EUROPEAN UNION

REPORT

4th NATIONAL HOSPITAL QUALITY FORUM

Ha Noi: 18th December
2018

This program is organized by

In cooperation with
 Table of contents
Y1. Context............................................................................................................5
2. Forum Goals...................................................................................................5
3. Methods...........................................................................................................6
4. Participated Delegates and Location ............................................................6
5. Reported Contents...........................................................................................8
6. Activities and Forum Contents........................................................................9
6.1.Opening remakrs by the Minister of the Ministry of Health and the Deputy
of theDelegation of the European Union in Vietnam ........................................9
6.2. Report on the situation of hospital quality management and implementation
of the hospital quality criteria for the period 2013-2018..................................11
Assoc. Prof.Dr. Luong Ngoc Khue, Director of the Healthcare Management
Department (Ministry of Health), presented the report of activities of hospital
quality management and implementation of the hospital quality criteria for the
period 2013-2018 ............................................................................................11
6.3. How to encourage continous quality improvement in hospital.................15
6.4. Statement by Vice Prime Minister Vu Duc Dam.......................................16
6.5. The role of the Department of Health in promoting activites of quality
improvement of hospitals and attached medical facilities................................17
6.6. Quality management and style innovation to increase efficiency and satisfy
patients at Ba RiaVung Tau Eye Hospital........................................................18
6.7. Improve clinical quality at Cho Ray Hospital..........................................18
6.8. Quality management result at Vietnam-Sweden Uong Bi Hospital...........19
6.9. .Experience in establishing and implementing of an incident report system
at Hung Vuong Hospital, Ho Chi Minh City....................................................20
6.10. Improving the quality of nutrition – abstinence activities in southern
hospitals, progession and challenges................................................................21
6.11. Renovating the finance mechanism and hospital autonomy to encourage
the improvement in healthcare quality............................................................22
6.12. Surveying the satisfaction of patients and medical staffs nationwide in
period 2015-2018 22
 6.13. Effectiveness and benefits after the implementation of the quality
improvement program according to the set of 83 Vietnam hospital quality
criteria of Hoan My Medical Group.................................................................23
6.14. Improve the quality of hospitals’ restroom.............................................23
6.15. Experience of the implementation of the set of hospital quality criteria in
setting up hospital quality for patients.............................................................23
6.16. The work of healthcare after 5 years of hospital quality improvement of
the Son La Sop Cop District General Hospital................................................23
Doctor Vu Van Hiep, the hospital director, reported on the effective
implementation of healthcare after 5 years of hospital quality imrpovement of
the Son La Sop Cop District General Hospital. Through training, experts
invitation, investment in facilities, people and after 5 years of the
implementation of the set of the 83 criteria, Sop Cop General Hospital has
been constantly renewed to improve professionals quality of cadres, attitude in
serving patients, healthcare quality to gain trust from patients and average
grade to 3.26 in 2018. The result is bare from the commitment of the Board of
Director and the whole hospital staffs. ..........................................................23
6.17. Quality improvement activities of the EU Technical Assistance Fund for
medical (EU-HF).............................................................................................24
6.18.Poster exhibition......................................................................................24
6.19. Conclusion..............................................................................................25
7. Conclusion and Advise..................................................................................25
7.1. Implement the set of criteria of hospital quality.........................................25
7.2. Complete the quality assesment criteria and current guidelines.............26
7.3. Recommend next steps to improve hospital quality...................................26
8. Media and image promotion.........................................................................27
9. Feedback of delegates on the organization of the Conference.....................28
10. Appendix.......................................................................................................44
1. Context

Since 2011, the European Union (EU) has been supporting Vietnam's Ministry of
Health (MOH) in the quality improvement process at medical facilities. With the support
of the Health Sector Capacity Building Support Project (HSCSP), MOH has developed a
National Action Plan to improve the quality of health care in the period of 2016-2020;
developed a set of criteria for quality assessment of hospitals (issued according to
Decision 4858 / Decison-MOH, piloting the quality assessment criteria of hospitals,
Circular No. 19/2013 / Circular-MOH July 12, 2013 guiding the quality management of
healthcare services in hospitals, a circular on quality control of hospital testing, decisions
on improvement of healthcare processes in clinics. After some time for pilot application,
Vietnamese hospital quality criteria set, version 2.0 was issued (Decision No. 6858 /
Decision-MOH of November 18, 2016 of the Minister of Health) on the basis of learn
from experience, modify and supplement the content of criteria and upgrade the quality
level from version 1.0. Many criteria are added with new sub-sections and have more
strict requirements.
Health Sector Policy Support Program Phase II (HSPSP-2) "Towards Fairness and
Quality of Healthcare Services in Vietnam" for the period of December 2014 - March
2018 will fund a support budget in the form of a Sector Reform Support Contract (worth
100 million Euro). This program provides the largest budget support for the medical
sector in Asia and aims to sustainably sustain the results of poverty reduction and
inclusive economic growth in Vietnam through support of a healthcare system
development towards equality, efficiency and quality improvement as proposed by the
medical sector strategy. The goal of equality is focused on focusing on the 10 poorest
provinces, including Lai Chau, Son La, Dien Bien, Kon Tum, Gia Lai, Ha Giang, Lao
Cai, Cao Bang, Yen Bai and Dak Nong.
Part of the budget support is used to enhance the application and implementation of
patient quality management and feedback systems in Vietnam. EU Technical Assistance
Fund for Health (EU-HF) - established by the EU in the framework of the HSPSP-2
program - will support the MOH and especially the Department of Healthcare
Management to achieve the goal through a number of activities focused on raising
awareness and capacity of healthcare management staff on quality management practices.
MOH and EU-HF have jointly organized the 4th National Hospital Quality Forum in
Hanoi on 18th December, 2018 to exchange experiences between hospitals in practice
and quality management initiatives, experience from applying the hospital quality
improvement criteria to enhance the quality of healthcare in the context of hospital
autonomy and financial mechanism reform

2. Forum Goals
 Enhancing the interest of leaders, managers and professionals on improving the
quality of healthcare
 Conclude the 5 years of the deployment of quality improvement nationally
 Summarizing 5 years of implementing the set of hospital quality criteria version
1.0 (Decision No. 4858 / Decision-MOH dated December 3, 2013) and
Vietnamese Hospital Quality Criteria version 2.0 (Decision No. 6858 / Decision-
MOH November 18, 2016)
 Sharing experiences, initiatives and good practices for quality improvement at
public and private medical facilities.
 Sharing experiences and initiatives on domestic and international quality
management
 Sharing the results on the judging on the hospital quality of hospitals in Vietnam.
 Sharing the results of the program to improve the quality of healthcare in the
direction of making patients the center of attention and reducing hospital
overloads in some local areas.

