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.
Trang 1The thesis is completed:
National Academy of Public Administration
Proposed supervisor:
1 Assoc Prof PhD Le Thi Van Hanh
2 Prof PhD Nguyen Cong Khan
Reviewer 1: ………
Reviewer 2:……… ………
Reviewer 3: ………
The thesis will be presented to the Evaluation council at National Academy of public administration Place: Room… ……, National Academy of public administration No: 77 – Nguyen Chi Thanh road – Dong Da district – Ha Noi Time: ………… …….………
The thesis can be found at the National Library of Vietnam or the library of
National Academy of Public Administration
MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HOME AFFAIRS
NATIONAL ACADEMY OF PUBLIC ADMINISTRATION
CAO HUNG THAI
MANAGING THE QUALITY OF MEDICAL EXAMINATION AND TREATMENT
AT PUBLIC HOSPITAL IN VIET NAM
Major: Public Administration Management
Major code: 62 34 82 01
SUMMARY OF THE DISSERTATION
Trang 2INTRODUCTION
1 The urgency of the research
When it comes to the quality of human life, health issues are often
mentioned Health is a state of entire physical, mental and social comfort, not
merely a condition of suffering no disease or injury Having good health is one
of the basic human rights in any race, religion, politics or any socio-economic
condition
Therefore, health care is one of important goals in the development
process and is placed in a high position: "Health is the most precious human
resource, one of the basic requirements for people to live happily, and an
important factor in economic, cultural, social and country-defense
development”
Human health is influenced by many factors such as the natural
environment (soil, water, air, climate), social environment (culture, education,
labor, studying), biological condition and genetics; individuals’ awareness of
taking care of their own health (physical training, personal hygiene, diet and
living habits) and, especially, medical activities In order to have good health, it
is crucial to prevent disease proactively and positively, practice food hygiene
and safety projects, enforce labor, school, and environmental sanitation,
periodic health examination, expanded program on Immunization, quarantine,
disease prevention, and only sick people and accident victims will come to
health agencies to get first aid, medical examination, treatment, and functional
rehabilitation depending on their health status and injuries It can be said that
health and medicine have a close and organic relationship
In the development process, depending on political institutions and
socio-economic condition, each government has its own direction to develop
national health, such as issuing strategies, policies and using government
management tools to intervene, regulate, support medical activities as well as
control health service quality, so as to ensure the effectiveness and efficiency of
government management and the rational use of the budget invested in health
Also, it is essential to help citizens easily access good quality health services,
meeting the increasing health care needs, in order to contribute to social equity
and security
In developed countries such as Northern Europe countries (welfare
state), United States of America, England, France, Japan, Korea, etc., health
service provision, in general, and medical examination and treatment services,
in particular, are noticed to invest for development The government management of providing health care services is quite complete, from the legal framework to the government management apparatus, to the support, inspection and supervision tools, ensuring health care services provided in compliance with the law and quality assurance New quality management methods are continuously applied by hospitals, such as comprehensive quality management, ISO quality management, JCI hospital quality assessment, etc., therefore the quality and effectiveness of medical examination and treatment are maintained and constantly improved, satisfying the patients
In the past 20 years, Asian countries such as Singapore, Thailand, Malaysia have had policies to manage the health care services quality through legal instruments and national quality improvement programs; the application
of ISO and JCI quality management has also been implemented and promoted
by health facilities Numerous hospitals have built and maintained the "good quality hospital" services admitted by the region and the world, meeting the demand and attracting citizens to seek medical treatment
In our country, during the Renovation period, especially since the Law
on Examination and Treatment was issued and took effect from January 1,
2011, it made a significant milestone in management activities as well as in health care services supply With the goals of placing patients at the center of health care, ensuring the safety of patients, implementing medical examination and treatment publicly, fairly and effectively, encouraging the application of hospital quality management standards in health facilities; Health care, in general, and medical treatment, in particular, have experienced a huge innovation and amelioration The system of policies and laws on medical examination and treatment continues to be improved; The government hospital system is concerned to invest to upgrade both facilities, equipment, and quality
of human resources; The health care expertise of hospitals has been gradually strengthened, contributing to the health care service quality development, satisfying the patients
However, the work of medical examination and treatment in the past has suffered from shortcomings and backwardness, facing difficulties and challenges:
First, whilst the health care service demand of citizens is rising both in quantity and quality, the capacity to provide medical examination and treatment services of health facilities is still limited, not yet met the service scope and quality Currently, disease patterns in Vietnam are increasingly diverse and
Trang 3complex: non-infectious diseases gradually increase, infectious diseases are
more complicated, numerous new epidemics emerged and so on On the other
hand, the socio-economic condition improved, incomes of citizens accelerated,
transportation was also more convenient This leads to increasing demand for
medical examination and treatment, although hospitals have not been invested
to upgrade in time, a huge number of facilities and equipment have been
deteriorated, and the competence of medical staff is still limited Hospital
overload has occurred at Central hospitals and upper-level hospital in Hanoi
and Ho Chi Minh City
Second, the context of globalization and world integration leads to rapid
