The thesis is completed: MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HOME AFFAIRS National Academy of Public Administration Proposed supervisor: Assoc Prof PhD Le Thi Van Hanh NATIONAL ACADEMY OF PUBLIC ADMINISTRATION 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 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 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 Research questions and scientific hypothesis of the subject 5.1 Research questions 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 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 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 Content of the thesis The dissertation layout, except for the Table of contents, Introduction, Conclusion, References, Appendix, has 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 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 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 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 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, Encarnaỗóo 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 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 hospitals applying the ISO 9001-2000 quality management system and 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, 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, 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 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, 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 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 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 groups: indicator group of general information on health facilities: 10 indicators ; indicator group of facilities inputs: indicators; indicator group of process and clinical outputs: 10 indicators; indicator group of process and service outputs: indicators; indicator group of management quality: indicators; indicator group of system and QM process: 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 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 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 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 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 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 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 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 special level hospitals, 31 first class hospital and 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 out of 19 (21%) hospitals applied ISO: 9001-2001, 9001-2008, 9001-2015; out of 19 (21%) hospitals applied ISO 16189; out of 19 (10%) hospitals applied TQM/CQI/QA-QI; out of 19 (32%) hospitals applied PDCA; out of 19 (10%) hospitals applied 5S; 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 On the basis of the literature review and the scientific basis for quality management of medical services in hospitals, Chapter 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 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 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 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 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 First, review and evaluate the contents and indicators of the set of criteria for assessing hospital quality including 83 criteria currently applied; detect inadequate limitations of the criteria and evaluation indicators of the set of criteria; compare and acquire experience from other set of criteria of neighboring countries and the world with similar socio-economic conditions and at the same time, assess the organization of implementing assessment of medical examination and treatment quality in hospitals under provincial and municipal Health Departments Second, develop guidelines for assessing hospital quality including the assessment process Third, the Ministry of Health, the Department of Health, hospitals need to actively spread propagandas and dissemination of the set of criteria for assessing the quality of hospitals to all hospitals and hospital departments under their management Fourth, ensure the conditions for the implementation of the hospital quality assessment criteria, strengthen and establish hospital’s quality improvement division/council/group/network 4.2.5 Strengthening the dissemination, guidance and supervision of the quality of medical examination and treatment of hospitals First, strengthen dissemination and awareness raising for government management for staffs Second, disseminate, guide and introduce new and advanced quality management models that developed countries in the world are applying Third, develop and implement the annual inspection plan for quality control and examination Fourth, apply IT in health care quality management especially in processing hospital quality assessment data, ensure the accuracy of assessment results 4.2.6 Attract, encourage and mobilize resources for quality management of medical examination and treatment First, on the basis of the need of hospitals and the Ministry of Health towards Central units, the need of the Department of Health towards the localities, summarize the development of the general plan for the whole sector, build the optimal budget plan prioritizes important activities that are allowed to take from the government budget and other sources of revenue originating from the government budget Second, take the initiative and make use of the technical support and funding from international organizations by designing projects that require international organizations’ support Third, promote socialization activities in quality management of medical services in hospitals Fourth, build a mechanism for the patients, the people and the community to participate in managing medical service quality Fifth, organize awards to encourage emulation and commendation for outstanding hospitals and individuals in quality management activities 4.2.7 Improving the effectiveness of quality management of medical examination and treatment in hospitals First, directors of hospitals thoroughly inform their respective hospital's officials and employees about the Government's undertakings, policies and laws, the Health care sector's regulations on quality management of medical examination and treatment, hospital’s policies, goals and quality solutions so that they can understand and agree on the implementation process Second, hospitals base on their own needs to develop an annual quality planning program Third, directors of hospitals issue documents to direct the implementation of the set of criteria for assessing hospital quality Fourth, hospitals strengthen their councils Fifth, promote the implementation of new management methods in hospital quality management Sixth, organize training courses for hospital staffs to improve knowledge