3. Methods
The conference includes plenary sessions ; poster exhibition on the results of
improving the quality of healthcare in the direction of making patients the center of
attention, towards the satisfaction of patients of hospitals nationwide, information
technology application ; discussion at the hall combined with direct exchanges between
delegates.
4. Delegates participated and location
The Forum is organized at My Dinh National Convention Center, Ha Noi.
Participants in the Forum were Mr. Vu Duc Dam, Member of the Party Central
Committee and the Deputy Prime Minister; Associate Prof. Dr. Nguyen Thi Kim Tien,
Minister of Health; leaders of departments, ministries, central branches, a number of
international organizations in Hanoi, delegates from the Ministry of Health, Department
of Health of provinces and cities nationwide, leaders and quality management officials
of hospitals nationwide. The total number of delegates is over 800 people.
Major participants of the Forum include:
 Delegates from Government agencies at the central level:
 Assoc. Prof. Dr. Nguyen Thi Kim Tien, Minister of Health
Assoc. Prof. Dr. Nguyen Viet Tien, Vice Minister of Health
 Assoc. Prof. Dr. Nguyen Truong Son, Vice Minister of Health
 Assoc. Prof. Dr. Luong Ngoc Khue, Director of the Healthcare Management
Department, MOH
 Assoc. Prof. Dr. Tran Quy Tuong, Director of the Information Technology
Department, MOH
 M.D. Dr. Nguyen Trong Khoa, Vice Director of the Healthcare Management
Department, MOH
 M.D Dr. Cao Hung Thai, Vice Director of the Healthcare Management
Department, MOH
 M.D Nguyen Nam Lien, Director of the Financial Planning Department, MOH
 Mr. Vu Dinh Anh, Director of the Commendation and Communication
Department, MOH
 Director of Departments under MOH
 EU representative participatiors
 Ms. Axelle Nicaise, Deputy of the EU Delegation in Vietnam
 Mr. Alejandro Montlban Carrasco – Head of Cooperation and Development
Department (EU)
 Mr. Le Van Thanh – Medical Program Manager (EU)
 Dr. Jose Cardona – Director of EU-HF
  Ms. Pham Hong Hanh, key expert no 3.
 Quality management and technical expert group of EU-HF
 Representatives of specialized associations: Vietnam Medical Association,
Vietnam Public Health Association, Vietnam Private Hospital Association;
Vietnam Nursing Association, Vietnam Association of Medical Economy, Private
Medical and Pharmaceutical Association
 Representatives of international organizations: WHO; UNICEF, World Bank,
GIZ, JICA.
 Provinces:
 Board of Director of Department of Health
 Director of planning and quality management, Manager of the hospital affiliated to
the Ministry of health, provincial, district and private hospital
 Organization Committee includes Deputy Prime Minister Vu Duc Dam, Assoc.
MD. Dr. Nguyen Thi Kim Tien - Minister, Dr. Nguyen Truong Son, Deputy
Minister of Health, Prof. PhD. Ngoc Khue Luong, Director of Medical Services

Administration, Ministry of Health, MD. Nguyen Trong Khoa, Deputy director

of the Department of Medical Services Administration, Ministry of Health, Le
Van Thanh - Health Program Manager (EU) presides.
Forum lasted until 23 pm on 12.18.2018, longer than expected.
The forum was part of 10th anniversary ceremony of establishment of Medical
Services Administration and 65 -year healthcare system.
 Deputy Prime Minister Vu Duc Dam gave a speech at forum