changes in medical technology, especially Information Technology Therefore,
it is crucial for technology and management system of Vietnamese hospital to
be promptly transformed in order to provide good quality and safe health care
services In other words, the quality of health care services in Vietnamese
hospital must meet a minimum quality standard and be constantly improved, in
accordance with regional and world quality
Third, government hospitals play a major and important role in providing
medical examination and treatment services to people As of December 31,
2016, there were 1424 hospitals overall with 252,600 beds, including 1252
government hospitals (88%) with 239,544 beds (95%) and 172 private hospitals
(12%) with 13,056 beds (5%) Thus, public hospitals play a key role in
providing health care services
In addition, the goal of fairness, efficiency, and development in health
care has been emphasized thanks to the change in the management system of
public hospitals The public hospital is established, invested, and issued the
rules of operation, financial, human resource management mechanism by the
Government, aiming to accomplish the national goal Currently, the
Government policy is implemented to grant autonomy and self-responsibility to
hospitals, creating a good condition for them to develop their full potential
Hence, there must be management and control tools to evaluate and analyze the
cost-effectiveness
Fourth, medical examination and treatment is a special type of service,
related to human health and life Users and beneficiaries of health care services
are patients, who need to quickly and promptly go to appropriate health
facilities when they get sick for emergency examination and treatment Thus,
they rarely have a chance to choose a suitable health facility
According to the above-mentioned theoretical and practical basis, as a civil servant who has worked for a long time in the healthcare industry and is currently working at the Medical Services Administration, the agency with the function of advising the Minister of Health on national management of medical examination and treatment, it is obvious to be aware of the limitation, backwardness, difficulty and the current challenges in managing health care quality These issues need to be tackled soon, in order to improve the quality of medical examination and treatment for citizens
There for the purpose of creating scientific evidence for developing policies and completing the management mechanism, as well as solving these above problems, the subject: "Quality management of Medical service in Vietnamese public hospitals" has been chosen
2 Research objectives and tasks 2.1 Research objectives
On the basis of theoretical and practical research on the quality of health care services, this dissertation proposes a number of solutions to strengthen the quality management of medical examination and treatment services in public hospitals, contributing to the national mission of protecting, taking care, and improving citizens’ health
- 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
Trang 4- 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
3 Subjects and scope of research
3.1 Research subjects
The subject of the dissertation is managing the quality of medical
examination and treatment in the hospital, including Government quality
management and hospital quality management
3.2 Research scope
The dissertation defines the scope of research as follows:
- Content: focus on researching quality management activities of medical
examination and treatment services in public hospitals including:
+ Government management activities (Government subject), limited to
central management agencies
+ The quality management of medical examination and treatment
services at hospitals (hospital subject), limited to Central hospitals under the
Ministry of Health
- Time: the period from 2011 to present, when the Law on Examination
and Treatment has been taking effect During the analysis and evaluation
process, data before 2011 can be used
- Space: Research on quality management of medical examination and
treatment services in public hospitals throughout the country
4 Methodology and research methods
4.1 Methodology
The dissertation is studied on the basis of Marxist-Leninist methodology
about dialectical and historical materialism; Ho Chi Minh thought and the
perspective of the Communist Party of Vietnam on the medical industry, in
order to interpret and analyze the quality management activities of public
hospitals in Vietnam
4.2 Research Methods
This dissertation using these research methods: methods of analyzing secondary sources; methods of sociological investigation; survey interview method
5 Research questions and scientific hypothesis of the subject 5.1 Research questions
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
Trang 5Third, it is essential to create a new solution and to change the way of
quality management of medical examination and treatment in public hospitals,
in accordance with the perspectives and orientations of the Government and
Communist Party of Vietnam, meeting the rising health needs of the people and
the trend of international integration
6 New contributions of the dissertation
The dissertation is completed, is an in-depth research project specialized
in public administration management This dissertation has some specific new
contributions:
- 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
- Clarified concepts, content and related factors affecting the quality and
quality management of medical examination and treatment in hospitals; pointed
out the methods and models of quality management that are being applied in
developed countries, drawing lessons that can be applied to Vietnam
- The dissertation has portrayed the actual situation of quality and quality
management of medical examination and treatment in Vietnamese public
hospitals (from the views of Government and hospitals)
- Proposing a number of new solutions to managing the quality of
medical examination and treatment in public hospitals, in accordance with the
perspectives and orientations of the Government and Communist Party of
Vietnam, meeting the increasing health demand of citizens and the trend of
international integration
7 The theoretical and practical signification of the dissertation
The dissertation supplemented and enriched the theory of quality
management of medical examination and treatment in hospitals, especially
public hospitals; clarified some theoretical issues on Government management
for medical examination and treatment services, and also clarified the situation
and propose some solutions to improve the quality management of medical
