
accordance with regional and world quality.
Third, government hospitals play a major and important role in providing
medical examination and treatment services to people. As of December 31,
2016, there were 1424 hospitals overall with 252,600 beds, including 1252
government hospitals (88%) with 239,544 beds (95%) and 172 private hospitals
(12%) with 13,056 beds (5%). Thus, public hospitals play a key role in
providing health care services.
In addition, the goal of fairness, efficiency, and development in health
care has been emphasized thanks to the change in the management system of
public hospitals. The public hospital is established, invested, and issued the
rules of operation, financial, human resource management mechanism by the
Government, aiming to accomplish the national goal. Currently, the
Government policy is implemented to grant autonomy and self-responsibility to
hospitals, creating a good condition for them to develop their full potential.
Hence, there must be management and control tools to evaluate and analyze the
cost-effectiveness.
Fourth, medical examination and treatment is a special type of service,

related to human health and life. Users and beneficiaries of health care services
are patients, who need to quickly and promptly go to appropriate health
facilities when they get sick for emergency examination and treatment. Thus,
they rarely have a chance to choose a suitable health facility.

According to the above-mentioned theoretical and practical basis, as a
civil servant who has worked for a long time in the healthcare industry and is
currently working at the Medical Services Administration, the agency with the
function of advising the Minister of Health on national management of medical
examination and treatment, it is obvious to be aware of the limitation,
backwardness, difficulty and the current challenges in managing health care
quality. These issues need to be tackled soon, in order to improve the quality of
medical examination and treatment for citizens.
There for the purpose of creating scientific evidence for developing
policies and completing the management mechanism, as well as solving these
above problems, the subject: "Quality management of Medical service in
Vietnamese public hospitals" has been chosen.
2. Research objectives and tasks
2.1. Research objectives
On the basis of theoretical and practical research on the quality of health
care services, this dissertation proposes a number of solutions to strengthen the
quality management of medical examination and treatment services in public
hospitals, contributing to the national mission of protecting, taking care, and
improving citizens’ health.
2.2. Research tasks
In order to achieve the above aims, this dissertation will focus on
performing the following main tasks:
- Overviewing the research situation related to the dissertation topic,
analyzing and clarifying not only the contents that can be inherited but also the
content and issues needed to make the continue studies.

- Researching, synthesizing and supplementing the theoretical basis for
managing the quality of medical examination and treatment in hospitals: clarify
the related concepts and factors; analyze the quality management content
including Government management and hospital management; analyze quality
management models and methods, and the international experience in health
quality management.
- Surveying, analyzing and assessing the status of the quality
management of medical examination and treatment in public hospitals in our
country currently: analyze the achievements, limitations, and the causes of
limitations.


- Summing up perspectives, orienting and proposing a number of health
quality management methods in public hospitals, which are suitable to the sight
and orientation of the Government and Communist Party of Vietnam, meeting
the citizen demand of protecting, taking care, improving health and
international integration.

This dissertation using these research methods: methods of analyzing
secondary sources; methods of sociological investigation; survey interview
method.
5. Research questions and scientific hypothesis of the subject
5.1. Research questions

3. Subjects and scope of research
3.1. Research subjects
The subject of the dissertation is managing the quality of medical
examination and treatment in the hospital, including Government quality
management and hospital quality management.
3.2. Research scope

The dissertation defines the scope of research as follows:
- Content: focus on researching quality management activities of medical
examination and treatment services in public hospitals including:
+ Government management activities (Government subject), limited to
central management agencies.
+ The quality management of medical examination and treatment
services at hospitals (hospital subject), limited to Central hospitals under the
Ministry of Health.
- Time: the period from 2011 to present, when the Law on Examination
and Treatment has been taking effect. During the analysis and evaluation
process, data before 2011 can be used.
- Space: Research on quality management of medical examination and
treatment services in public hospitals throughout the country.
4. Methodology and research methods
4.1. Methodology
The dissertation is studied on the basis of Marxist-Leninist methodology
about dialectical and historical materialism; Ho Chi Minh thought and the
perspective of the Communist Party of Vietnam on the medical industry, in
order to interpret and analyze the quality management activities of public
hospitals in Vietnam.
4.2. Research Methods

This dissertation will address the following main research questions:
First, what is the definition of the quality of medical examination and
treatment; and quality management of medical examination and treatment in
public hospitals? What is it measured by? What content is included? What
factors does it depend on? How to manage the quality of medical examination
and treatment in countries around the world, and what lessons can be learned to
apply in Vietnam practice?
Second, nowadays, what is the status of quality management of medical

examination and treatment in public hospitals, including Government
management and hospital management? How is the pilot application of the
quality assessment criteria of medical examination and treatment in hospitals
implemented?
Third, what are the perspectives and orientations for managing the
quality of medical examination and treatment in hospitals nowadays? What
kind of Government management solutions need to be implemented to improve
the quality of medical examination and treatment in Vietnamese public
hospitals in the upcoming time?
5.2. Scientific hypothesis
From the research questions, the research hypothesis of this dissertation
is:
First, the concepts related to the quality of medical examination and
treatment and quality management of medical examination and treatment in
hospitals are unclear, differently understood; content and factors related to
quality management of medical examination and treatment in hospitals have
not been clarified; there are differences in the quality management of medical
examination and treatment in Vietnam and other countries in the world.
Second, there are limitations and shortcomings in quality management of
medical examination and treatment in Vietnamese public hospitals; no standard
measuring toolset for evaluation; not yet meet the demand of medical
examination and treatment of citizens.


Third, it is essential to create a new solution and to change the way of
quality management of medical examination and treatment in public hospitals,
in accordance with the perspectives and orientations of the Government and
Communist Party of Vietnam, meeting the rising health needs of the people and
the trend of international integration.
6. New contributions of the dissertation

for health civil servants, officials, managers in research, performing
professional tasks and policy-making in medical examination and treatment
field.
8. Content of the thesis
The dissertation layout, except for the Table of contents, Introduction,
Conclusion, References, Appendix, has 4 chapters:

The dissertation is completed, is an in-depth research project specialized
in public administration management. This dissertation has some specific new
contributions:

topic;

- Through an overview of the research situation related to the dissertation
topic, an unfinished issue has been found that needs further research on the
theory and practice of the quality of medical examination and treatment and
quality management of medical examination and treatment in Vietnamese
public hospitals.

Chapter 3: Current status of quality management of medical examination
and treatment in Vietnamese public hospitals;

- Clarified concepts, content and related factors affecting the quality and
quality management of medical examination and treatment in hospitals; pointed
out the methods and models of quality management that are being applied in
developed countries, drawing lessons that can be applied to Vietnam.
- The dissertation has portrayed the actual situation of quality and quality
management of medical examination and treatment in Vietnamese public
hospitals (from the views of Government and hospitals).

- Proposing a number of new solutions to managing the quality of
medical examination and treatment in public hospitals, in accordance with the
perspectives and orientations of the Government and Communist Party of
Vietnam, meeting the increasing health demand of citizens and the trend of
international integration.
7. The theoretical and practical signification of the dissertation
The dissertation supplemented and enriched the theory of quality
management of medical examination and treatment in hospitals, especially
public hospitals; clarified some theoretical issues on Government management
for medical examination and treatment services, and also clarified the situation
and propose some solutions to improve the quality management of medical
examination and treatment in hospitals.
This dissertation can be used as a utility reference for researchers,
lecturers, and students in the research, teaching and learning at the training,
administrative, and health facilities. At the same time, it can also be a reference

Chapter 1: Overview of the research situation related to the dissertation
Chapter 2: Scientific basis for quality management of medical
examination and treatment in public hospitals;

Chapter 4: Orientation and solutions for managing the quality of medical
examination and treatment in Vietnamese public hospitals;
Chapter 1: OVERVIEW OF THE RESEARCH SITUATION RELATED
TO THE DISSERTATION TOPIC.
1.1. Research projects related to the topic
1.1.1. Research projects on Government quality management of medical
examination and treatment
Foreign works
- The book "Measuring and managing medical quality" by authors
Maimunah A. Hamid, Sondi Sararaks, AFAI-Assaf, Low Lee Lan of the Health

System Research Institute of Ministry of Health Malaysia pointed out that
Health quality management is closely related to the improvement of health
care.
- The study of Ali Mohammad Mosadeghrad on factors affecting the
quality of health care services, with the main purpose is to identify factors
affecting health quality in Iran.
- Research by Jack A. Meyer, Sharon Silow-Carroll, Todd Kutyla, Larry
S. Stepnick, and Lise S. Rybowski in July 2004, about hospital quality
components for success, generalization and lessons learned.
- Buciuniene et al (2006) studied the attitudes of managers on the quality
management system at nursing and supporting hospitals in Latvia. This study


aims to understand the attitude of hospital managers on the application of the
quality management system.

people. This dissertation also provides more specific, scientific arguments on
the inner content of Government management by law in health science;

- Study of Heidari Gorji AM, Farooquye JA. Through the comparison of
health care services in three countries, based on the Baldrige health care criteria
to evaluate excellent performance in 2009-2010 and the guidelines for hospitals
proposed by The American Hospital Association.

- Author Pham Van Tac in the Public Administration Doctoral
dissertation "Government management of a contingent of post-graduate
specialists in the medical industry" has studied theoretical, practical issues and
the solutions to improve Government management of a contingent of postgraduate specialists in the healthcare industry.