Minister of Health Nguyen Thi Kim Tien gave a speech at forum

5. The content of the report

 Total 18 reports were presented in three main theme:
 3 reports of MOH
 1 report of international experts
 2 reports of foreign experts of official representative of EU-HF
  1 report of Ho Chi Minh Department of Health
 2 reports of hospitals under MOH (Cho Ray hospital, Vietnam-Swedish Uong Bi
Hospital)
 4 reports of provincial hospitals (Hung Vuong, Eye-Vung Tau, Vietnam - Czech
Haiphong)
 2 reports of district hospitals
 1 report of the Nutrition Center City
 2 reports of private hospitals (Hoan My, VINMEC)
 poster: 120 poster
 the main thematic: 3 parallel sessions by leaders and experts
 Topic 1: The prominent changes after 5 years of implementation of policies to
improve the quality of examination and treatment
 Topic 2: Experience in application of hospital quality criteria
 Topic 3: Innovation in financial mechanisms and improvement of the quality of
medical examination and treatment on patient’ satisfaction
6. Forum content and happenings
6.1. The opening speech of Minister of BYT and Deputy Head of the EU delegation
in Vietnam
The Forum opened with the opening speech of the Assocte Prof. MD. Nguyen Thi
Kim Tien, Health Minister and Mrs Axelle Nicaise, Deputy Head of the delegation of the
European Union EU in Vietnam.
The Minister highlighted the achievements of the health sector in improving people's
health, improving the quality of medical examination and treatment, improving the
quality of grassroots health care, comprehensively innovating attitudes with humorous
styles. Patient satisfaction oriented attitudes.
The Minister appreciated the EU's support for the health sector in general and in
particular in the field of QUALITY MANAGEMENT improvement of healthcare
facilities, build hospital quality criteria. With the support of the EU, MOH has
developed, promulgated and improved 83 criteria for assessing hospital quality with the
ultimate purpose of QM being the satisfaction of patients.
The Minister mentioned the key activities of the health sector with solutions to
reduce hospital load, satellite hospital project, Project 1816, transferring many
techniques from the central to the provincial level, the renovation project.
comprehensive attitude towards the satisfaction of patients has brought certain results.
The satisfaction rate of patients is increasing and many hospitals have a satisfaction rate
of 80-90%.
The Minister emphasized the results in developing and issuing many important
policies such as universal health insurance, reforming payment methods, building basic
and advanced health service packages, developing lower facilities. floors and
equipment, strengthening training for health workers at all levels, developing
specialized health, grassroots health, family medicine, developing private health, issuing
many professional processes in Guidelines on medical examination and treatment, non-
communicable disease control strategies, including initiatives to examine and treat non-
communicable diseases at the grassroots level, infection control, antibiotic resistance
were also mentioned to among many achievements to improve service quality.
The Minister also stated that the medical examination and treatment system still has
many shortcomings that need to be overcome such as the slow reform of thinking of
some leaders and medical staff in the new situation, hospital overload, medical
incidents. Unfortunate departments occur at all levels. The Minister called on hospital
managers and leaders to change management thinking, considering hospital
management as a profession and BV director must be a CEO. The Minister requested
the implementation of synchronous solutions to improve and overcome the situation of
hospital overload, promote the application of information technology, apply
management standards and check the quality of medical examination and treatment
services. The Minister directed the need to promote independent assessment of hospital
quality.
Ministers requested the participants in the forum to share experiences, discuss and
launched initiatives in quality improvement activities in all health care
services; complete portfolio of services and technical services to ensure the quality of
technical services evenly among all levels; innovative style, service attitude; focus on
improving the weak activity as moderate nutrition, infection control; building safe
hospitals, civilization, towards implementation of the comprehensive care of
patients. Followed by Axelle Nicaise speech, Deputy Head of EU Delegation in
Vietnam. She show hornor to meet and work with the Deputy Prime Minister, Minister
of Health and delegates attended the Forum. She is delighted to continuely witnessing
high commitment of the Ministry of Health, health departments, public and private
medical establishments in improving the quality of medical services after 5 years from
the medical assistance activities of the EU's first time in Vietnam and considered it as
one of the core objectives of the reform of the health sector. 
Deputy Head of the EU Delegation in Vietnam stated Europe is a close friend with
Vietnam has many years of experience in the development of European societies for
centuries shows that education, justice and healthcare are the core elements to ensure a
stable society, prosperity and freedom. If the health sector is not easily accessible to
people and not well managed will affect the lives of people and increased social
insecurity, increased morbidity, mortality. The Government, MoH focus on change
management methods, improving the quality of services of health care in the direction
of equal access to the health system, increasing the coverage of health insurance,
development system health information, problem solving budget and finances related to
healthcare services for everyone must be equal access to health systems demonstrate
habits change from focusing on quantity to focus on quality. 
The forum will be an opportunity to discuss strategies to improve the quality of
health care in the next 5 years. improve the quality of services of health care in the
direction of equal access to the health system, increasing the coverage of health
insurance, development of the system of health information, solve problems and budget
resources relating to health services for everyone must be equal access to health systems
demonstrate habits change from focusing on quantity to a focus on quality. The forum
will be an opportunity to discuss strategies to improve the quality of health care in the
next 5 years. improve the quality of services of health care in the direction of equal
access to the health system, increasing the coverage of health insurance, development of
the system of health information, solve problems and budget resources relating to health
services for everyone must be equal access to health systems demonstrate habits change
from focusing on quantity to a focus on quality. The forum will be an opportunity to
discuss strategies to improve the quality of health care in the next 5 years. resolving
budget issues and financial-related health services to people should be equal access to
health systems demonstrate habits change from focusing on quantity to a focus on
quality. The forum will be an opportunity to discuss strategies to improve the quality of
health care in the next 5 years. resolving budget issues and financial-related health
services to people should be equal access to health systems demonstrate habits change

from focusing on quantity to a focus on quality. The forum will be an opportunity to

discuss strategies to improve the quality of health care in the next 5 years.

Mrs Axelle Nicaise, Deputy Head of the EU delegation to speak at the Forum.
6.2. Report on the situation of hospital quality management and implement The
quality criteria of hospitals 2013-2018 stages.
Associate Prof Ngoc Khue Luong, Director of Medical Services Administration has presented
the report of the activities of quality management of medical examination and treatment
as well as implement the quality criteria of hospitals in stages of 2013-2018
Bureau Chief has stressed the direction of the Deputy Prime Minister, Vu Duc Dam at
the Forum in 2013 as the Health Ministry and the hospital need to manage and improve
the quality of medical examination and treatment, effective use of medical financing , the
quality of human resources, enhance the sense of implementing the code of conduct and
professional ethics to "... sick people to enjoy good quality medical services for the same
suit, with drugs at reasonable cost".
 Quality management is also a priority task of the medical profession in the Minister's
new term of "comprehensive innovation quality treatment, patient-centric, patient
satisfaction oriented ".

PGS.TS Luong Ngoc Khue - Director of Administration Medical Service report on

the status of the hospital quality Vietnam after five years of implementation of
innovative policies
To implement the above tasks, with the motto "patient-centered, patient safety as the
No. 1" Administration of Examination and Treatment has developed many normative
law:
- Circular 01/2013 / TT-BYT dated 11/01/2013 of the Ministry of Health to guide
the implementation of quality management testing
- Circular No. 19/2013 / TT-BYT dated 07/12/2013 guiding hospital quality of
service management
- Decision No. 4858 / QD-BYT dated 12/3/2013 issued pilot’s hospital quality
assessment criteria
- Circular No. 04/2015 / TT-BYT dated 03/17 / 2015 regulations on recoginition of
quality management standards of medical facilities
- Decision 6858 / QD-BYT dated 18/11/2016 issued hospital quality assessment
criteria version 2.0 (from pilot to formal)
- Decision No. 4276 / QD-BYT dated 14/10/2015 approved a national action
program to improve management capacity of quality of medical examination and
treatment up to 2025
 The text above has been publizlized, implement and deploy in whole system of
medical examination and treatment; Hospital Quality Forum organized first time in
2012, the second in 2013 and the third in 2016; created documents on quality
management, patient safety, hospital management, ... Training on Quality Management
for 30 classes in several provinces with about thousands of participants from hundreds
of hospitals; held conferences constantly to guide the examination and assessment of
hospital quality, towards the satisfaction of patients and patients' safety in 2013, 2014,
2015, 2016, 2017, 2018.
During implementation of the regulations on quality management, Administration of
Examination and Treatment in early stage, also faced many difficulties and challenges:
- Collapse Awareness and the Tragic and conservative Consciousness, rigid thinking
and slow leaner. Some leaders of the Health Department also said that evaluation
criterions are strict and difficult.
- Implementation of quality management is formalistic and action as counter
measure and perfunctory in assessment.
- The quality of human resources is still low, the allocation of human resources
between public hospitals and private clinics, upstream and downstream hospitals are
quite different and create gap
- The level of payment of health insurance and medical services is low, not
commensurate with the actual costs that patients and units have to pay.
- The payment mechanism has not reached the regional countries; Financial
autonomy is also a difficult problem for unit leaders when they want to improve the
lives of health workers.
- The problem of hospital overcrowding remains a difficult challenge for the
hospital needed to rbe solve if improved the quality of healthcare.
However, with the efforts of the entire medical examination and treatment system,
all units agreed, joining hands to improve quality and achieved quite spectacular
achievements after
- Awareness on quality management has changed markedly, the implementation
and evaluation of quality has come into essence and depth.-
- GPA of Quality Management went up including professional activities (Chart 1),
development of human resources (Figure 2) are increased, especially activities
quality improvement (Figure 4), instruction to patients (Figure 3) has increased
significantly: from 1.77 to 2.51 and from 2.39 increased to 3.15 increase.
Chart 1. Hospital quality GPA of hospitals across the country in 5 years