examination and treatment in hospitals
This dissertation can be used as a utility reference for researchers,
lecturers, and students in the research, teaching and learning at the training,
administrative, and health facilities At the same time, it can also be a reference
for health civil servants, officials, managers in research, performing professional tasks and policy-making in medical examination and treatment field
8 Content of the thesis The dissertation layout, except for the Table of contents, Introduction, Conclusion, References, Appendix, has 4 chapters:
Chapter 1: Overview of the research situation related to the dissertation topic;
Chapter 2: Scientific basis for quality management of medical examination and treatment in public hospitals;
Chapter 3: Current status of quality management of medical examination and treatment in Vietnamese 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
Trang 6aims to understand the attitude of hospital managers on the application of the
quality management system
- 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
- Selbmann HK research on assessment and recognition of health care
quality in Germany shows an increasing number of calls to assess and confirm
hospital quality,in order to see transparency in the health care system in
Germany
Domestic works
- The "Continuously training on hospital quality management" by the
Medical Services Administration - Ministry of Health, which used for hospital
leaders and managers cadres, was published in 2015 with 6 main following
topics include: General overview of hospital quality management, Guidance on
hospital quality management, Quality measurement, Role of hospital leaders,
Staff encouragement and Strategic planning methods to improve hospital
quality
- The book "General report of the Medical industry 2012, improving the
quality of medical examination and treatment services", which published in
2012 has updated the health status and the influencing factors, also updated the
status of the health care system and fulfilled the tasks set out in the 5-year
Health Plan 2011-2015
- The book "Good practices of patient safety and quality management in
some Vietnamese hospitals", written by Luong Ngoc Khue and colleagues in
2016, included 4 main parts: (1) Applying hospital quality assessment criteria;
(2) Introducing quality management and quality improvement lessons; (3)
Lessons on practice using hospital quality assessment criteria for quality
improvement; (4) Introducing measures related to patient safety, comparing to
criteria in the hospital quality assessment criteria
- Author Nguyen Huy Quang in the Doctoral dissertation "Government
management by law in the Healthcare industry in our country nowadays"
analyzed the inner function, clarifying the concept of the healthcare industry as
medical activities Hence, it is obviously to specify the medical industry as one
of the factors that positively affect health, particularly, protects the health of
people This dissertation also provides more specific, scientific arguments on the inner content of Government management by law in health science;
- 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 post-graduate specialists in the healthcare industry
- 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
Trang 7qualifications in special grade hospitals in Vietnam" has introduced the
concept, internal contents of Government management, factors affecting
Government management activities and proposed solutions to improve
Government management in fostering officials with postgraduate qualifications
in special grade hospitals in Vietnam
- The research evaluating the status of implementing medical service
quality management by the Medical Services Administration in 2012 This
research has just assessed the status of implementing quality management of
hospitals without assessing the implementation of Government management
agencies
1.1.2 Hospital quality management research
Foreign works
- First, research of Alaraki M.S about Total quality management (TQM)
provided a solution for patients’ safety and significantly helped improve
hospital operations
- Research of Nicolay CR, Purkayastha S, Greenhalgh A, Benn J,
Chaturvedi S, Phillips N, Darzi A about the implementation of a Quality
improvement (QI) method described serving the surgical care and analysis of
statistical results
- Research of Sussmane JB, Torbati D, Gitlow HS had the purpose of
measuring and assessing the quality of health care at Pediatric intensive care
units (PICU) during plasma replacement
- Research by Revere L, Black K on integrating 6 Sigma into existing
TQM program, facilitated the process improvement through detailed data
analysis
- Research by Lebuisson and colleagues at a French hospital had the goal
of achieving ISO 9001-2000 certification in the refractive error laser treatment
- A recent study by Lorenzen and colleagues at the Radiotherapy
Department of a university hospital in Germany has assessed the change of the
department quality indicators after applying the Quality Management System
according to ISO 9001- 2000
- Another study by Helbig and colleagues is performed at an outpatient
clinic of a university hospital in Germany This study concluded that a
systematic assessment of the current organizational structure of outpatient
clinics, using the current situation analysis to identify the problem and its causes, is crucial to improve service quality
- Beholz S1, Koch C, Konertz W studied certification and quality management of a cardiology center at a University based on ISO 9001-2000
- Beholz et al in 2003, also conducted research to assess the impact of a quality management system based on ISO 9001-2000 at the cardiology center above-mentioned
- Research by Duvauferrier R1 et al, had the purpose of transitioning from the combining TQM management model based on "EFQM" (European Foundation for Quality Management) model, and quality assurance based on the ISO 9000-1994 certification model; to the ISO 9001-2000 certification model, applied to process management and the integration of ensuring management and quality
- Articles of Pereira P, Westgard JO, Encarnação P, Seghatchian J, de Sousa G discussed good manufacturing practices and good laboratory practices
as well as the trends of standards
- Research by Seki A, Kugawa S, Miya T showed that it is more than 10 years since the International Organization for Standardization (ISO) 15189, which issued in 2003, has regulated the quality and capacity of medical laboratories
- Research by Rizzi F, Pizzuto M, Lodetti L, Corli O, Da D D, Damiani