- Selbmann HK research on assessment and recognition of health care

quality in Germany shows an increasing number of calls to assess and confirm
hospital quality,in order to see transparency in the health care system in
Germany.
Domestic works
- The "Continuously training on hospital quality management" by the
Medical Services Administration - Ministry of Health, which used for hospital
leaders and managers cadres, was published in 2015 with 6 main following
topics include: General overview of hospital quality management, Guidance on
hospital quality management, Quality measurement, Role of hospital leaders,
Staff encouragement and Strategic planning methods to improve hospital
quality.
- The book "General report of the Medical industry 2012, improving the
quality of medical examination and treatment services", which published in
2012 has updated the health status and the influencing factors, also updated the
status of the health care system and fulfilled the tasks set out in the 5-year
Health Plan 2011-2015.
- The book "Good practices of patient safety and quality management in
some Vietnamese hospitals", written by Luong Ngoc Khue and colleagues in
2016, included 4 main parts: (1) Applying hospital quality assessment criteria;
(2) Introducing quality management and quality improvement lessons; (3)
Lessons on practice using hospital quality assessment criteria for quality
improvement; (4) Introducing measures related to patient safety, comparing to
criteria in the hospital quality assessment criteria.
- Author Nguyen Huy Quang in the Doctoral dissertation "Government
management by law in the Healthcare industry in our country nowadays"
analyzed the inner function, clarifying the concept of the healthcare industry as
medical activities. Hence, it is obviously to specify the medical industry as one
of the factors that positively affect health, particularly, protects the health of

- Author Nguyen Minh Loi in the Public Administration Doctoral

dissertation "Government management of training human resources for nursing
in Vietnam at the present time" has analyzed the internal concepts and
proposed the concept of Government management of training human resources
for nursing, determined the contents of Government management and analyzed
the factors related to Government management activities, proposed solutions to
improve Government management of nursing training.
- Author Le Quang Cuong in the article "Health care and health markets"
has concluded: Owing to the feature of health, health care services, and health
care market, the Government plays a significant role in management and
provision of health care services.
- Author Truong Bao Thanh in the Ph.D. dissertation "Competition
policy in providing health services in Vietnam" has systematized and clarified
the theoretical basis on competition policy in the health service supply chain,...
the issues need to be resolved can be found; some perspectives and solutions
should also be proposed to improve competition policy in the health service
supply chain in Vietnam at the present time.
- Author Le Thu Thuy in the Political Economy Ph.D. dissertation in
2018 "Improving the quality of health care services of central hospitals in
Hanoi" clarified the role of the Government and the market; studying the
experiences of other countries to draw lessons about improving the quality of
health care services in hospitals,... proposing basic solutions to improve the
quality of health care services in central hospitals in Hanoi.
- Author Trinh Thi Ly with the research "Model of hospital quality
management and solutions proposing for application in Hai Phong" has studied
and analyzed the hospital quality management model, thereby selecting the
appropriate model to apply hospital quality management in Hai Phong.
- Author Vu Tien Dung in the Public Administration Doctoral
dissertation "Government management in fostering officials with postgraduate

qualifications in special grade hospitals in Vietnam" has introduced the
concept, internal contents of Government management, factors affecting
Government management activities and proposed solutions to improve
Government management in fostering officials with postgraduate qualifications
in special grade hospitals in Vietnam.
- The research evaluating the status of implementing medical service
quality management by the Medical Services Administration in 2012. This
research has just assessed the status of implementing quality management of
hospitals without assessing the implementation of Government management
agencies.
1.1.2. Hospital quality management research
Foreign works
- First, research of Alaraki M.S. about Total quality management (TQM)
provided a solution for patients’ safety and significantly helped improve
hospital operations.
- Research of Nicolay CR, Purkayastha S, Greenhalgh A, Benn J,
Chaturvedi S, Phillips N, Darzi A. about the implementation of a Quality
improvement (QI) method described serving the surgical care and analysis of
statistical results.
- Research of Sussmane JB, Torbati D, Gitlow HS. had the purpose of
measuring and assessing the quality of health care at Pediatric intensive care
units (PICU) during plasma replacement.
- Research by Revere L, Black K. on integrating 6 Sigma into existing
TQM program, facilitated the process improvement through detailed data
analysis.
- Research by Lebuisson and colleagues at a French hospital had the goal
of achieving ISO 9001-2000 certification in the refractive error laser treatment.
- A recent study by Lorenzen and colleagues at the Radiotherapy
Department of a university hospital in Germany has assessed the change of the
department quality indicators after applying the Quality Management System

according to ISO 9001- 2000.
- Another study by Helbig and colleagues is performed at an outpatient
clinic of a university hospital in Germany. This study concluded that a
systematic assessment of the current organizational structure of outpatient

clinics, using the current situation analysis to identify the problem and its
causes, is crucial to improve service quality.
- Beholz S1, Koch C, Konertz W. studied certification and quality
management of a cardiology center at a University based on ISO 9001-2000.
- Beholz et al in 2003, also conducted research to assess the impact of a
quality management system based on ISO 9001-2000 at the cardiology center
above-mentioned.
- Research by Duvauferrier R1 et al, had the purpose of transitioning
from the combining TQM management model based on "EFQM" (European
Foundation for Quality Management) model, and quality assurance based on
the ISO 9000-1994 certification model; to the ISO 9001-2000 certification
model, applied to process management and the integration of ensuring
management and quality.
- Articles of Pereira P, Westgard JO, Encarnação P, Seghatchian J, de
Sousa G. discussed good manufacturing practices and good laboratory practices
as well as the trends of standards.
- Research by Seki A, Kugawa S, Miya T. showed that it is more than 10
years since the International Organization for Standardization (ISO) 15189,
which issued in 2003, has regulated the quality and capacity of medical
laboratories.
- Research by Rizzi F, Pizzuto M, Lodetti L, Corli O, Da D D, Damiani
ME, Mihali D, Piva L, Saita L, Vinci M, Bonaldi A, which described the main
results of the certification process based on JCI criteria for the hospital home
model, are implemented by palliative care clinics of 7 hospitals in Milan for
cancer patients.

- Research by Tekkesin N, Kilinc C, Keskin K. at Memorial Hospital has
a laboratory service that provides Easy Stat and regular testing. The use of
standardized processes and the regular staff training, combined with an
exchange of the referral management system based on existing research with an
electronic system, can increase safety in the pre-analysis process.
Domestic works
The study of Nguyen Thi Xuyen and colleagues in the period from 20072008 at 5 hospitals applying the ISO 9001-2000 quality management system
and 4 hospitals that have not applied ISO have drawn conclusions: Application
of ISO 9001-2000 quality management system has improved the effectiveness
of hospital management and the professional quality of hospitals.


1.2. Reviews and evaluations on the research projects have been
mentioned
1.2.1. The inherited content from those research projects
First, the overview reports have clarified the urgency and benefits
contents of implementing quality management activities, in general, and quality
management activities in the healthcare industry, in particular; current quality
management principles and trends; and a number of concepts and factors in
term of quality and quality management in the medical industry.
Second, the overview researcheshave also confirmed that health service
is a type of service but have its own features, directly related to human health,
is a lack of competitiveness and incomplete market.
Third, the overview reports both domestic and foreign showed the
important role of the Government in controlling the quality of health services
and in requiring Government management by law in the healthcare industry.
Fourth, the overview researches have shown that a number of quality
management models are being applied by countries around the world,
especially developed countries, to improve the quality of medical examination
and treatment and the operational effectiveness of medical organizations, such

as TQM, PDCA, 6 sigma, Lean, ISO models.
Fifth, the overview studies have also clearly pointed out some
Government management solutions for a contingent of post-graduate specialists
and the development of human resources for nursing in Vietnam.
Sixth, the review studies indicated that measuring and assessing the
quality of health services needs to have a set of tools including evaluation
criteria, evaluation criteria group on input, process, and output condition.
1.2.2. The content has not been mentioned or clarified in the overview
researches
First, the overview studies have mentioned the urgency and advantages
of quality management in the healthcare industry in general for countries
around the world but have not mentioned deeply and specifically for the
practice condition in Vietnam.
Second, the overview reports have referred to general concepts related to
quality and medical quality management but approached excessively different
aspects.

Third, there are a number of overview documents and projects that refer
to the quality of health service management but have just stopped in several
aspects of the Government management in the medical industry or only
mentioned the implementation of quality management in hospitals.
Fourth, the review studies have mentioned factors affecting the quality
and quality management but only in the scope of a hospital or hospital
department.
Fifth, new management models applied in hospitals were mentioned in a
huge number of studies by foreign authors, for instance, management applying
ISO standards, PDCA method, 6 sigma, Lean, whereas domestic research has
mentioned the application of ISO model in hospitals.
Sixth, the overview studies also showed several sets of criteria to assess
the quality of medical examination and treatment, which are applied by some

developed countries, and the set of criteria for quality assessment that piloted in
Vietnamese hospitals.
Seventh, no study has been conducted for research on the current status
of medical examination and treatment quality management or quality
assessment of medical services in Vietnamese hospitals, for instance, clarifying
the organization has the evaluation function and the way to evaluate.
1.2.3. The research direction of the dissertation
First, it is essential for the dissertation to clarify both the theoretical and
practical basis of the health care service quality management issue, such as:
clarifying concepts related to the topic; analyzing the hospital quality
management of medical examination and treatment in both Government
management and hospital management contents; quality management of
medical examination and treatment; analyzing and studying models and lessons
learned from countries around the world to choose the application in Vietnam
in the field of medical care quality management.
Second, researching and assessing the status of quality management of
medical services in hospitals. Proposing standards, regulations and
implementing quality management activities, so as to clarify the factors
affecting the quality management of medical examination and treatment in
hospitals.
Third, study the sight and perspective of the Government and
Communist Party of Vietnam on national health, thereby proposing solutions


for quality management of medical examination and treatment in Vietnamese
public hospitals in the new situation.
Conclusion of Chapter 1
The results of the review showed that whilst several clarified contents
and issues need to be inherited, the issues related to the topic but have not been
mentioned or incompletely, generally, incomprehensibly mentioned are in need

of further research to clarify; Also, viewpoints and orientations of quality
management and specific solutions are essential to enhance the quality of
medical examination and treatment in public hospitals nowadays.
Chapter 2: SCIENTIFIC BASIS FOR QUALITY MANAGEMENT OF
MEDICAL EXAMINATION AND TREATMENT IN PUBLIC HOSPITALS
2.1. Quality of medical examination and treatment in hospitals
2.1.1. Hospital and hospital roles
2.1.1.1. Hospital definition
Hospital is a facility for medical examination and treatment with
minimal infrastructure and equipment meeting the standards and requirements
for medical examination and treatment according to regulations; with suitable
human resources and practitioners (granted practicing certificates); licensed by
authorized Government agencies for medical examination and treatment
activities; has executive management apparatus and functional departments,
distributes the use of resources for organizing medical examination and
treatment activities and scientific, technical, and administrative advances
application to maintain and improve the quality of medical examination and
treatment, meeting the increasing health care demand. In addition, the hospital
also carries out prevention, training, scientific research, mentoring and
international cooperation activities.
2.1.1.2. Roles of hospitals and public hospitals
Hospital is an integral part of the health system and is an important
component in providing health care services to citizens.
- Hospital is the face of the health care industry, with the basic functions
and missions of comprehensive health care for the people and the community,
including health prevention, treatment, and improvement; including even
scientific research, medical staff training, and international cooperation in the
form of both inpatient and outpatient treatment.