5
4.5
4
3.5
3 2.8 2.75 2.77
2.39 2.44
2.5
2
1.5
1
0.5
0
Năm 2013 Năm 2014 Năm 2015 Năm 2016 Năm 2017

Chart 2. Hospital quality GPA by level in 5 years

5
4.5
4
3.5
3 Năm 2013
2.5 Năm 2014
2 Năm 2015
1.5 Năm 2016
1 Năm 2017
0.5
0
BV Trung BV tuyến BV tuyến BV ngoài
ương tỉnh huyện công lập

Chart 3. GPA Part A (towards the patient)

 5
4.5
4
3.5 3.04 3.15
3 2.91
2.66
2.5 2.39
2
1.5
1
0.5
0 Năm 2013 Năm 2014 Năm 2015 Năm 2016 Năm 2017

Chart 4: GPA Part D (quality improvement activities)

5
4.5
4
3.5
3 2.51
2.29 2.49
2.5 2.12
2 1.77
1.5
1
0.5
0 Năm 2013 Năm 2014 Năm 2015 Năm 2016 Năm 2017

The results of quality management have been highly appreciated not only from the
health sector. "I also sometimes" do not believe "such a big change of the health sector -
Minister of MOH" but also receive From the National Assembly, civil society and civil
society delegates, "Voters highly appreciate quality of medical examination and
treatment in recent times that have been shown some positive and clear changes and
continue to improve”.
The patients were more satisfied: the results of interviews with 3,000 patients after
leaving the hospital showed that the satisfaction rate was quite high at 79.6%
According to a PAPI survey released in April, 2018 has shown: "Lubrication" rate in
the field of healthcare examiniation and treatment has markedly reduced, specifically,
"Rate of respondents said they had to bribe healthcare workers at public hospitals in
district/city fell from 17% in 2016 to 9% in 2017. Overall, 33 provinces have this content
index score increased compared to year 2016 ". In particular, Annual Community Health
Worker Conference 2017 and  Direction of Health Strategy ( Ministry of Heath) on Jan
19, 2018
Annual Community Health Worker Conference, Deputy Prime Minister Vu Duc Dam
emphasized “ in general, quality of examination and treatment, spirit and attitude of the
medical staff are significantly improved. This is not just a day's work but a result of a lot
of effort”
Besides achievement and efforts of the whole industry, such as: hospitals in the South
of change innovative thinking and have the apparent step forward, some hospitals in the
North to actively improve quality and become ' bright spot ", Many hospitals have not
properly evaluated the role of quality improvement, have not changed their thinking about
the role of hospitals and health workers in the new situation and therefore have not
prevented some of the medical problems unfortunately happen.
In the next five-year period, the entire medical industry continues to promote the
results achieved aming to achieve target of innovation and integration:
- Promote quality improvement, interest in patient safety, better lifestyle and
working conditions of health workers.
- Continue to build, supplement and complete the set of criteria, documents,
guidelines in the standardized way to assess and announce top quality hospitals,
creating motivation for development.
- Quality evaluation results attached with the form of rewards and encouragement in
form of financial mechanism.
6.3. How to encourage continuous quality improvements in the hospital
MD. Dr. Shinsuke Murai, Chief Advisor of JICA on Quality Hospital Management
in the Lao’s Democratic Republic, National Center for Global Health and Medicine
(NCGM) Tokyo, Japan.
Dr. Shinsuke Murai has introduced concept of quality: “Quality is factor ensuring
objective achievement or expected results which is measured by the degree of
completion of objectives”, “quality means that product’s elements meet customers’
need and satisfaction "and think" quality "means think " target ".
When hospital selects a subject for improvement also means hospital commitment
to hospital quality improvement
Quality management has been put into the medical field in Japan originated from
a number of incidents of medical causes of death in Japan in 1999, 2000
Based on evaluation and study on causes of the incident, managers have
developed programs and Hospital standardization and Hospital Quality Certification
program in 1951.
The core values of quality management in Japan include:
 Culture quality
 Customer oriented
 Reduce the fatality
 Technical processes also based on customer needs
 Fact-based management
 Respect for humanity
 Quality of process
 Flaws is treasure and opportunity to improve
Criterions for quality assessment of hospitals in Vietnam is in accordance with the
real situation, the step-by-step approach, continuous quality improvement that has
been announced in public
The experience of Laos: service quality criterions was controlled and established
by hospitals. These criterions are grouped into quality requirements at 5 different
levels. Quality improvement requires 5 good elements for success: good reception,
clean, pleasant, good diagnosis, good treatment and 1 satisfied. The first time Laos
has held Forum on quality improvement in Feb 2018.
In the future, we can improve hospital quality and safety to prepare for the rapid
progress of medical technology; rising hospital prices are encouraged to develop
 mechanisms of hospital quality and safety; Experience of Head of Quality
Management is required to become Director of hospital; investment opportunities,
sharing and discussion for hospital quality control staffs / Patient safety. Apart from
external opportunities provided by Board of Directors of Hospital; each hospital
started using exisiting quality criterions to improve hospital quality and provide
better patient safety.
The manager is the one who decides which quality requirements of the hospital
should be prioritized, who (department / department) does what time with
responsibility and resources, ... Maintainance and improvement of quality and safety
of the hospital needs efforts throughout the hospital