ME, Mihali D, Piva L, Saita L, Vinci M, Bonaldi A, which described the main results of the certification process based on JCI criteria for the hospital home model, are implemented by palliative care clinics of 7 hospitals in Milan for cancer patients
- Research by Tekkesin N, Kilinc C, Keskin K at Memorial Hospital has
a laboratory service that provides Easy Stat and regular testing The use of standardized processes and the regular staff training, combined with an exchange of the referral management system based on existing research with an electronic system, can increase safety in the pre-analysis process
Domestic works The study of Nguyen Thi Xuyen and colleagues in the period from 2007-
2008 at 5 hospitals applying the ISO 9001-2000 quality management system and 4 hospitals that have not applied ISO have drawn conclusions: Application
of ISO 9001-2000 quality management system has improved the effectiveness
of hospital management and the professional quality of hospitals
Trang 81.2 Reviews and evaluations on the research projects have been
mentioned
1.2.1 The inherited content from those research projects
First, the overview reports have clarified the urgency and benefits
contents of implementing quality management activities, in general, and quality
management activities in the healthcare industry, in particular; current quality
management principles and trends; and a number of concepts and factors in
term of quality and quality management in the medical industry
Second, the overview researcheshave also confirmed that health service
is a type of service but have its own features, directly related to human health,
is a lack of competitiveness and incomplete market
Third, the overview reports both domestic and foreign showed the
important role of the Government in controlling the quality of health services
and in requiring Government management by law in the healthcare industry
Fourth, the overview researches have shown that a number of quality
management models are being applied by countries around the world,
especially developed countries, to improve the quality of medical examination
and treatment and the operational effectiveness of medical organizations, such
as TQM, PDCA, 6 sigma, Lean, ISO models
Fifth, the overview studies have also clearly pointed out some
Government management solutions for a contingent of post-graduate specialists
and the development of human resources for nursing in Vietnam
Sixth, the review studies indicated that measuring and assessing the
quality of health services needs to have a set of tools including evaluation
criteria, evaluation criteria group on input, process, and output condition
1.2.2 The content has not been mentioned or clarified in the overview
researches
First, the overview studies have mentioned the urgency and advantages
of quality management in the healthcare industry in general for countries
around the world but have not mentioned deeply and specifically for the
practice condition in Vietnam
Second, the overview reports have referred to general concepts related to
quality and medical quality management but approached excessively different
aspects
Third, there are a number of overview documents and projects that refer
to the quality of health service management but have just stopped in several aspects of the Government management in the medical industry or only mentioned the implementation of quality management in hospitals
Fourth, the review studies have mentioned factors affecting the quality and quality management but only in the scope of a hospital or hospital department
Fifth, new management models applied in hospitals were mentioned in a huge number of studies by foreign authors, for instance, management applying ISO standards, PDCA method, 6 sigma, Lean, whereas domestic research has mentioned the application of ISO model in hospitals
Sixth, the overview studies also showed several sets of criteria to assess the quality of medical examination and treatment, which are applied by some developed countries, and the set of criteria for quality assessment that piloted in Vietnamese hospitals
Seventh, no study has been conducted for research on the current status
of medical examination and treatment quality management or quality assessment of medical services in Vietnamese hospitals, for instance, clarifying the organization has the evaluation function and the way to evaluate
1.2.3 The research direction of the dissertation First, it is essential for the dissertation to clarify both the theoretical and practical basis of the health care service quality management issue, such as: clarifying concepts related to the topic; analyzing the hospital quality management of medical examination and treatment in both Government management and hospital management contents; quality management of medical examination and treatment; analyzing and studying models and lessons learned from countries around the world to choose the application in Vietnam
in the field of medical care quality management
Second, researching and assessing the status of quality management of medical services in hospitals Proposing standards, regulations and implementing quality management activities, so as to clarify the factors affecting the quality management of medical examination and treatment in hospitals
Third, study the sight and perspective of the Government and Communist Party of Vietnam on national health, thereby proposing solutions
Trang 9for quality management of medical examination and treatment in Vietnamese
public hospitals in the new situation
Conclusion of Chapter 1
The results of the review showed that whilst several clarified contents
and issues need to be inherited, the issues related to the topic but have not been
mentioned or incompletely, generally, incomprehensibly mentioned are in need
of further research to clarify; Also, viewpoints and orientations of quality
management and specific solutions are essential to enhance the quality of
medical examination and treatment in public hospitals nowadays
Chapter 2: SCIENTIFIC BASIS FOR QUALITY MANAGEMENT OF
MEDICAL EXAMINATION AND TREATMENT IN PUBLIC HOSPITALS
2.1 Quality of medical examination and treatment in hospitals
2.1.1 Hospital and hospital roles
2.1.1.1 Hospital definition
Hospital is a facility for medical examination and treatment with
minimal infrastructure and equipment meeting the standards and requirements
for medical examination and treatment according to regulations; with suitable
human resources and practitioners (granted practicing certificates); licensed by
authorized Government agencies for medical examination and treatment
activities; has executive management apparatus and functional departments,
distributes the use of resources for organizing medical examination and