- Vietnamese public hospital is a Government service unit with an

important and key role in providing medical services.
2.1.2. Quality of medical examination and treatment in hospitals
2.1.2.1. Definition of Medical examination and treatment
In a narrow sense, the medical examination and treatment of physicians
(practitioners) is to conduct examination (ask for medical questions, study
medical history, physical examination) and appoint tests (if necessary) to
diagnose disease, then use recognized medical methods, techniques and
licensed drugs for patients’ emergency treatment, treatment, taking care and
rehabilitation.
In a broad sense, it is the hospital medical examination and treatment
activities, that is, the activities of managing, administering and using human
resources (practitioners and medical staff), infrastructure, equipments,
finance... and medical methods, techniques for medical examination, diagnosis,
first aid, treatment, taking care and rehabilitation for patients.
2.1.2.2. Definition of Quality of medical examination and treatment
According to W. Edwards Deming, when quality and efficiency increase,
volatility decreases. Joseph Juran believes that quality must firstly identify
customers.
Based on the processes, missions, and expectations of the results,
"Quality does not exist randomly but is the result of decisive intent, serious
effort, smart direction, and skillful execution". This is a definition of quality
with the processes, missions, and expectations of the results.
Based on the industrial model, "Quality considers customers as the
center. Therefore, meeting the demands and expectations of customers is the
main purpose of quality”.
Based on the basic principles of leadership and management, "Quality is
working in the right way from the first time and making it better in subsequent
times."
Quality in health care industry has diversely different approaches:
+ From the perspective of the patient and their family, as the beneficiary

of the service, the customer: concerning the type of health care and its
effectiveness.
+ From the perspective of the service providers (medical staff or health
facilities): paying more attention to the scientific process of health care, the


ability to diagnose and treat a case but paying little attention to convenience
and even focusing less on the "care" aspect.
+ Managers also have a different approach to quality. Managers believe
that quality is accessible and acceptable ability, effectiveness, suitability, and
effectiveness in providing health care services.
Another approach: Quality is an incremental improvement. In the
opinion of the National Roundtable on Health Care Quality, the University of
Massachusetts: "Quality of care is the improvement level of the ability to
achieve health outcomes for individuals and the public, with possible medical
services, and be consistent with current professional knowledge”.
According to Christian Grönroos: The quality of medical examination
and treatment combines two separate components: operational quality and
professional quality.
According to Donabedian A: Quality of medical services includes
applying medical science and technology in the best way to maximize health
benefits without increasing the corresponding risks, caused by this technique.
According to John Øvretveit: Quality of medical examination and
treatment is a form of effective organizing resources to meet the health care
demands of those most in need for health care and prevention, not causing
waste but ensuring to fit higher requirements.
According to WHO, the quality of medical examination and treatment is
the level of achieving the internal purposes of a health care system, to improve
health and meet the reasonable expectations of citizens.
In summary, there are different approaches to quality of medical

examination and treatment, however, according to the author, when
approaching the concept of medical examination and treatment quality, 6
following criteria and quality aspects are needed to pay attention:
First - Safety: Providing medical examination and treatment services
with reduced risks for service beneficiaries. This is consistent with the goal of
the Law on Examination and Treatment, the safety of patients, which is the
most important and necessary thing.
Second - Effectiveness: Providing medical examination and treatment
services based on evidence and must bring about health improvement for
individuals and communities, whereas continuously enhancing the quality to
meet the needs of patients.

Third - patient-centered: Providing medical examination and treatment
services ought to take into account the interests and aspirations of individual
service users and the cultures of the communities. The current goal of both the
Law on Examination and Treatment and the entire health care system is to
place patients at the center, satisfying the patients.
Fourth - Timely: Medical examination and treatment services are
provided promptly, reasonably geographically, and in facilities that have the
skills and resources appropriate to the medical requirements;
Fifth - Efficiency: Providing medical examination and treatment services
with maximum use of resources and avoid waste;
Sixth - Equally: Providing medical examination and treatment services
with no difference in quality based on individual characteristics such as gender,
race, ethnicity, geographical position, or socio-economic status. It is crucial to
fairly implement in the health care system.
2.2. Quality management of medical examination and treatment in
hospitals
2.2.1. Definition of quality management of medical examination and
treatment in hospitals

According to GOST 15467-70, quality management (QM) is to build and
maintain the inevitable quality level of products in designing, manufacturing,
circulating and consuming process.
A.G. Robertson, a British expert on quality, said: QM is defined as a
management system to build the process and to coordinate efforts of different
units, therefore maintaining and enhancing the quality of organizations.
A.V. Feigenbaum, an American scientist, believed that: QM is an
effective and unified system, combines various departments within an
organization.
- Professor, Dr. Kaoru Ishikawwa, a famous expert in the field of QM
defined that: QM is researching, developing, designing, manufacturing and
maintaining the most quality, economical, and useful products for consumers,
and always try to satisfy the consumers.
Philip Crosby, an American expert in quality defined QM as a systematic
means, ensuring the respect for all components of an action plan.
International Organization for Standardization ISO 9000 stated that: QM
is an activity, which has a general management function, aimed at setting


policies, objectives, responsibilities and implementing them through measures
such as quality planning, quality control, quality assurance, and quality
improvement within a quality system.
Therefore, Quality Management includes main activities such as quality
assurance, quality control, quality improvement, quality assessment.
Definition of quality management of medical examination and treatment
in hospitals
In conclusion, quality management of medical examination and
treatment in hospitals is understood as: "(1) The overall management activities
of the Government includes the formulation of policies and regulations;
performing inspection, supervision, and evaluation; as well as measures to

handle violations; so that regulations are implemented and (2) Hospital
activities include the implementation of Government policies and regulations;
application of management measures and methods, in order to ensure, maintain
and improve the quality of medical examination and treatment in hospitals.
According to the author research, 96.65% of respondents agreed with this
definition.
Diagram. The quality management system of medical examination and
treatment in hospitals

Government quality management of medical examination and treatment
– macro-management and Hospital quality management - micromanagement
have an organic and close relationship, whereby Government management
plays a key role. Government management has an orientation feature, ensuring
the quality of health care services in hospitals, whilst hospital quality
management has a promotive role to improve the quality of health care services
in hospitals.
2.2.2. Content of quality management of medical examination and
treatment in hospitals
2.2.2.1. Government quality management of medical examination and
treatment
Management is the impact process of the management subject to the
management object by certain tools and methods to achieve the objectives, or
in other words, it is the organizational and directional impact process of the

management subject to the management object to achieve the purposes.
Management functions include planning, organization, leadership,
administration, human resources, finance, inspection and handling of
violations.
Government management, an authorized activity of the Government, is
permitted to use Government power to regulate social relations. Government

management is considered as a functional activity of the Government in term of
social management, also can be considered as a special functional activity.
Government management, in a broad sense, is the entire operation of the
Government apparatus, from legislative, executive activities to judicial
activities.
Government management of hospital quality of health care services is
the controlling and influencing management objects by the Government
through its legal system, policies and organizational system of management
agencies, in order to ensure and protect the legitimate rights and benefits of
patients and practitioners, therefore achieve the goals of improving the quality
of health care services, the safety of patients and the assurance of social
security. Accordingly, the Government issued quality standards and
requirements to achieve quality standards through strategies, programs, plans,
indicators...; Hospitals are also supported with the institutional system and the
necessary resources to achieve quality standards, but discipline could be
imposed if the quality standards have not been met.
The subject of Government management of medical examination and
treatment activities is the Government with the agencies system which divided
into levels from the central to local levels and including three areas: legislative,
executive and judicial, in which Administrative management (executive) of
medical examination and treatment is a very substantial field. The object of the
Government management of medical examination and treatment is
organizations, individuals, health facilities, practitioners and patients.
The content of Government management of medical examination and
treatment in hospitals includes:
a) Develop and organize the implementation of strategies, programs, and
plans for quality management in hospitals. Formulating strategies and programs
on quality management of medical examination and treatment must ensure the
requirements: First, exactly assessing the status of medical examination and
treatment quality, quality management of medical examination and treatment

currently, the difficulties and challenges, limitation and their causes; Second,


identifying the objectives and trends of quality, QM, medical system
development and health care demands of people, requirements for socioeconomic development, regional and world integration trends; Third,
identifying key solutions to enhance quality management of medical
examination and treatment, in accordance with the current status, situation,
requirements for socio-economic development, and the general development
trend of the country.
b) Developing and implementing laws on quality management of
medical examination and treatment: Law is a tool for the Government to
maintain its dominance, perform its functions and duties. The legal system on
quality control must be objective, consistent with the characteristics and
features of the healthcare industry, in general, and the field of medical
examination and treatment, in particular, and at the same time meeting these
requirements: First, regulations on operating condition for health facilities with
different types such as hospitals and clinics... Regulations on minimum
standards to ensure the quality of medical examination and treatment in
hospitals; Second, regulations on competency standards for practitioners and
the hospital leaders such as practitioners must have a practicing certificate and
can only work within the limits of professional activities granted in the practice
certificate; Third, regulations on organizational structure and personnel
including officers have practice certificates, other staffs of health facilities, and
QM organizational apparatus and human resources of agencies; Fourth,
regulations on the roles and responsibilities of stakeholders in health care
quality management, support fettle such as training, calling for funding for QM
activities.
In order for the promulgation and implementation of the law on quality
management to go into real life, the formulation and promulgation must ensure
the following principles: Ensuring the appropriateness, priority and urgent