6.4. Speech by Deputy Prime Minister Vu Duc Dam

Deputy Prime Minister Vu Duc Dam has recalled for a number of issues and
requests raised by National Forum on Hospital Quality first time in 2013. Deputy
Prime Minister emphasized that medical facilities have to change thinking in
examination and treatment, cure the sick. Building hospital quality assessment
cretierions are on trend and international criteria, measurable, and especially
mechanisms for external organizations to collect information directly from patients.
Issues related to people's health from prevention to treatment, quality of
examination and treatment must be publicized and transparent. The health sector
should continue to mobilize and mobilize organizations such as Vietnam General
Medicine Association, Associations, especially those of patients and people to
participate in improving the process of hospitals management.
6.5. The role of the Department of Health in promoting quality improvement
activities of hospitals and medical facilities attached
Assoc. Prof. M.D. Tang Chi Thuong, Deputy director of Ho Chi Minh City
Department of Health (DoH) mentioned the role of Department of Health in
promoting service quality of hospitals and medical facilities attached.
Activities for hospital quality improvement of Ho Chi Minh City Department of
Health is divided into 6 groups:
- Establishment of the Council of the quality control of DoH and concretize
into 5 goals with a practical action program
 - " Patient dissatisfaction "perceived as a starting point for activities improve
the quality of the hospital
- Support to improve capacity in activities of hospital quality improvement
- Connect upstream hospitals with downstream hospitals to enhance the
quality of examination and treatment
- Vote and recommend replication of good practice throughout the healthcare
industry city
- Publicilized hospital quality assessment for people to know and to choose
Quality management Council of the Department of health includes 6 boards
are dedicated to implement 5 quality objectives (more secure, more efficient,
more feasible treatment costs, faster, more satisfied) in priority  of city hospitals,
district hospitals, private hospitals, clinics, private and specialty clinics/wards.  
Slogan "patient dissatisfaction and experience" perceived as starting point for
hospital quality improvement activities, DoH kiosk for hospital quality survey
system to collect patients’ feedback in 53 public hospitals. 
At the same time, the Health Department also supports capacity in improving for
service hospital through building data system in treatment regimen in all
hospitals and clinics, continuous training of hospital management and hospital
quality management. DoH connects upstream and downstream hospital and initial
care facilities to improve the quality of medical examination and treatment.  The
process of "red link" among hospitals help pregnancy to overcome the door of
death in a spectacular way. 
Health sector have conducted to reviews, vote and replicate execution in
entire medical industry in city level: organizing "good nursing" contest for
patient safety and hospital quality. DoH publicilize results of hospital quality
assessment and medical facilities for people to know and to choose.  
Ho Chi Minh City DoH was actively using existing resources, providing
guidelines and having creative forms to stimulate and promote deployment of
hospital quality improvement aiming to goal acheivements
6.6. Quality management and innovative styles to improve efficiency and patient
satisfaction of Eye Hospital, BA RIA-Vung Tau
Specialist II Nguyen Viet Giap, Director of the Eye Hospital, BA RIA-Vung Tau
presented on quality management and innovative styles to improve hospital efficiency
and patient satisfaction.
Eye Hospital is the hospital a specialist second class of BA RIA-Vung Tau province,
with 100 beds, 15 departments and 95 employees. The hospital was given the completely
autonomous funding operations in 2017.
Initially, the hospital deployed the hospital quality management to deal with the
regulations of the Department of Health, the Ministry of Health. During implementing
program, hospitals receive some results relating to role, efficiency and benefits of
hospital quality management.
All quality improvement activities are performed through 3 levels: first updating
knowledge, then is changing attitudes and changing behaviors. Quality indicators are
measurement and periodic evaluation: input indicators, output indicators and process
indicators. Through the process of implementing quality management from the year 2015
so far, the hospital has obtained some encouraging results, such as:
- Develop a code of conduct for hospital staffs
- Creating a favorable environment for staff and patients
- Clear signs and information
- Green, beautiful and greenful campus and toilets
- Develop a safety checklist for patients with eye surgery
- Professional activities also improved significantly: Total outpatient, inpatient,
some eye surgeries increased significantly since 2015 to present.
- The satisfaction of the patients increased from 90% to 98.2% in 2015 in 2018.