treatment activities and scientific, technical, and administrative advances
application to maintain and improve the quality of medical examination and
treatment, meeting the increasing health care demand In addition, the hospital
also carries out prevention, training, scientific research, mentoring and
international cooperation activities
2.1.1.2 Roles of hospitals and public hospitals
Hospital is an integral part of the health system and is an important
component in providing health care services to citizens
- Hospital is the face of the health care industry, with the basic functions
and missions of comprehensive health care for the people and the community,
including health prevention, treatment, and improvement; including even
scientific research, medical staff training, and international cooperation in the
form of both inpatient and outpatient treatment
- Vietnamese public hospital is a Government service unit with an important and key role in providing medical services
2.1.2 Quality of medical examination and treatment in hospitals 2.1.2.1 Definition of Medical examination and treatment
In a narrow sense, the medical examination and treatment of physicians (practitioners) is to conduct examination (ask for medical questions, study medical history, physical examination) and appoint tests (if necessary) to diagnose disease, then use recognized medical methods, techniques and licensed drugs for patients’ emergency treatment, treatment, taking care and rehabilitation
In a broad sense, it is the hospital medical examination and treatment activities, that is, the activities of managing, administering and using human resources (practitioners and medical staff), infrastructure, equipments, finance and medical methods, techniques for medical examination, diagnosis, first aid, treatment, taking care and rehabilitation for patients
2.1.2.2 Definition of Quality of medical examination and treatment According to W Edwards Deming, when quality and efficiency increase, volatility decreases Joseph Juran believes that quality must firstly identify customers
Based on the processes, missions, and expectations of the results,
"Quality does not exist randomly but is the result of decisive intent, serious effort, smart direction, and skillful execution" This is a definition of quality with the processes, missions, and expectations of the results
Based on the industrial model, "Quality considers customers as the center Therefore, meeting the demands and expectations of customers is the main purpose of quality”
Based on the basic principles of leadership and management, "Quality is working in the right way from the first time and making it better in subsequent times."
Quality in health care industry has diversely different approaches: + From the perspective of the patient and their family, as the beneficiary
of the service, the customer: concerning the type of health care and its effectiveness
+ From the perspective of the service providers (medical staff or health facilities): paying more attention to the scientific process of health care, the
Trang 10ability to diagnose and treat a case but paying little attention to convenience
and even focusing less on the "care" aspect
+ Managers also have a different approach to quality Managers believe
that quality is accessible and acceptable ability, effectiveness, suitability, and
effectiveness in providing health care services
Another approach: Quality is an incremental improvement In the
opinion of the National Roundtable on Health Care Quality, the University of
Massachusetts: "Quality of care is the improvement level of the ability to
achieve health outcomes for individuals and the public, with possible medical
services, and be consistent with current professional knowledge”
According to Christian Grönroos: The quality of medical examination
and treatment combines two separate components: operational quality and
professional quality
According to Donabedian A: Quality of medical services includes
applying medical science and technology in the best way to maximize health
benefits without increasing the corresponding risks, caused by this technique
According to John Øvretveit: Quality of medical examination and
treatment is a form of effective organizing resources to meet the health care
demands of those most in need for health care and prevention, not causing
waste but ensuring to fit higher requirements
According to WHO, the quality of medical examination and treatment is
the level of achieving the internal purposes of a health care system, to improve
health and meet the reasonable expectations of citizens
In summary, there are different approaches to quality of medical
examination and treatment, however, according to the author, when
approaching the concept of medical examination and treatment quality, 6
following criteria and quality aspects are needed to pay attention:
First - Safety: Providing medical examination and treatment services
with reduced risks for service beneficiaries This is consistent with the goal of
the Law on Examination and Treatment, the safety of patients, which is the
most important and necessary thing
Second - Effectiveness: Providing medical examination and treatment
services based on evidence and must bring about health improvement for
individuals and communities, whereas continuously enhancing the quality to
meet the needs of patients
Third - patient-centered: Providing medical examination and treatment services ought to take into account the interests and aspirations of individual service users and the cultures of the communities The current goal of both the Law on Examination and Treatment and the entire health care system is to place patients at the center, satisfying the patients
Fourth - Timely: Medical examination and treatment services are provided promptly, reasonably geographically, and in facilities that have the skills and resources appropriate to the medical requirements;
Fifth - Efficiency: Providing medical examination and treatment services with maximum use of resources and avoid waste;
Sixth - Equally: Providing medical examination and treatment services with no difference in quality based on individual characteristics such as gender, race, ethnicity, geographical position, or socio-economic status It is crucial to fairly implement in the health care system
2.2 Quality management of medical examination and treatment in hospitals
2.2.1 Definition of quality management of medical examination and treatment in hospitals
According to GOST 15467-70, quality management (QM) is to build and maintain the inevitable quality level of products in designing, manufacturing, circulating and consuming process