issues in health care quality management need to be properly identified; Ensure
the legality and consistency of legal documents. The formulation of legal
documents on quality management must be consistent with the Constitution,
Law and must not be contrary and overlap with other Laws, creating a
consistent legal document system; Comply with the order, procedures and
forms of issuing legal documents; Ensure the publicity and transparency in the
formulation process of legal documents; Ensure the reliability, impartiality and
fairness for subjects and objects related to medical quality management.
c) Organize the apparatus, develop the Government management group
and officers do quality management work in hospitals. The construction of the

organizational structure must ensure the following principles: First, the
structure, which is rational, streamlined and efficient, must be organized in a
unified way, consistent with the functions and missions; Second, there must be
a clear assignment of duties and responsibilities between constituent parts,
leaders, and officers, with a regulation system that assists departments to work
in coordination, avoiding overlapping; Third, along with building
organizational apparatus, it is essential to educate and develop a contingent of
cadres working in Government management and local quality management.
d) Resources mobilization and support for health care quality
management activities: In order to bring strategies, planning, and legal
programs into real life, together with organizational system and Government
management officials, it is indispensable to have resources including finance,
human resources, and facilities for health care quality management activities.
e) Inspection, supervision, and evaluation of health care service quality
management activities: Inspection, one of the momentous contents of
Government management by law, has a purpose of ensuring the management
apparatus operates in accordance with the law and also consolidating the
effectiveness and efficiency of Government management.
2.2.2.2. Quality management of medical examination and treatment in

hospitals
a) Hospital quality management system.
- Elements of the hospital quality management system: According to the
International Organization for Standardization, a quality management system
consists of 3 elements: organizational structure; regulations that the
organization must comply with; and processes. Thus, the hospital quality
management system of medical examination and treatment will include the
following factors: Organizational structure of hospitals; The regulations that
hospitals must adhere to, include a variety of types such as professional
principles, standards, requirements, for instance: guidelines for diagnosis and
treatment, technical procedures, internal regulations, instructions, rules, etc.;
and Processes. The process is a collection of interrelated activities that turn the
input into the output.
- Formulation of hospital quality management system for health care
services: To begin with, it is essential to select a suitable quality management
system; After selecting, coming up with construction planning, includes:
building a system of overall plan and a system of detailed plans, routes,
implementation time, funding and scope of application, etc.; Then build quality


management system including: setting up the organizational structure of
quality, appointing leaders, establishing departments, teams, coordination
groups, advice groups (if necessary), hospital councils such as Quality Council,
Scientific Council, Drug and Treatment Council, etc. In the next step, assess the
quality management system. Assessment is performed in 3 types: Internal
assessment - first party evaluation; Assessment of patients and their family second party evaluation; Certification assessment - third party evaluation.
Finally, maintain and develop the quality management system.
b) Some principles of building a quality management system in
hospitals: Customer orientation principles; Attach importance to human factors
in quality management; Quality management must be synchronous and

comprehensive; Quality management must be implemented simultaneously
with the requirements to ensure and improve the quality. Quality assurance and
quality improvement are two related issues; Quality management must ensure
the process characteristics; Examination principle.
c) Popular quality management models applied in hospitals: First, the
quality management system based on ISO standards. The administrative
innovation of some countries had mentioned this issue and considered it as a
way to improve the quality of citizen services - Second, PDCA Cycle. This
cycle, based on the scientific method developed by Francis Bacon in 1620,
described the 3-step process as "hypothesis" - "experimental" - "evaluation";
Third, 6 sigma model: 6 Sigma is a method that is proceeded rigorously,
scientifically, focusing on the effective implementation of recognized quality
management techniques and principles; Fourth, Lean management (Lean) has
originated from the Toyota Production System (TPS) and has been gradually
implemented throughout all activities of Toyota since the 1950s.
2.2.3. Factors affecting the quality and quality management of medical
examination and treatment in public hospitals
2.2.3.1. Political - administrative environment and Government policies
Government management of hospital quality of medical examination and
treatment services must be consistent with the perspectives and revolutionary
policies of the Communist Party of Vietnam, in accordance with the policies
and institutional systems of the Government.
The appropriate Government policies for medical examination and
treatment not only promotes, improves the Government management
effectiveness and efficiency of medical examination and treatment quality but

also ensures and meets the increasing demand for medical services of the
people.
2.2.3.2. The socio-economic globalization tendency and the sharp
development of science and technology.

Globalization along with the sharp development of science and
technology generated various positive results, leading to a rapid change in
medical science and technology. Globalization, besides the positive side, also
has negative aspects, which can be the loss of the national cultural identities or
the rapid disease transmission among countries and regions. Therefore, in term
of medical examination and treatment activities, it is indispensable to have
reasonable policies and solutions to solve the problems that globalization and
the development of science and technology resulted in, on both the positive and
negative aspects.
2.2.3.3 The disease patterns change, population fluctuation and the
increasing demand for medical examination and treatment of citizens.
Currently, changes in disease pattern have resulted from environmental
pollution, climate change, and socio-economic development. Noncommunicable diseases rapidly increase, while infectious diseases have been
complicated developing. Epidemics regularly occur, the risks of outbreaks,
especially of emerging infectious diseases rise, antibiotic resistance problem is
becoming increasingly serious, etc. The population growth, rapid aging speed,
the golden population stages had passed, etc... are some of the reasons for the
increasing demand for health care of people. Therefore, medical examination
and treatment services have been greatly impacted.
Thus, with the changing patterns of disease, population fluctuations and
increasing medical needs of the people, it is necessary to have appropriate
policies, strategies, and innovation in the management activities of medical
examination and treatment, especially quality management activities of medical
examination and treatment in public hospitals.
2.2.3.4. Human Resources
In quality management, people hold the leading position in the process of
quality formation, assurance, and improvement of products and services. In the
hospital quality management of health care services, human resources in the
management apparatus, as the contingent of professionals who directly provide
health care services, play a leading, decisive role and make a major impact to

quality and quality management of medical examination and treatment services.


2.2.3.5. Leadership and management
Leadership and Management are two terms that are widely used in
human, organizational and social management. In general management, one of
the success factors is the role of the leaders and the managers. For that reason,
all countries around the world are interested in developing a team of leaders
and managers for the future, although the level of concern may diverse. Many
countries have considered educating leaders and managers as a long-term
strategy of developing human resources in Government agencies and other
organizations.
Quality control of health care services in hospitals in the context of
globalization, international economic integration, strong progress of science
and technology, changes in operating mechanisms and financial mechanisms...
requires raising numerous good leaders and managers.
2.2.3.6. Operating mechanism and financial mechanism for the hospital
During the innovation period, the Government management role in the
health care system has been changed. When our country has converted a
centrally planned economy to a socialist-oriented market economy, important
innovations have been performed in the health care system: From a completely
free medical treatment regime to a part free medical treatment regime;
Implementing compulsory health insurance policies; Developing private
medical practice; Opening the market for medicines; and Renewing the
operating and financial mechanism for public health service units.
The above innovations, especially the innovations in the operating
mechanism and financial mechanism for public hospitals have a great impact
on the Government management system and the quality management of
medical examination and treatment in hospitals. Thus, in term of quality
management activities, this issue must be paid much attention to propose

appropriate solutions.
2.2.4. International experience in quality management of medical
examination and treatment and lessons for Vietnam
2.2.4.1. International experience in quality management of medical
examination and treatment
a) Experience in Government management of quality of medical
examination and treatment
Currently, a national strategy on quality has been applied in many
countries around the world based on a mixture of compulsory and voluntary

quality management. Policies, strategies, and plans for quality management of
medical examination and treatment are issued in the form of laws, decrees or
guiding circulars.
b) Experience in developing standards for assessing the quality of
medical examination and treatment in hospitals
The set of hospital quality standards was built based on the consensus of
agencies under the Ministry of Health, Medical Associations, Hospital
Associations based on the context and health system structure of each country.
The International Society for Quality in Health Care (ISQua) has issued the
basic principles and requirements framework for developing health facility
quality standards.
Version 3.0 in 2007 introduced 6 principles of building quality standards
include: First, improve the quality; secondly, focus on the patients and service
beneficiaries; Third, planning and implementing plans; Fourth, safety; Fifth,
formulating standards; Sixth, measuring standard.
In Thailand, a set of specific quality assessment indicators for health
service providers has been developed with a total of 42 indicators in 6 groups:
indicator group of general information on health facilities: 10 indicators ;
indicator group of facilities inputs: 7 indicators; indicator group of process and
clinical outputs: 10 indicators; indicator group of process and service outputs: 9

indicators; indicator group of management quality: 3 indicators; indicator group
of system and QM process: 3 indicators.
c) Experience in assessing and certificating implementation of quality of
medical examination and treatment in hospitals
The decade of the 1990s experienced a rapid development with the
establishment of hospital standards and quality assessment organizations in
European countries, Australia, the US, and some Asian, African countries.
Organizations for assessing and certificating hospital quality are usually
non-profit organizations, operating internationally or nationally.
As of November 2011, there are 19 organizations for assessing and
certificating quality accredited by IS Qua based on standards for external
quality assessment organizations introduced by IS Qua.
IS Qua also appraised hospital quality standards developed by standards
and quality assessment organizations. To date, 35 standard sets of 21
organizations have been appraised by IS Qua.