6.7. Clinical quality improvement at the Cho Ray Hospital

Ph.D, M.D. Ton Thanh Tra, Head of Hospital quality management, Cho Ray Hospital
reported results of clinical quality improvement after the Hospital applied the criteria and
indicators of quality.
Cho Ray Hospital is the hospital a special class with more than 3,000 beds and more
than 4,000 medical personnel. The quality improvement for hospitals is a major
challenge. However, the hospital had directed fiercely and there are many solutions to
implement effective management of clinical quality in hospital. The quality management
system of the hospital is fully equipped with clear quality indicators from the input
indicators, process indicators to the output indicators. Clinical quality indicators also
materialized from the elements related to the structural indicators and to the factors
relating to process indicators and output indicators. Hence, the results of clinical quality
improvement are evaluated easily:
- Surveillance of antibiotic use: Patient compliabce with antibiotic usage increased
from 58.7% in 2014 to 90.7% in 2018; Antibiotic treatment costs decreased by
roughly 10-30%.
- Decreased 30% incidence of pneumonia related to mechanical ventilation
compared to the deployment
- Reduce the risk of falls, ulcers due to hold-up, the risk of errors due to the
ventilator, hospital infections
- Satisfaction of patients and medical staff increased over the years.
- Through the process of quality improvement, hospitals have noticed: clinical
quality are important elements to bring satisfaction to patients and clinical quality
need to be built, measured, monitored, surveilled and continuously improved and
selected in priority when conducting quality improvement based on site and
specific conditions and in accordance with guidance the Ministry of Health.
6.8. The results of quality control at the hospital, Vietnam-Sweden Uông Bi
Ph.D, M.D Trần Viết Tiệp – Director of Vietnam Hospital - Thuy Sweden Uong Bi
presented results of quality management at the hospital.
Vietnam-Sweden hospital, Uong BI is the Central Hospital, the # 1 close at Northeast
Vietnam, with 1,000 beds, has a quality management system in fullest. Our motto: quality
management is the effective management of resources, process, regulations, instructions;
crisis management; managing diagnostic results, continuous quality treatment and
improvement. Hospital implement incentivized mechanism of quality control, construction
of quality culture "don't criticize and encourage learning" and has gained many significant
results:
- Results reported incidents increased from 2 in 2014, increased by 1336 reports in
2018.
- Rate of process compliance, regulations, the treatment regimen increased year by
years.
- The rate of prophylactic antibiotic usage increased: 11.89% in 2016, 65.9% in
2017 was 82.65% and in 2018 is.
- Proportion of drug spending / total hospital fees: <20%
- High rate of illness / disease recovery:> 95%
 - Satisfaction of patients and medical staff increased, the compliment letter of
patients increased from 342 in 2017 to 788 in 2018
- The quality score of the hospital increased from 3.28 in 2015 to 4.14 in 2018.
To obtain these results thanks to the hospital conducted a continuous quality
improvement. Quality is safety, good service, good and enhance treatment effectiveness,
efficiency and so the hospital has not stopped developing in a sustainable way.
6.9. The results of quality control at the hospital, Vietnam-Sweden Uông Bi
Ph.M, M.D Phan Thi Hang, Deputy Director of Hung Vuong hospital presented
deployment of medical incidents reporting system in hospitals
Hung Vuong Hospital is located in Ho Chi Minh City and has many effective
solutions to deploy medical incidents reporting system in hospitals
- Establishing a process to receiving and solving incidents reports, regulations on
mandatory incident reports, creation of voluntary incident reports forms,
instructions for incidents reports
- Training in incident reports, provide documentation for reference
- Rewarding when reporting incidents
- Creating culture patient safety, Standardizing Patient Safety Risk Management
- Training leadership thinking and communication to create closeness between
leaders and employees
- Creating software for online incident reports
- Improve the quantity and quality of incident reports
In the first time of reporting incidents, there were still many barriers that prevented
employees from reporting such as: report cards were not available in the department, too
long report cards did not have time to fill in the votes, but there was no problem. time to
report, do not understand when to report or think "reports are not processed" or reported
but not responded to, and sometimes bring fear (discipline, afraid of colleagues
hating, ...). But after learning, guiding and encouraging, the number of compulsory and
voluntary reports has increased over the years, the time to resolve incidents has been
reduced
Lessons learned that the hospital had been after the deployment of the medical
incident reports are:
 - Creating the medical incident reports system accompanied with culture of patient
safety
- Presenting the medical incident reports for Board of Directors and staffs
- Analyzing incidents and problem-solving methods to build trust among employees
- Introduce learning content in form of vivid and innovative way
- Eliminate culture of accusation and develop self-discipline and self-responsibility
culture.
6.10. Improve the quality of nutrition activities regime – in the southern area
hospital, progress and challenges
Specialist II . Do Thi Ngoc Diep, Director of the Nutrition Center of Ho Chi Minh

presented Abstinence nutrition activities in hospitals in South

Nutrition plays an important role in the treatment and nutritional care for patients.

Approriate and timely nutrition help to increase efficiency, reduce the risk of

malnutrition, infectious hospitals and other complications, reduce the time and cost of

treatment.

The Ministry of Health has issued Circular 08/2011 / TT-BYT on guidline for

nutrition abstinence in the hospital, hospital quality criteria included criteria C7 of

nutrition abstinence, Circular 28 / 2015 / BYT-BNV TTLT 7/10/2015 standards of

nutrition professional title confirmed the interest level of the Ministry of Health with this

important task.

In reality, nutrition abstinence activities of many hospitals are facing many

difficulties due to its activities are not interested and should be coordinated and linked

with multiple departments, divisions in implementation, lack of infrastructure and

equipment, lack of specialized human resources and organization and execution ability

and capacity... Quality level nutritional abstinence in almost hospitals are low. The

proportion of patients receiving nutrition intervention is low leading to deplayed

detection of malnutrition and rate of malnutrition in the hospital is up to 40% higher.

 In this context, HCMC Nutrition Center with strong desire to support hospitals

accessing to qualified nutrition abstinence activities in a scientific and practical way on

the basis of standardized nutrition activities abstinence conducted several studies on

situation and solutions for quality improvement of nutrition abstinence in the Ho Chi

Minh city and other southern provinces. The main solution is to provide continuous

profesional education of nutrition knowledge, nutrition abstinence and emphasize

nutrition education content related to Hospital quality criteria for 1000 official healthcare

staffs/ year and put nutrition education content related to Hospital quality criteria into

training program for healthcare professionals of Department of Health and other

hospitals, implement pilot test, support practice and communication, persuade and invite

advocacy leaders and, Japanese and Australian experts to share experiences;

By 2018, Nutrition Center together with experts in nutrition and quality management

field a set of guidelines for practicing hospital nutrition abstinence covered the main

contents inclusing implementation of nutrition abstinence activities, nutrition status

assessemnt, nutrition intervention and abstinence and nurturing care, oraginize and

provide standard meals and meal portion, principles of menus design and menu

templates based on the guidance of scientific nutrition abstinence, nutrition abstinence

model in some advanced countries and Vietnam; organize the construction of the system

held the Nutrition Department of the BV restriction standards of quality criteria BV

Department of MOH. construction principle menu and sample menu based guidelines on

nutrition science abstinence, abstinence nutrition model in some advanced countries,

Vietnam and practices; build organizational system of the Department of Nutrition and

Dietetics under the standard of hospital quality criteria of Ministry of Health

 Nutritional status assesment toolkit and Hospital Menu Assessment of Nutrient

Composition and Patient Satisfaction was introduced in many hospital and receive highly

appriciated and positive feedbacksof the hospitals leading to quality level of hospitals

nutrients abstinence have risen from 2, 56 in 2015 to 3.0 in 2017.