A.G Robertson, a British expert on quality, said: QM is defined as a management system to build the process and to coordinate efforts of different units, therefore maintaining and enhancing the quality of organizations
A.V Feigenbaum, an American scientist, believed that: QM is an effective and unified system, combines various departments within an organization
- Professor, Dr Kaoru Ishikawwa, a famous expert in the field of QM defined that: QM is researching, developing, designing, manufacturing and maintaining the most quality, economical, and useful products for consumers, and always try to satisfy the consumers
Philip Crosby, an American expert in quality defined QM as a systematic means, ensuring the respect for all components of an action plan
International Organization for Standardization ISO 9000 stated that: QM
is an activity, which has a general management function, aimed at setting
Trang 11policies, objectives, responsibilities and implementing them through measures
such as quality planning, quality control, quality assurance, and quality
improvement within a quality system
Therefore, Quality Management includes main activities such as quality
assurance, quality control, quality improvement, quality assessment
Definition of quality management of medical examination and treatment
in hospitals
In conclusion, quality management of medical examination and
treatment in hospitals is understood as: "(1) The overall management activities
of the Government includes the formulation of policies and regulations;
performing inspection, supervision, and evaluation; as well as measures to
handle violations; so that regulations are implemented and (2) Hospital
activities include the implementation of Government policies and regulations;
application of management measures and methods, in order to ensure, maintain
and improve the quality of medical examination and treatment in hospitals
According to the author research, 96.65% of respondents agreed with this
definition
Diagram The quality management system of medical examination and
treatment in hospitals
Government quality management of medical examination and treatment
– macro-management and Hospital quality management - micromanagement
have an organic and close relationship, whereby Government management
plays a key role Government management has an orientation feature, ensuring
the quality of health care services in hospitals, whilst hospital quality
management has a promotive role to improve the quality of health care services
Management is the impact process of the management subject to the
management object by certain tools and methods to achieve the objectives, or
in other words, it is the organizational and directional impact process of the
management subject to the management object to achieve the purposes Management functions include planning, organization, leadership, administration, human resources, finance, inspection and handling of violations
Government management, an authorized activity of the Government, is permitted to use Government power to regulate social relations Government management is considered as a functional activity of the Government in term of social management, also can be considered as a special functional activity Government management, in a broad sense, is the entire operation of the Government apparatus, from legislative, executive activities to judicial activities
Government management of hospital quality of health care services is the controlling and influencing management objects by the Government through its legal system, policies and organizational system of management agencies, in order to ensure and protect the legitimate rights and benefits of patients and practitioners, therefore achieve the goals of improving the quality
of health care services, the safety of patients and the assurance of social security Accordingly, the Government issued quality standards and requirements to achieve quality standards through strategies, programs, plans, indicators ; Hospitals are also supported with the institutional system and the necessary resources to achieve quality standards, but discipline could be imposed if the quality standards have not been met
The subject of Government management of medical examination and treatment activities is the Government with the agencies system which divided into levels from the central to local levels and including three areas: legislative, executive and judicial, in which Administrative management (executive) of medical examination and treatment is a very substantial field The object of the Government management of medical examination and treatment is organizations, individuals, health facilities, practitioners and patients
The content of Government management of medical examination and treatment in hospitals includes:
a) Develop and organize the implementation of strategies, programs, and plans for quality management in hospitals Formulating strategies and programs
on quality management of medical examination and treatment must ensure the requirements: First, exactly assessing the status of medical examination and treatment quality, quality management of medical examination and treatment currently, the difficulties and challenges, limitation and their causes; Second,
Trang 12identifying the objectives and trends of quality, QM, medical system
development and health care demands of people, requirements for
socio-economic development, regional and world integration trends; Third,
identifying key solutions to enhance quality management of medical
examination and treatment, in accordance with the current status, situation,
requirements for socio-economic development, and the general development
trend of the country
b) Developing and implementing laws on quality management of
medical examination and treatment: Law is a tool for the Government to
maintain its dominance, perform its functions and duties The legal system on
quality control must be objective, consistent with the characteristics and
features of the healthcare industry, in general, and the field of medical
examination and treatment, in particular, and at the same time meeting these
requirements: First, regulations on operating condition for health facilities with
different types such as hospitals and clinics Regulations on minimum
standards to ensure the quality of medical examination and treatment in
hospitals; Second, regulations on competency standards for practitioners and
the hospital leaders such as practitioners must have a practicing certificate and
can only work within the limits of professional activities granted in the practice
certificate; Third, regulations on organizational structure and personnel
including officers have practice certificates, other staffs of health facilities, and