d) Experience in The Quality Assurance Programme of the Ministry of
Health (MOH) Malaysia
The goal of The Quality Assurance Programme is to ensure that patients,
their family members, and the community can benefit the most from the
services of the Ministry of Health with the available resources.
With national health indicators, the most common indicators are used to
assess health care quality. Indicators that are of great interest in different
regions are selected as general assessment indicators for most hospitals.
With specific hospital measurement indicators, certain deficiencies can
be identified for each hospital. After conducting a survey and assessing the
implementation of the hospital health care process, weaknesses will be
specified.
In the hospital condition, HSA is considered as a useful tool to develop

the skills of the quality assurance program.
The parts of the 8-step quality assurance program are conducted into a
closed cycle.
2.2.4.2. Some experienced lessons for Vietnam
First, improving the institution for quality management of medical
examination and treatment, based on that, building a legal framework for
quality management of hospital health care services.
Second, researching and applying the standards, models, and methods of
quality management.
Third, in terms of quality measurement, it is possible to develop a set of
tools for assessing hospital quality, applied throughout the country.
Fourth, mandatory requiring hospitals to develop quality management
programs or plans and implementing quality improvement of health care
services, meeting the satisfaction of patients.
Finally, establishing an accreditation/recognition organization for the
quality of medical examination and treatment to ensure professionalism,
objectivity, and independence in quality assessment.
CONCLUSION OF CHAPTER 2
Through studying, researching and referencing domestic as well as
foreign documents and research projects related to the theme of this
dissertation, and through using modern scientific research methods such as

secondary document analysis and comparative methods, Chapter 2 has clarified
the theoretical and practical basis for quality management of medical
examination and treatment in public hospitals. Chapter 2’s specific research
results are as follow:
First, this chapter clarified the concept of hospital, hospital classification,
the roles of hospital and public hospital in Vietnam respectively.
Second, this chapter clarified the following concepts: medical
examination and treatment, quality of medical examination and treatment,

quality management and lastly, medical examination and treatment quality
management in hospitals.
Third, this chapter analyzed and clarified the content of medical
examination and treatment quality management in hospitals. Accordingly,
medical examination and treatment quality management in hospitals consists of
2 levels: macro level – government management of quality of medical
examination and treatment and micro level - management of quality of medical
examination and treatment at hospital level.
Fourth, this chapter researched, analyzed and pointed out some related
factors affecting the quality and quality management of medical examination
and treatment in hospitals.
Lastly, this chapter studied, researched, compared international
experiences concerning quality management of medical examination and
treatment and concluded a lesson on quality management of medical
examination and treatment in hospitals that can be applied in Vietnam.
Chapter 3: CURRENT STATUS OF QUALITY MANAGEMENT OF
MEDICAL EXAMINATION AND TREATMENT OF VIETNAMESE
PUBLIC HOSPITALS
3.1. Current status of medical examination and treatment quality in
public hospitals
3.1.1. Overview of Vietnam’s health system
3.1.2. Overview of Vietnam public hospital system
3.1.2.1. Hospital network system
The system of public hospitals is divided into three levels: central
hospital; provincial hospital that includes general and specialized hospitals in
each provinces and cities, some of which are the last level of the area or district
level.


3.1.2.2. Medical examination and treatment quality in hospitals

The capacity and quality of treatment at all levels is significantly
improved. Regimen systems and guidelines for treatment of many diseases are
built and deployed uniformly throughout the country.
Many new high technologies in treatment such as organ transplantation,
cardiovascular intervention, endoscopic surgery, labor support, nuclear
medicine etc., are applied and mastered.
By many synchronous solutions, the most drastic being deploying
satellite hospital model, combining public and private, reforming administrative
procedures in medical services, the state of being overloaded at hospitals has
initially be reduced.
Quality assessment method is changed basically and hospitals are
classified according to international criteria and satisfaction index of the
people.
Application of information technology in medical care and hospital
management has been strongly promoted. Nearly 14,000 medical
establishments throughout the country are connected online with the social
insurance agency to serve the automatic health insurance assessment and step
by step set up electronic medical records and manage the people's health
profiles.
The number of outpatient medical visits has continuously increased over
the years according to all hospitals.
The number of inpatient patients increased steadily over the years and
also increased in all hospital levels.
The assessment result of hospital quality according to 83 criteria: Table
3.5 shows that the average quality assessment score of public hospitals
nationwide has increased steadily over the years. And the quality of medical
examination and treatment of central hospitals is higher than that of provincial
and district hospitals. This shows that the quality of medical examination and
treatment is gradually improved.
Average assessment score of public hospitals from 2013 – 2015

Hospital level
Year
Central
Provincial
District
Average score of hospitals
2013
3,03
2,67 2,40
2,70

2014

3,40
2,80 2,55
2,92
2015
3,45
2,85 2,58
2,96
Average score
3,29 2,77
2,51
3.2. Current status of quality management of medical examination and
treatment in Vietnam public hospitals
3.2.1. Current status of government management
3.2.1.1. Develop strategiesand plans for quality management of medical
examination and treatment
Achievements: In recent years, many strategies and plans for health care
in general and medical care in particular have been issued to guide as well as

implement the views and guidelines of the government about health care and
medical care activities such as:
The socio-economic development strategy for 2011-2020 period ratified
by the 11th National Congress of the Communist Party of Vietnam stated the
following: "Strongly develop health care, improve the quality health care etc.
Reform the operational mechanism, especially the financial mechanism of
public health facilities towards autonomy, openness and transparency.
Standardize the quality of health services, hospitals and step by step approach
regional and international standards”.
The National Strategy for the protection, care and improvement of the
people's health in the period of 2011-2020 and the vision of 2030 comment:
"The Government consolidates macro management, directs the development of
health care and improvement of the people's health... implementation of
continuous and comprehensive care for patients; focus on the patients; develop
a program to ensure and improve the quality of medical services; consolidate
the mechanism for handling, responding to opinions and protecting the interests
of patients; building and applying quality management standards suitable to
hospitals in Vietnam, step by step applying regional and international standards
in medical examination and treatment. Setting up a management system, testing
and controlling the quality of medical examination and treatment services from
central to local levels ... Improving hospital management capacity, ensuring
efficient use of resources in hospitals; strengthen administrative procedure
reform, application of information technology in hospital management”.


In addition, the Prime Minister and Minister of Health have issued and
implemented important decisions such as the Prime Minister's Decision No.
153/2006/QĐ-TTg approving the planning of Vietnamese health system in the
period of 2010 to 2020 and stating the establishment of medical examination
and treatment network in accordance with technical lines from low to high

levels and ensuring the continuity of professional level; Decision No.
30/2008/QĐ-TTg of the Prime Minister approving the planning of development
of medical examination and treatment network by 2010 and the vision of 2020;
Ministry of Health's Plan No. 39/KH-BYT on protection, care and
improvement of people's health in the period of 2016-2020; Decision No.
4276/QDĐ-BYT of the Minister of Health in 2015 approving the "National
Action Program on improving the quality of medical examination and treatment
capacity from now to 2025".
Decision No. 2348/QĐ-TTg of 2016 of the Prime Minister approving the
draft on building and developing the base health network in accordance with
the new situation with the goal of renovating organizational structure, operation
mechanism, financial mechanism, human resource development to improve
supply capacity and service quality of the base health network.
The above policies, strategies and plans are promulgated and
implemented in reality, reflecting the thorough direction of Vietnamese
government with the aim of strengthening and improving the quality of health
care in general and medical care in particular, contributing to the protection,
care and improvement of people's health and proving the importance of quality
management of medical care in socio-economic development.
Limitations and shortcomings: A number of policies, strategies, plans,
and slow plans have been issued and amended in time but they have yet proven
to be realistic and practical. Apart from that, the organization of
implementation at ministerial and local levels has not been drastic, proactive
and lack of synchronous solutions.
3.2.1.2. Develop and implement a legal system on quality management
of medical examination and treatment
Achievements
The Law on Medical Examination and Treatment was passed by the 12th
National Assembly on December 4, 2009. The Vietnam President signed the
issuance of Order No. 17/2009/L-CTN to announce said Law which takes

effect from January 1, 2011. This is the first law on medical examination and
treatment, which is an important sector of Vietnam's health system. The Law

on Medical Examination and Treatment institutionalizes the views of
Vietnamese Government on medical examination and treatment. Vietnamese
Government constantly emphasizes the consistent goal which is to improve step
by step the quality of medical examination and treatment in order to better meet
the demand for care, protection and improvement of people's health.
To enforce the Law on Medical Examination and Treatment, the
Vietnam Government has issued four Decrees: Decree No. 87/2011/NĐ-CP
dated September 27, 2011 detailing and guiding the implementation of a
number of articles of the Law on Medical Examination and Treatment; Decree
No. 86/2011/NĐ-CP dated October 21, 2011 prescribing the sanctioning of
administrative violations in medical examination and treatment; Decree No.
102/2011/NĐ-CP dated November 14, 2011 regulating liability insurance for
medical examination and treatment; Decree No. 109/2016/NĐ-CP providing
guidelines for some articles of the Law on Medical Examination and Treatment
to replace Decree No. 87/2011/NĐ-CP.
The Ministry of Health has issued more than 40 guiding circulars under
the following six groups and issues. First, stipulating conditions for granting
licenses for medical examination and treatment facilities. Second, regulating
professional activities in medical examination and treatment. Third, regulating
the application of new techniques andmethods in medical examination and
treatment. Fourth, stipulating errors in technical expertise in medical
examination and treatment.Fifth, regulating quality certification for medical
examination and treatment establishments. Sixth, regulating quality
certification organizations for medical examination and treatment facilities in
order to ensure the independence and publicity in assessing the quality of
medical examination and treatment in hospitals and promoting socialization
sources and international integration.