Dr. Diep proposed

- Organize training program, CME specialized Nutrition and Dietetics

- Standardize criteria of technical expertise about Nutrition and Abstinence

- Promulgate a list of technical expertise for Nutrition and Abstinence Field

- Standardize criteria for Department of Nutrition and Dietetics

- Allocate number of nutritionist and abstinenist/ beds

- Creating conditions for granting practicing certificates, grade transfer for

nutritionist and abstinenist

- Health insurance payment for feeding patients

- Practical Nutritious Meal Model

6.11. Financial mechanism innovation, self promoting hospitals improve the quality
of medical examination and treatment
M.PhD. Nguyen Nam Lien, Director of the Department of Planning - Finance
presented the financial mechanism, the price of services and the quality of medical
services and treatment.
Board of Directors in most hospitals should focus on improving healthcare quality
and completing technical categories, synchronizing dynamic policy of universal health
insurance and encouraging the expansion of patient caring services alongside healthcare
6.12. Survey of the satisfaction of patients and medical staff nationwide, 2015-2018
stage
PhD. Duong Huy Luong, Deputy of Quality Management Division, Medical Services
Administration reported shortly results of surveys of patient satisfaction based on
experience of in patients from admission, blood tests, tatics, treatment, healthcare staff
attitude to treatment outcomes, compared with patient’s expectations before admission.
 Patient Satisfaction Survey were deployed in hospitals nationwide, patient feedbacks
was recorded and shown survey results, which are relatively consistent with hospital
quality
PhD. Luong stressed the satisfaction of the patient is the most important criteria in
assessment of hospital service quality, a measurable reflect about the outputs of public
and private medical facilities.
6.13. Efficiency and benefits apply quality improvement programs according to 83

criteria of quality of hospital Vietnam Hoan My Medical Corporation

M.D Nguyen Huu Tram Em stating the investment in facilities and human resources
especially high-quality adminstration should be matched to Vietnam hospital quality
criteria. Top priorities is simple project with high feasiblity in immedicate deployement
and measuarable results. Training program for behavior chaning and knowledge and skill
upgrade should be accompanied effectively with hospital quality improvement journey
6.14. Improving the quality of the hospital toilets
Quality management department - Vietnam - Czech Haiphong friendship hospital has
shown importance of improving the quality of public toilets
Vietnam - Czech Friendship Hospital, First class general hospital with more than 1,000
beds, 52 departments and divisions, Intensive center with the goal of "patient- centric", the
hospital has always improved quality patient service.
The results of hospital quality evaluation increased year by year (from 3.17 in 2013 to
4.03 in 2018).
The toilet situation in 2014, the year 2015 is the horrors of patient and their relatives:
the wet and dirty floor, leaking faucets, moldy, stain, dirty wall. The hospital has
launched a plan to renovate the toilet with the aim of "minimizing hospital infections
arised from toilet and hygine problems of patients and medical staffs." In addition to the
slogan "as comfortable as at home" and "medical staff and patient shared toilets", the
hospital has invested and deployed multiple sync solutions such as: budgeting,
training/coaching/ knowledge updates on hygiene for healthcare workers, recording and
announcing in the area of sanitation, ...) in order to improve the hospital toilets. And after
4 years of deployment (from the year 2014 to 2018) the results achieved: patient
satisfaction in 2014 at the rate of 1 to the year 2018 has reached level 5.
6.15. The experience of application the quality criteria set in lậpbệnh hospital
quality Institute geared to human disease
PhD. Truong Vinh Long, Director of 115 Gia An hospital stated facilities investment
for comprehensive care for patients. Departments are investing in sync modern
equipment and manpower
6.16. Work after 05 years of health care quality improvement of hospitals Sop Cop
District Son La
Specialist 1 Vu Van Hiep, Director of the hospital reported on the effective
implementation of the examination and treatment after 5 years improved the quality of
Sop Cop hospital, Son La. Through training, coaching, expert consulting, investment in
infrastructure and manpower, after 5 years of applying 83 criterions, the hospital Sop is
renewed constantly to improve knowlege and expertise of medical staff, service attitude,
quality of examination and treatment for building trust among patient, the average score
in 2018 rose by 3.26. Results achieved in attempt of the Board of Directors and staff of
the hospital
6.17.  Quality improvement activities of the Technical Assistance Fund of the EU on
health (EU-HF)
Mr. Le Thanh and Mr. Jose Cardona, Director of the medical foundation for the EU-
HF has introduced programs to support the health sector policy, phase 2 (HSPSP 2)
funded by the EU. The program consists of 3 components: EU support fo health sector
reform, the EU technical support for health and education, training human resources for
health.
Specific objectives of the program:
 ‘Support for the achievement of the policy of the health sector ... are set out in
the Plan sector 5-year period from 2011 to 2015' 
 ‘Contribute to the development of health policy in the period 2016-2020'. 
 ‘Progress attainable of universal health care '' 
o 'Improving the availability and quality of health services at the lower
levels (district and commune)' 
o Special focus on 10 target provinces (in some of the poorest)
Target of EU Fund - HF:
 Support partners to achieve the objectives identified in the program HSPSP 2 
  Support the reforms in the health sector 
 Ensure providing timely services with expert quality 
 Food communication activities and promotion of the EU's support for
Vietnam's health sector
Strategic priorities of the project with aims of improving system data and user
data; strengthening management, improving planning and budgeting and operations
research to identify barriers and propose solutions. 
The Fund's overall plan EU-HF concentrate on the following areas: administration,
communication, finance, service and promote the image of the EU and policy dialogue
.
6.18. Poster exhibition
 150 posters sent to the forum with groups of topics to improve hospital quality
according to the Quality Criteria:
 Quality Management according to model 5S 
 Information Technology Application
 Treatment quality improvement and new technologies
 Improvement of satisfaction patients 
 Deployment of testing, monitoring, measuring quality
 Financial solutions
There have been 50 selected posters for exhibitions attracting numerous participants,
views, discussion and learning. This is a new initiative to help convey the diversity and
creativity of the hospitals in the quality management and improvement
Professional Council were graded and Director of Medical Services Administration
has awarded for the highest quality poster on the evening of the same day. 
6.19. Conclusion
Associate Prof. Dr. Ngoc Khue Luong highly appreciated repoters, delegates and
guests, speakers with high contributed feedbacks showing their enthusiasm and
motivation in improving the quality till the last minute of day.
Dr Khue stressed that hospital quality has strong connections with the cost of
services. Prices of services can increase if hospital quality improved. Some benefits of
 quality management include increase in patient satisfaction, reduction in medical
errors, increase in hospital prestige, decrease in service costs and efficiency and
revenue increase