QM organizational apparatus and human resources of agencies; Fourth,
regulations on the roles and responsibilities of stakeholders in health care
quality management, support fettle such as training, calling for funding for QM
activities
In order for the promulgation and implementation of the law on quality
management to go into real life, the formulation and promulgation must ensure
the following principles: Ensuring the appropriateness, priority and urgent
issues in health care quality management need to be properly identified; Ensure
the legality and consistency of legal documents The formulation of legal
documents on quality management must be consistent with the Constitution,
Law and must not be contrary and overlap with other Laws, creating a
consistent legal document system; Comply with the order, procedures and
forms of issuing legal documents; Ensure the publicity and transparency in the
formulation process of legal documents; Ensure the reliability, impartiality and
fairness for subjects and objects related to medical quality management
c) Organize the apparatus, develop the Government management group
and officers do quality management work in hospitals The construction of the
organizational structure must ensure the following principles: First, the structure, which is rational, streamlined and efficient, must be organized in a unified way, consistent with the functions and missions; Second, there must be
a clear assignment of duties and responsibilities between constituent parts, leaders, and officers, with a regulation system that assists departments to work
in coordination, avoiding overlapping; Third, along with building organizational apparatus, it is essential to educate and develop a contingent of cadres working in Government management and local quality management d) Resources mobilization and support for health care quality management activities: In order to bring strategies, planning, and legal programs into real life, together with organizational system and Government management officials, it is indispensable to have resources including finance, human resources, and facilities for health care quality management activities e) Inspection, supervision, and evaluation of health care service quality management activities: Inspection, one of the momentous contents of Government management by law, has a purpose of ensuring the management apparatus operates in accordance with the law and also consolidating the effectiveness and efficiency of Government management
2.2.2.2 Quality management of medical examination and treatment in hospitals
a) Hospital quality management system
- Elements of the hospital quality management system: According to the International Organization for Standardization, a quality management system consists of 3 elements: organizational structure; regulations that the organization must comply with; and processes Thus, the hospital quality management system of medical examination and treatment will include the following factors: Organizational structure of hospitals; The regulations that hospitals must adhere to, include a variety of types such as professional principles, standards, requirements, for instance: guidelines for diagnosis and treatment, technical procedures, internal regulations, instructions, rules, etc.; and Processes The process is a collection of interrelated activities that turn the input into the output
- Formulation of hospital quality management system for health care services: To begin with, it is essential to select a suitable quality management system; After selecting, coming up with construction planning, includes: building a system of overall plan and a system of detailed plans, routes, implementation time, funding and scope of application, etc.; Then build quality
Trang 13management system including: setting up the organizational structure of
quality, appointing leaders, establishing departments, teams, coordination
groups, advice groups (if necessary), hospital councils such as Quality Council,
Scientific Council, Drug and Treatment Council, etc In the next step, assess the
quality management system Assessment is performed in 3 types: Internal
assessment - first party evaluation; Assessment of patients and their family -
second party evaluation; Certification assessment - third party evaluation
Finally, maintain and develop the quality management system
b) Some principles of building a quality management system in
hospitals: Customer orientation principles; Attach importance to human factors
in quality management; Quality management must be synchronous and
comprehensive; Quality management must be implemented simultaneously
with the requirements to ensure and improve the quality Quality assurance and
quality improvement are two related issues; Quality management must ensure
the process characteristics; Examination principle
c) Popular quality management models applied in hospitals: First, the
quality management system based on ISO standards The administrative
innovation of some countries had mentioned this issue and considered it as a
way to improve the quality of citizen services - Second, PDCA Cycle This
cycle, based on the scientific method developed by Francis Bacon in 1620,
described the 3-step process as "hypothesis" - "experimental" - "evaluation";
Third, 6 sigma model: 6 Sigma is a method that is proceeded rigorously,
scientifically, focusing on the effective implementation of recognized quality
management techniques and principles; Fourth, Lean management (Lean) has
originated from the Toyota Production System (TPS) and has been gradually
implemented throughout all activities of Toyota since the 1950s
2.2.3 Factors affecting the quality and quality management of medical
examination and treatment in public hospitals
2.2.3.1 Political - administrative environment and Government policies
Government management of hospital quality of medical examination and
treatment services must be consistent with the perspectives and revolutionary
policies of the Communist Party of Vietnam, in accordance with the policies
and institutional systems of the Government
The appropriate Government policies for medical examination and
treatment not only promotes, improves the Government management
effectiveness and efficiency of medical examination and treatment quality but
also ensures and meets the increasing demand for medical services of the people
2.2.3.2 The socio-economic globalization tendency and the sharp development of science and technology