The Ministry of Health has also issued many regulations on technical and
professional guidance, guidelines for diagnosis and treatment, technical and
professional procedures for medical examination and treatment, radiation
safety, blood transfusion safety, etc. and hundreds of guides and technical
processes of 28 sectors and specialties. In parallel with the construction and
issuance of legal documents guiding the implementation of the Law on Medical
Examination and Treatment and professional regulations, the Ministry of
Health also has directives to manage urgent issues, such as: Directive No.
05/CT-BYT dated September 10, 2012 on enhancing the implementation of
measures to improve the quality of medical examination and treatment after
adjusting medical service fees; Directive No. 03/CT-BYT dated April 1, 2013


on strengthening solutions to effectively implement the code of behavior to
improve professional ethics and follow Ho Chi Minh's moral example at
medical examination and treatment facilities; Directive No. 09/CT-BYT dated
November 22, 2013 on enhancing the reception and handling of people's
feedback on the quality of medical examination and treatment services through
hotlines; Decision No. 1313/QD-BYT dated April 22, 2013 on guiding the
process of medical examination at hospitals.
Furthermore, Vietnam has also signed the Framework Agreement on
Conditions for nursing practice among ASEAN countries and the upcoming
Framework Agreement on Conditions for doctor and dentist professions.
Limitations and shortcomings.
- The system of documents guiding the implementation of the Law on
Medical Examination and Treatment has not been completed. The issuance of
several legal documents guiding the implementation of the Law on Medical
Examination and Treatment were slow and not in time.
- The feasibility of some contents of the Law on Medical Examination
and Treatment and guiding documents for implementation of the Law is not

high.
- The consistency of the Law and the guiding documents with other legal
documents is not high and not yet practical.
- The Law is not relevant in many ways such as: Regulations on granting
practice certificates and one-time operation licenses are inconsistent with
ASEAN and international integration trends; The standard of 2 years of
continuous medical training in order to receive a practice certificate is difficult
to monitor and manage and there is no clear mechanism to detect suspensions
etc.
3.2.1.3. Setup the system of quality management of medical examination
and treatment
Achievements
Along with the promulgation of legal policies, the system of government
management of health care in general and medical care in particular has been
formed and regularly strengthened in accordance with the functions, tasks and
specific situation of each development stage of Vietnam and each organizations
including government agencies such as The National Assembly, Government,
Ministry of Health and relevant ministries, People's Committees of provinces
and cities directly under the Central Government. The National Assembly is the
highest power body of The Socialist Republic of Vietnam, exercising the right

to constitutional law, deciding important issues of the country and supreme
supervision over the activities of the government.
The Law on Medical Examination and Treatment stipulates the
responsibility of government management of medical examination and
treatment, whereby the Government unifies government management of
medical examination and treatment; The Ministry of Health is responsible to
the Government for implementing government management of medical
examination and treatment; ministries and ministerial-level agencies shall,
within the scope of their tasks and powers, have to coordinate with the Ministry

of Health in performing the government management of medical examination
and treatment; people's committees of provinces and cities directly under the
Central Government shall, within the scope of their tasks and powers, perform
government management of medical examination and treatment within their
respective localities. Thus, the system of government management is designed
synchronously from central to local levels.
At medical examination and treatment facilities, the hospital is
responsible for formulating and submitting to the authorized government
agencies to approve the management system to implement the function of
medical examination and treatment quality management. Circular No.
19/2013/TT-BYT dated July 12, 2013 of the Minister of Health guiding the
implementation of quality management of medical examination and treatment
quality management services in hospitals regulates that quality management
system in hospitals includes a quality management committee with the hospital
director as the president and deputy director in charge of professional affairs as
vice president, a quality control department/group, specialized staff in quality
management and a quality management network suitable to the size of the
hospital.
The hospital quality management network is set up from the hospital
level to each faculties, departments and units in the hospital with the quality
control department/group as their activity coordinator.
Limitations
The system of state management of health care at central and local levels
changes according to each term, which can create disturbance and lack of
stability.
The coordination between government management agencies at central
level which are the Ministry of Health and local people's committees of
provinces and cities as well as the coordination between organizations under

the Ministry of Health and each local Department of Health are yet to be strict
and unified.
Quality control departments/divisions are but newly established in every
hospital, the mechanism of coordination with the other departments is not
specific, operation is overlapping.
3.2.1.4. The group of civil servants managing government management
and officials managing the quality of medical examination and treatment at
hospitals
Achievements
Civil servants managing government management of medical
examination and treatment quality at central level are civil servants of offices,
inspectorates and other departments under the Ministry of Health.
Concentrating on the implementing government management tasks is the
Medical Examination and Treatment Management Department. The members
of government management team at provincial Health Departments and
Medical Departments are civil servants belonging to the Department of Health
Services under the Department of Health. Quality management officers often
takes part in quality management concurrently with their main profession and
are allowed to attend basic training courses about hospital quality management.
The group of government management civil servants at central and local levels
is recruited and arranged according to Law on Cadres and Civil Servants.
The members of the quality management of medical examination and
treatment team at hospitals are officers of the Quality Control Department or
the Quality Control Team or officers of the General Planning Division who is
assigned to perform the task of managing medical service quality of the
hospital and are trained on hospital quality management.
In order to implement the Law on Cadres and Civil Servants, the
Ministry of Health has collaborated with the Ministry of Home Affairs to
develop the standards and professional title codes for doctors, physicians,
nurses and medical technicians as a basis for recruitment, assignment of

professional titles and assessment of officials in the health sector.
Limitations and shortcomings
The number and quality of civil servants working on government
management of medical examination and treatment is still limited, failing to
meet the requirements of quality management tasks, has uneven capacities, not
yet fully trained in quality management of medical examination and treatment.

Civil servants are tasked with a small number of specialized tasks and are
mainly concurrent civil servants. Officials who directly perform quality
management work in hospitals are mainly doing so in concurrent with their
main posts, with little training in quality management knowledge and skills.
3.2.1.5. Support, attract and mobilize resources for quality management
of medical examination and treatment
Achievements
The Government has approved many investment projects to upgrade and
renovate Vietnamese hospitals through mobilizing Government bonds such as
Decision No. 225/QĐ-TTg and Decision No. 47/QĐ-TTg investing in
upgrading district hospitals, Decision No. 930/QĐ-TTg investing in upgrading
obstetric, pediatric, tuberculosis, leprosy, mental hospitals and general hospitals
in mountainous, remote and poor areas.
The Government has had many policies to support and mobilize
domestic and foreign resources, calling for support from international
organizations and development partners to help Vietnam implement strategies,
policies and laws. Especially develop and implement the Law on Medical
Examination and Treatment. Some projects help improving the quality of
medical examination and treatment of provincial hospitals is supported by
JICA. The project supports the management of issuing practice certificate and
operation license is supported by the World Bank. The project supports the
improvement of hospital quality management is supported by the EU. Medical
examination and treatment capacity improvement project is supported by JICA

etc. The important support of health care partners and governments has helped
Vietnam implement many activities to ensure and improve the quality of
medical care, contributing to improving the quality of health care in general
and medical services in particular.
The Government has issued resolutions on socialization of health care to
mobilize resources from enterprises and the people. Government’s Decree No.
59/2014/NĐ-CP amending and supplementing a number of articles of
Government's Decree No. 69/2008/NĐ-CP of May 30, 2008 on policies to
encourage socialization of activities in the field of education, vocational
training, health, culture, sport, environment and public-private cooperation in
the field of health, etc.
The Government has directed the implementation of the renewal of the
operational mechanism and financial mechanism of public business units such
as the implementation of Decree No. 43/2004/NĐ-CP, Decree No. 16/NĐ-CP,


Decree No. 85/2012/NĐ-CP of the Government on the operational mechanism,
financial mechanism for public health service units and prices of medical
examination and treatment services for public medical examination and
treatment establishments.
In addition, in order to encourage the strengthening of hospital quality
management, the Ministry of Health has regulations concerning competition
and reward for hospitals every year. Accordingly, hospitals with an average
score of 3.0/5.0 or higher will be considered for evaluation of emulation and
reward.
Limitations and shortcomings
Funds from government budget allocated annually have not met the
demand for investment, upgrading hospitals and are still vague and unstable.
Funds from government budget are allocated annually but approval is
slow, procedures are troublesome and the asking-giving practice still exists.

3.2.1.6. About inspection and examination of hospital quality
Achievements
Every year, the Ministry of Health and the Department of Health develop
plans to inspect medical examination and treatment activities from central to
local levels (inspection according to plan). In addition, they also conduct
unexpected inspections. The Department of Medical Examination and
Treatment also strengthens the organization of specialized inspections through
which to promptly correct violations of hospitals in medical examination and
treatment activities.
The Ministry of Health developed and issued Decision No. 4858/QĐBYT on the criteria for assessing the quality of Vietnamese hospitals. This set
of criteria has 5 parts with 83 criteria, over 1500 sub-categories including group
of criteria for patient satisfaction, group of criteria for quality of cadres, group
of criteria for technical and professional areas, group of criteria for quality
improvement. For specialized hospitals, a specific group of specialized criteria
will be added. This set of criteria was test applied for 3 years from 2013-2015.
Reports from 25 out of 63 Health Departments of provinces and cities
under central authority, 17 out of 38 central hospitals under the Ministry of
Health and 291 out of 1,300 hospitals under the Department of Health and the
survey results and evaluations at 3 provinces, Dien Bien, Thua Thien Hue and
Ho Chi Minh City’s construction and implementation of hospital quality
assessment according to the set of 83 criteria showed results in some aspect.