and skills on hospital quality management Seventh, ensure resources to implement hospital’s plans and programs CONCLUSION OF CHAPTER On the basis of the general research results, theoretical basis (arguments) and the reality (demonstration) of hospital quality management of medical examination and treatment, Chapter has summarized and analyzed the views of the Government on health care, especially medical examination and treatment and based on that, suggested directives for hospital quality management of medical examination and treatment and proposed a number of new solutions for quality management of medical examination and treatment in Vietnam public hospitals First, improve and organize the implementation of policies, strategies and plans on management of medical examination and treatment quality Second, improve and organize the implementation of the legal system and professional regulations in managing the quality of medical examination and treatment in hospitals Third, strengthen and improve organizational capacity and government management team on management of medical examination and treatment quality Fourth, develop and issue a set of criteria for assessing medical examination and treatment quality in Vietnamese hospitals Fifth, strengthen the dissemination, guidance and inspection of medical examination and treatment quality in hospitals Sixth, attract, encourage and mobilize resources for management of medical examination and treatment quality Seventh, improve the effectiveness of quality management of medical examination and treatment in hospitals limitations and shortcomings that need to be overcome and the causes of those limitations and shortcomings If the above solutions are implemented, they can contribute to improving the quality of hospital examination and treatment to satisfy the patients' satisfaction Fourth, the dissertation analyzed Government's views and policies on health care The researcher suggested directives for managing the quality of medical examination and treatment in hospitals and groups of management solution First, i CONCLUSION The dissertation is an intensive scientific research project specialized in public administration The results of the dissertation are expressed through the following main contents and issues: First, the dissertation has reviewed domestic and foreign researches, inherited the contents and problems each researches has clarified Issues related to the dissertation topic that domestic and foreign researches have not mentioned are studied, researched and clarified in the dissertation Second, the dissertation has clarified the concepts and issues related to the dissertation topic including: concept of hospital, hospital classification, role of Vietnamese hospitals and public hospitals, concept of medical examination and treatment, quality of medical examination and treatment, quality management of medical examination and treatment The dissertation analyzed and clarified the content of managing the quality of medical examination and treatment in hospitals including levels: macro level - government management of the quality of medical examination and treatment and micro level - managing the quality of medical examination and treatment in hospitals; studied, analyzed and pointed out some relevant factors affecting the quality and management of the quality of medical examination and treatment in hospitals; studied international experience and summarized lessons that can be applied in Vietnam Third, the dissertation described the health system and the system of medical examination and treatment networks and public hospitals in Vietnam and assess the overall quality of medical examination and treatment in Vietnam hospitals At the same time, depicted the actual situation of the quality and quality management of medical examination and treatment in public hospitals, analyzed the achieved results, the current shortcomings of government management, assess the status of hospital quality assessment tools piloted by the Ministry of Health, analyzed and assessed the status of quality management in hospitals The dissertation also analyzed and assessed the positives in managing the quality of medical examination and treatment in hospitals, mprove and organize the implementation of policies, strategies and plans on management of medical examination and treatment quality Second, improve and organize the implementation of the legal system and professional regulations in managing the quality of medical examination and treatment in hospitals Third, strengthen and improve the organizational capacity and the government management team on the quality of medical examination and treatment Fourth, develop and promulgate a set of criteria for assessing the quality of medical examination and treatment in Vietnam hospitals Fifth, strengthen the dissemination, guidance and supervision of the quality of medical examination and treatment in hospitals Sixth, attract, encourage and mobilize resources for management of medical examination and treatment quality Seventh, improve the effectiveness of quality management of medical examination and treatment in hospitals The dissertation has completed adding theoretical arguments on managing the quality of medical examination and treatment in hospitals; clarified the status, provided evidences and on that basis, suggested directions and proposed some solutions to improve the quality of medical examination and treatment in public hospitals in Vietnam The dissertation can be used as a useful reference for researchers, lecturers and students in researching, teaching and learning at administrative and medical science training institutions At the same time, it can also be used as a reference for officials, civil servants, health officials and managers in research, implementation of professional tasks and planning medical examination and treatment However, in the scope of the topic, the dissertation inevitably has some limitations The researcher hopes that this dissertation will continue to be studied more deeply and broadly to contribute to perfecting the theory on quality management of medical examination and treatment and provide scientific evidences for the development of health policy planning in Vietnam REFERENCES Cao Hung Thai (2002) "Improving management efficiency of leaders and managers of units under the Ministry of Health" Master's thesis Cao Hung Thai "Innovating the training and retraining of cadres An important solution to improve the quality of leaders and managers at the Ministry of Health" Journal of Medicine and Pharmacy Information No 3/2003; Cao Hung Thai "Innovating the appointment of cadres to improve the operational efficiency of leaders and managers at the Ministry of Health." 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