Globalization along with the sharp development of science and technology generated various positive results, leading to a rapid change in medical science and technology Globalization, besides the positive side, also has negative aspects, which can be the loss of the national cultural identities or the rapid disease transmission among countries and regions Therefore, in term
of medical examination and treatment activities, it is indispensable to have reasonable policies and solutions to solve the problems that globalization and the development of science and technology resulted in, on both the positive and negative aspects
2.2.3.3 The disease patterns change, population fluctuation and the increasing demand for medical examination and treatment of citizens
Currently, changes in disease pattern have resulted from environmental pollution, climate change, and socio-economic development Non-communicable diseases rapidly increase, while infectious diseases have been complicated developing Epidemics regularly occur, the risks of outbreaks, especially of emerging infectious diseases rise, antibiotic resistance problem is becoming increasingly serious, etc The population growth, rapid aging speed, the golden population stages had passed, etc are some of the reasons for the increasing demand for health care of people Therefore, medical examination and treatment services have been greatly impacted
Thus, with the changing patterns of disease, population fluctuations and increasing medical needs of the people, it is necessary to have appropriate policies, strategies, and innovation in the management activities of medical examination and treatment, especially quality management activities of medical examination and treatment in public hospitals
2.2.3.4 Human Resources
In quality management, people hold the leading position in the process of quality formation, assurance, and improvement of products and services In the hospital quality management of health care services, human resources in the management apparatus, as the contingent of professionals who directly provide health care services, play a leading, decisive role and make a major impact to quality and quality management of medical examination and treatment services
Trang 142.2.3.5 Leadership and management
Leadership and Management are two terms that are widely used in
human, organizational and social management In general management, one of
the success factors is the role of the leaders and the managers For that reason,
all countries around the world are interested in developing a team of leaders
and managers for the future, although the level of concern may diverse Many
countries have considered educating leaders and managers as a long-term
strategy of developing human resources in Government agencies and other
organizations
Quality control of health care services in hospitals in the context of
globalization, international economic integration, strong progress of science
and technology, changes in operating mechanisms and financial mechanisms
requires raising numerous good leaders and managers
2.2.3.6 Operating mechanism and financial mechanism for the hospital
During the innovation period, the Government management role in the
health care system has been changed When our country has converted a
centrally planned economy to a socialist-oriented market economy, important
innovations have been performed in the health care system: From a completely
free medical treatment regime to a part free medical treatment regime;
Implementing compulsory health insurance policies; Developing private
medical practice; Opening the market for medicines; and Renewing the
operating and financial mechanism for public health service units
The above innovations, especially the innovations in the operating
mechanism and financial mechanism for public hospitals have a great impact
on the Government management system and the quality management of
medical examination and treatment in hospitals Thus, in term of quality
management activities, this issue must be paid much attention to propose
appropriate solutions
2.2.4 International experience in quality management of medical
examination and treatment and lessons for Vietnam
2.2.4.1 International experience in quality management of medical
examination and treatment
a) Experience in Government management of quality of medical
examination and treatment
Currently, a national strategy on quality has been applied in many
countries around the world based on a mixture of compulsory and voluntary
quality management Policies, strategies, and plans for quality management of medical examination and treatment are issued in the form of laws, decrees or guiding circulars
b) Experience in developing standards for assessing the quality of medical examination and treatment in hospitals
The set of hospital quality standards was built based on the consensus of agencies under the Ministry of Health, Medical Associations, Hospital Associations based on the context and health system structure of each country The International Society for Quality in Health Care (ISQua) has issued the basic principles and requirements framework for developing health facility quality standards
Version 3.0 in 2007 introduced 6 principles of building quality standards include: First, improve the quality; secondly, focus on the patients and service beneficiaries; Third, planning and implementing plans; Fourth, safety; Fifth, formulating standards; Sixth, measuring standard
In Thailand, a set of specific quality assessment indicators for health service providers has been developed with a total of 42 indicators in 6 groups: indicator group of general information on health facilities: 10 indicators ; indicator group of facilities inputs: 7 indicators; indicator group of process and clinical outputs: 10 indicators; indicator group of process and service outputs: 9 indicators; indicator group of management quality: 3 indicators; indicator group
of system and QM process: 3 indicators
c) Experience in assessing and certificating implementation of quality of medical examination and treatment in hospitals
The decade of the 1990s experienced a rapid development with the establishment of hospital standards and quality assessment organizations in European countries, Australia, the US, and some Asian, African countries Organizations for assessing and certificating hospital quality are usually non-profit organizations, operating internationally or nationally
As of November 2011, there are 19 organizations for assessing and certificating quality accredited by IS Qua based on standards for external quality assessment organizations introduced by IS Qua
IS Qua also appraised hospital quality standards developed by standards and quality assessment organizations To date, 35 standard sets of 21 organizations have been appraised by IS Qua