Such as the guiding, propagating and disseminating of the set of criteria, the
assurance of conditions for implementing the set of criteria for assessing
hospital quality, the organization, examination and evaluation of hospital
quality with the set of criteria. The results of inspection and evaluation showed
that the quality increased steadily over the years from 2013 to 2015, but not
evenly among the levels in the medical examination and treatment system.
Some central hospitals had lower quality scores than city hospitals, even lower
than district hospitals. There was a difference between the hospital’s selfassessment and the Ministry of Health and the Department of Health’s

reassessment, but it was not high and tends to decrease. In 2013, hospitals’ selfassessment average score was 2.5 points, the Ministry of Health’s assessment
average score was 2.45 points. In 2014, hospitals’ self-assessment average
score was 2.8 points, the Ministry of Health’s assessment average score was2.4
points. In 2015, hospitals’ self-assessment average score was 3.03 points, the
Ministry of Health’s assessment average score was2.7 points and the
organization of assessment according to the set of criteria has an impact on the
improvement of medical examination and treatment quality.
Limitations, shortcomings and causes
The number of annual inspection teams is still small, mainly inspecting
quality control of medical examination and treatment in coordination with
specialized health inspection. The test implementation of quality assessment of
hospitals according to the set of 83 criteria, in addition to its achievements,
reveals limitations and difficulties. The cause of these limitations and
inadequacies being the negligent from executing units such as hospital leaders
who have yet to paid attention to and to elaborate specific plans for
implementation every year; the existence of inappropriate assessment criteria,
some criteria that are difficult to improve and the summarizing work of
statistics for scoring of the set of criteria requires users to be proficient in
Excel.
3.2.2. Current status of quality management of medical examination and
treatment at hospitals
In order to assess the status of medical examination and treatment quality
management at hospitals, PhD student and the research team conducted a
survey at 37 central hospitals under the Ministry of Health, including 4 special
level hospitals, 31 first class hospital and 2 second class hospitals. The research
period extended from January 2015 to June 2016.


Research result shows that 100% of hospitals planed and organized the
implementation of quality control program.

Some hospitals also suggest that the set of criteria should be amended and
supplemented (40.5%).

100% of hospitals have emulation and reward council, infection control
council, medicine and treatment council, hospital management council. 56% of
hospitals have Quality Control Department, Quality Control Team, some other
councils with a low percentage of 20%.

3.3. General assessment of quality management of medical examination
and treatment

The average professional staff numbers per hospital is 2.4 staffs, the
average concurrent staff numbers per hospital is 13.7 staffs.
51% of hospitals have applied models and methods in hospital quality
management, of which 4 out of 19 (21%) hospitals applied ISO: 9001-2001,
9001-2008, 9001-2015; 4 out of 19 (21%) hospitals applied ISO 16189; 2 out
of 19 (10%) hospitals applied TQM/CQI/QA-QI; 6 out of 19 (32%) hospitals
applied PDCA; 2 out of 19 (10%) hospitals applied 5S; 1 out of 19 (5%)
hospitals applied SLAMTA. There were 12 out of 19 hospitals (63.1%) applied
on the whole hospital scale. The proportion of hospitals applying quality
management model in administration accounts for the lowest rate with 5.3%.
97.3% of hospitals applied IT in prescription, 59.5% of hospitals applied
IT in managing electronic medical records, 62.2% of hospitals applied IT in
managing medical equipment.
In addition, hospitals also applied IT in managing consumables, finance
and accounting, human resources etc.
Regarding the examination and assessment of hospital quality, the
average quality assessment of central hospitals from 2013 to 2015 tends to
increase steadily over the years.

In terms of reward and discipline, hospitals base on the results of hospital
quality assessment to consider appropriate reward and punishment.
The research result also shows that the difficulties in implementing
quality management of medical examination and treatment at hospitals mainly
concern facilities, hospital overload, human resource and human resource
plans.
In addition, during the implementation process, 100% of hospitals
proposed to the Ministry of Health and related agencies the need to organize
short-term and long-term training courses on quality management of medical
examination and treatment to improve human resource quality. In parallel with
that, it is necessary to issue circulars and guidance on implementing medical
service quality management, a guideline on how to use the set of 83 criteria etc.

3.3.1. Government management of medical examination and treatment
quality management
Positive points
First, on the basis of the Central Resolutions on health care, the system
of macro policies, strategies, plans on health care in general and medical care
quality management in particular has been developed, promulgated and
organized to strictly implement and step by step put into practice. Health
network system, medical examination and treatment network including public
hospital system has been established across central to local levels, reaching
people in regions including rural and remote areas, border areas and islands
across the country and constantly developing in both quantity and quality,
gradually meeting the people's medical needs. In particular, the system of
public hospitals plays a key role, a key position in providing medical services
and implementing social security policies.
Second, the legal system on medical examination and treatment has been
gradually strengthened and improved, especially the introduction of the Law on
Medical Examination and Treatment, related laws and legal documents guiding

the implementation of the law were promulgated, developed and executed. The
birth of the Law on Medical Examination and Treatment is an important
milestone marking a new development, institutionalizing the Vietnam
Government’s views on medical examination and treatment, creating a legal
corridor for medical examination and treatment activities. In the current period
of reforming the health system, the Law on Medical Examination and
Treatment is the legal basis to protect the legitimate rights and interests of
patients and practitioners of medical examination and treatment, to improve the
quality of medical examination and treatment, to reduce troubles for patients, to
improve availability in access to medical services, to determine the foundation
for the development of evidence-based medicine for the benefit of patients.
This is a legal basis to adjust the relationship between patients and practitioners
of medical examination and treatment with medical examination and treatment
facilities. The organization of implementation has been promoted and
strengthened, contributing to gradually improving the quality of medical
services, meeting the satisfaction of patients.


Third, the organization of government management system for medical
examination and treatment quality from central to local levels continues to be
strengthened, the authority and responsibility and coordination of each
government management agencies at all levels are clearly defined. In particular,
the positions, functions, tasks and organizational structure of the Ministry of
Health and provincial health departments are clearly defined.
Fourth, the government management teams at central and local levels are
trained on basic quality management to meet the task requirements.
Fifth, inspection is carried out regularly. The Ministry of Health has
issued and piloted the set of criteria for assessing the quality of medical
examination and treatment services in hospitals, which is an important tool for
quality control of medical services in hospitals.

Sixth, investment from the government budget is strengthened and
implemented with concrete planning. The acts of attracting investment,
socializing and implementing autonomy and self-responsibility mechanisms in
hospitals have achieved initial results.
Limitations and what causes them
First, a number of policies, strategies, plans and slow plans have been
issued and amended in time but they have not been very practical with low
feasibility. Implementation at ministerial and local levels has not been drastic,
proactive and lack of synchronous solutions.
Second, the issuance of legal documents guiding the implementation of
the Law on Medical Examination and Treatment is still slow and not timely.
Some contents of the Law on Medical Examination and Treatment and
documents guiding the implementation of the Law are not consistent with
international practices, low in feasibility, inconsistent with other laws,
impractical and even cause complication in the implement process.
Third, government management system at all levels by termcaused
instability. The coordination of government management between central and
local authorities is not sufficient. The number, structure and quality of
government management civil servants on medical examination and treatment
are still limited compared to actual demand.
Fourth, inspection work is not frequent. Test deployment of the set of
criterias for assessing quality of medical examination and treatment showed
some limitations and shortcomings that need to be adjusted.The assessment
system is not professional, the assessment results are not close to reality, the

funding for quality management is small and lack of necessary support
solutions to promote quality management.
Fifth, the government budget and investment for health care in general
and quality management in particular are still limited, not meeting the actual
demand.

The above mentioned shortcomings are mainly due to subjective
causes.The institutionalization of the Government's guidelines into policies and
laws in the field of medical examination and treatment is slow, lacking, not
synchronized and inappropriate with the situation. Many government
committees, leaders and heads of agencies, organizations, units are not fully
aware and lack of political determination, aggressiveness and synchronization
in directing and organizing implementation. The act of propagating, thoroughly
grasping the guidelines, policies and laws are not frequently carried out.Many
facilities still rely on the Government in quality management.
The system of policies, laws and professional regulations related to
quality management is not completed.
Resources for quality management activities are limited, the facilities
and equipment of hospitals aren’t sufficient, limited budget, lack of human
resourcesespecially in mountainous, remote and disadvantagedd areas. Hospital
overloading, especially at central hospitals and highest level hospitals of Hanoi
and Ho Chi Minh City still exists.
The participation of the community, the patients, family members of the
patients in improving the quality of medical care of hospitals is still limited.
3.3.2. Quality management of medical examination and treatment at
hospitals
Positive points
Hospitals in general and central hospitals under the Ministry of Health in
particular have strengthened hospital quality management activities, such as
developing quality management programs and plans, organizing Quality
Management Department in hospitals, strengthen some councils such as
emulation, reward, medicine and treatment, infection control, quality
management, science and technology, patient councils etc., assigning people to
directly manage quality management, research and apply quality management
models in hospitals, deploying the application of information technology,
annual assessment of hospital quality, implementing solutions to ensure patient

safety. Due to these activities, the quality of medical services in hospitals has
been gradually improved to meet the medical needs of the people.
Limitations and what causes them
The activities ofcouncils in hospitals are still conceptual. Many hospitals
have yet to set up councils such as moral council, nursing council and risk
management units. The group of officers directly working on quality
management in hospitalsis still lacking, unspecialized, mostly treating quality
management as a side job and isn’t fully trained in quality management and
often changes. The application of advanced quality management models
already existed worldwide is still limited. The application of methods and
models of quality management in hospitals in the administrative and clinical
areas is still low.
The cause of these limitations is mainly due to inadequate awareness of
officials, civil servants, employees in hospitals about quality management and
the role of quality management in hospitals.The determination of the leaders is
not high. The facilities and equipment have not yet met the set standards, the
group of civil servants who directly take part in quality management is still
weak and lacking.
CONCLUSION OF CHAPTER 3
On the basis of the literature review and the scientific basis for quality
management of medical services in hospitals, Chapter 3 has clarified the status
of medical examination and treatment quality of Vietnam's public hospitals
with the following main points.
First, described and generalized the health care system and the system of
medical examination and treatment networks in Vietnam, especially the
network of public hospitals.
Second,analyzed and evaluated the overall quality of medical
examination and treatment in hospitals both in quantity and quality through a

number of basic indicators from reports and results of hospital quality
assessment of the Ministry of Health and other Health Departments.
Third, analyzed and depicted the actual status of medical examination
and treatment quality management in public hospitals through assessing the
government management on medical examination and treatment quality and
quality management in hospitals, analyzed the achieved results. The current
shortcomings of government management are reflected in the contents of
policies, strategies and plans. The system of law documents and legal

documents guiding the implementation of laws, organization of systems and
staffs, inspection, analyzation and assessment of the current status of the set of
criteria is carried out by the Ministry of Health. Chapter 3 also analyzed and
assesse the current status of quality management in hospitals according to
contents such as the development of quality management programs and plans,
selection of quality management systems, organization to ensure the condition
of the quality control systems and teams and propose some ideas on the quality
management activities of some units.
Fourth, analyze and evaluate the positive points inquality management
of medical services in hospitals, the limitations and shortcomings that need to
be overcome and the causes of limitationsto propose solutions to improve
themin the coming time and to contribuit to improving the quality of medical
care to meet the satisfaction of the patients.
CHAPTER 4: ORIENTATION AND SOLUTION FOR MANAGING
THE QUALITY OF MEDICAL EXAMINATION AND TREATMENT IN
VIETNAMESE PUBLIC HOSPITALS
4.1. The direction and orientation of the Government on health care
In each of the development stages of the country, the Vietnam
Government is always interested in the protection, care and improvement of the
people's health. This is expressed in various government documents. Resolution
No. 46-NQ/TW dated February 23, 2005 of the Politburo on care, protection

and improvement of the people's health in the new situation has given 5
Government's directives on health care. Resolutions of the 11th and
12thNational Congress continue to specify the following: Improve the quality
of medical examination and treatment and rehabilitation at all levels. ..Promote
the reform of administrative procedures, apply information technology, apply
management and quality control standards for medical services. Conclusion
No. 118-KL/TW dated January 4, 2016 of the Secretariat Member of Party
Central Committee on continuing successfully implement Resolution No. 46NQ/BCT. The Secretariat requested the executive committees, authorities,
departments, ministries, branches, Fatherland Front, political and social
organizations at all levels to continue to perform more actively the views,
objectives, tasks and main solutions that has been pointed out in Politburo
Resolution No. 46.
Decision No. 122/QĐ-TTg dated November 10, 2013 of the Prime
Minister on the National Strategy to protect and improve people's health in the
period of 2011 to 2020 and the vision of 2030 stated: "Improve the network of


medical examination and treatment at all levels, implement continuous and
comprehensive care for patients; focus on the patients; develop a program to
ensure and improve the quality of medical services...; formulate and apply
quality management standards suitable to hospitals in Vietnam, step by step
applying regional and international standards in medical examination and
treatment. Establish a management, verification and control system for quality
of medical examination and treatment services from central to local levels”.

disadvantaged socio-economic conditions and areas with extreme
disadvantaged socio-economic conditions. Promote socialization of medical
examination and treatment activities. Encourage organizations and individuals
to invest in developing medical examination and treatment services. Encourage
scientific and technological research and application in medical examination

and treatment. Combine modern medicine with traditional medicine in medical
examination and treatment.

Resolution No. 20-NQ/TW dated October 25, 2017 of the 6th plenum of
the 12th Central Executive Committee on protection, care and improvement of
the people's health in the new situation specified in its tasks and solutions
section: "Improve the quality of medical care, overcome basically hospital
overload .... Issue evaluation criteria, conduct independent inspection, rank
hospitals according to quality in accordance with international practices.
Resolution No. 19-NQ/TW dated October 25, 2017 of the 6th plenum of
the 12th Central Executive Committee on continuing to renovate the
organization and management system, improving the quality and operational
efficiency of public service units specified in its direction section: (1)
Reforming the organization and management system and improving the quality
and performance of public service units are some of the top prioritized, urgent
and long-term tasks for all levels of party committees, authorities and the whole
political system; ... (4) Implement drastically and synchronously the tasks and
solutions set out in the process of renovating the organization and management
system, improve the quality and operational efficiency of public service units
associated with the renovation of the political system and administrative
reform.

On the basis of researching and thoroughly grasping the views of the
Government, stemming from the current situation and the trend of change and
development of health care in the period of international economic integration,
government management of health care in general and medical care in
particular, including quality management of medical services of hospitals, the
researcher proposes some specific directives as follows:
First, it is necessary to strengthen the dissemination and awareness
raising of the people, the community and all levels in the implementation of

national health strategies, policies, programs and plans in general and quality
management of medical examination and treatment in particular to apply the
Government's views and resolutions into real life.

The 2009 Law on Medical Examination and Treatment introduced the
Government policy on medical examination and treatment. Accordingly,
prioritize using government budget to meet the basic needs of medical
examination and treatment of the people. Prioritize using the budget for health
care for people who have contributed to the revolution, children, the poor,
farmers, ethnic minorities and people in areas with disadvantaged socioeconomic conditions and areas with extreme disadvantaged socio-economic
conditions; strengthen the development of health care human resources,
especially health care human resources in areas with disadvantaged socioeconomic conditions and areas with extreme disadvantaged socio-economic
conditions. Implement a time limited rotation regime for those practicing at
medical examination and treatment facilities from the higher level to the lower
level, from areas with normal socio-economic conditions to areas with

Third, continue to consolidate the system of government management on
medical examination and treatment from the central to local levels in
accordance with the practical situation, make sure the system is capable of
performing tasks, pays attention to building and developing a team of
government management staffs and civil servants who directly perform the task
of quality management in hospitals through recruiting, training, planning,
allocating and using this team efficiently. Organize a system with a suitable
structure and qualified staff that will be the core in implementing quality
management of medical services in hospitals and meeting the purposes of the
tasks set.

Second, perfect the system of legal policies to institutionalize and
concretize the Government's views on health care. Policies and legal
regulations should be institutionalized in a timely and adequate manner,

creating a legal corridor to act as an important basis for implementation in all
levels, branches, organizations and individuals to improve the efficiency and
the effectiveness of government management and to improve the quality of
medical services for the sake of the people.

Fourth, strengthen inspection, examination and supervision of
implementation, review and evaluate the achieved results, difficulties and


challenges. Find out the causes and propose solutions to continue to adjust and
improve legal regulations and organize better implementation of medical care
quality management.
Fifth, complete the set of criteria to evaluate the quality of medical
examination and treatment services in hospitals in order to perform
international integration and in accordance with the actual situation of Vietnam.
Research and establish an independent assessing organization for medical
examination and treatment quality of medical facilities, attract and mobilize
resources such as facilities, equipment, human resources and finance to
effectively implement the Government's guidelines and policies on medical
examination and treatment quality management in hospitals in the new
situation.
Sixth, strengthen quality management at medical examination and
treatment facilities, especially public hospitals. Promote the active role of
hospitals in developing programs, medical care quality management plans,
encouraging the application of advanced quality management models and
methods.
4.2. Some solutions to manage the quality of medical examination and
treatment in public hospitals in Vietnam
4.2.1. Complete and organize the implementation of policies, strategies
and plans on the quality of medical examination and treatment

First, review and assess the impact of issued policies, strategies, plans
and programs. Study, adjust, amend and supplement the objectives, tasks and
solutions of policies, strategies and plans so as to suit the Government's guiding
points. Second, review and evaluate the status of the medical examination and
treatment system, especially in public hospitals. Third, evaluate the
implementation of Decision No. 4276/QĐ-BYT of the Minister of Health dated
October 14, 2015 approving the "National Action Program on improving
medical examination and treatment quality management capacity in the period
from now to 2025”.
4.2.2. Complete and organize the implementation of the legal system and
professional regulations in medical examination and treatment
First, it is necessary to organize an assessment of the impact of the Law
on Medical Examination and Treatment after 8 years of implementation.
Second, on the basis of the arguments from the results of assessing the
implementation of the Law on Medical Examination and Treatment in the past,

request the Ministry of Health to conduct researches in order to propose
abolishment, modification and supplementation of some legal contents to the
authorized agencies. Third, review and assess the impact in the process of
implementing documents guiding the implementation of the Law on Medical
Examination and Treatment, including Decrees and Circulars guiding the
implementation of said Law. Fourth, formulate and promulgate a Circular
regulating the pre-professional training regime, aiming at the examination to
issue practicing certificate. Fifth, develop and issue national technical standards
for hospitals. Sixth, develop and promulgate a set of hospital quality standards
including standards for clinical and subclinical faculties, standards for
practitioners' qualifications for each department, prioritize the development and
completion of the test deployment of 5 sets of competency standards for
practitioners for specialty groups before 2020.
In parallel with the development of the set of hospital quality standards,

develop and promulgate guidelines for diagnosis and treatment, technical
procedures, patient care procedures etc.
4.2.3. Strengthen and improve organizational capacity and government
management team on quality management of medical examination and
treatment
First, strengthen the organizational structure of the state management
agency in quality management of medical examination and treatment at central
and local levels. Second, develop and approve the set of textbooks and
materials on continuous training of quality management and patient safety.
Third, review and evaluate the implementation process to amend and
supplement Circular No. 19/2013/TT-BYT dated July 12, 2013 of the Minister
of Health guiding the implementation of service quality control at medical
facilities in accordance with the actual situation, the Government's guidance
and the "National Action Program on improving the quality of medical
examination and treatment for the period from now to 2025" issued under
Decision No. 4276/QĐ-BYT of the Ministry of Health in 2015, to achieve the
objective of building and perfecting the national quality management system
for medical examination and treatment. Fourth, establish an independent
quality accrediting/inspecting organization of Vietnam with functions and tasks
of assessing and recognizing hospital quality.
4.2.4. Complete the set of criteria for assessing the quality of medical
examination and treatment in Vietnam hospitals