7. Conclusions and Recommendations

7.1. Implementation of the quality criteria for hospital
Delegates have better understanding in hospital quality criteria and play important
role in effective implementation of programs to improve the quality of hospital.
Not only the public hospitals that private hospitals have used hospital quality
criteria as a standard tool in quality management and action implementation. A set of
criteria was used to measure the quality improvement of the hospital as well as
comparisons with other hospitals. The basic hospital quality assessments to determine
the priorities of hospital quality improvement, criteria with low scores should be
improved and hospital should prioritize those issues without wasting money to resolve
Quality management and improvement is the responsibility of all medical staff in the
hospital for implementation and need to understand that the reputation of the hospital
will be associated with the quality management system
Man power for hospital quality management included medical staffs in management
level and divisions to supervise and support the organization of medical discussions to
find out the solutions and root causes.
Ministry of Health and the medical management agencies should organize training
on modern hospital management for leaders at all levels of hospitals in the aim of quality
management must be aligned with the hospital management
The results of the quality assessment must be announced to patient with information
about the quality of the service and they can decide which service they should opt
to. Hospitals should publish creative activities to improve hospital quality in order to
motivate staff and support the culture of hospital quality. In addition to improve the
image and acceptance of the medical service in Vietnam.
In order to independent assessment of hospital quality according to 83 criteria
combined with patient feedback records to ensure transparency and equality in scoring
and ranking hospitals
Besides building regimen to guide the process of treatment, hospitals should
supervise strictly to implementation of this process protocols at all levels
7.2. Perfecting the quality evaluation criteria and guidelines applicable
 Some criteria for nutrition abstinence care, nursing care, patient care should be
supplemented.
 Ministry of Health should develop guidelines for capacity framework of
nutrinionist, nutrition staff
  Use the human resources for medical secretaries at hospitals to reduce the
workload for nutritionist
 The criteria for hospital quality should be modified to better suitable with the
culture of different provinces, for example language requirements,
communication, infrastructure and nutritionist allocation
 Build more treatment regimens, patient care standards.
 Create management program towards application of information technology
interconnection between levels
7.3. Recommended next steps to improve the quality of hospital
- The commitment of the hospital about the advanced and continuous quality
improvement. Hospitals need to manually select a theme need to be improved.
- Implementation of comprehensive care including providing standard meals for
patients to reduce pressure on the excessively overcrowded hospitals and to
create conditions for improving quality and safety. comprehensive responsibility
of the hospital in caring for patients during hospitalized and discharged from
hospitals must be strictly enforced through specific legal provisions.
- Renewal of payments and investment methods has a big contribute to
improvement of the quality of patient satisfaction.
- Implementing the price increase of health services is important to improve
service quality
- The PPP will be a good solution to increase the financial investment for hospitals
to improve the infrastructure and services
- Patients satisfaction and hospital staffs should be regarded as two aspects of a
problem and need to be solved in parallel.
- Committee to evaluate and ensure transparency of results of quality assessment.
- Organize many exchange programs with the participation of experts

8. Media and publicity photos

The national quality forum has been coordinated by the European Union Hospital
HF Some communication activities have been implemented to publicize the project's
image, including display of media documents in the European Union, banner, standee,
European Union and Vietnam flat, upload image, video and online articles
Horizontal banners placed on the stage in the conference room are printed in
Vietnamese and English language with the logo of MOH, EU, EU-HF was placed in the
corner of the Conference room and near the registration desk, as well as the table display
of communication and PR materials. Photo of the workshop was taken by a professional
photographer hired by the EU-HF.

The photos and news forums were broadcast on the radio channel in 19 countries and
news released in different newspapers.
See image link and the program of the Forum:
Source Link

Video synthesis EU-HF http://www.euhf.vn/communication/video-gallery/

- https://vtv.vn/suc-khoe/dien-dan-quoc-gia-ve-chat-luong-benh-vien-
lan-thu-iv-20181218101542269.htm (Daily life)
VTV1

Truyền hình Nhân dân

https://www.youtube.com/watch?v=eFwgGBNKqUs
https://www.youtube.com/watch?v=h7n5sTfoepg

Video synthesis EU- http://www.euhf.vn/communication/video-gallery/

HF

List of articles about the conference is posted here:

http://www.euhf.vn/communication/news/
Showing better participation in the EU, all documents supporting the promotion of
medical quality in Vietnam will receive reference quality..
9. The feedback back stitching organization represents the conference.
Based on the Forum assessment forms and direct opinions of participants, 80% rated
very good, 18% good and 2% average.
Opinions on organizational issues:
 Location : suitable, propose for upcoming event in the Central provinces.
  Timing: appropriate, propose in the middle of the year allowing hospitals to
quickly apply results from the forum to meet the needs of quality improvement.
 Duration: extra time to discuss
Comments on technical issues:
 The topic distribution is rational
 Speakers have practical experience with persuasive reports
Theme related to Experience in application of the criteria for quality hospitals
are highly appreicated nd receive high attention of delegates, Some hard-to-choose
criteria for reporting are an opportunity to connect hospitals, experts and support
for quality improvement.
Topic of financial mechanism innovation, improving the quality of medical
examination and treatment towards the satisfaction of patients and helpful health
workers in the context of innovation. Reports on the experience of hospitals that
are facing financial difficulties and professional human resources should be
mentioned to share experiences of improving quality effectively.
 Poster for exhibition is a new initiative to help convey the diversity and
creativity of the hospitals in the management and improving the quality of
patient service, attracting the interest of delegations.
 A number of indicators of hospital quality assessment criterions have not
been understood clearly and become difficult to perform
Proposed
- Forums, conferences and seminars on quality management should be held more
often for experience sharing and learning
- Periodic training programs for management staffs and staffs who are responsible
for quality management
- Some compromising topics for training include: quality improvement model and
implementation methodology; improving the behavior of medical staffs to
patients and patients' relatives; patient safety; medical incident reporting
system; infection control ; skills for priority determination, planning skills to
implement hospital quality criteria ...
- The topics discussed include: cost factor of hospital fees, cooperation
mechanisms, coordination, socialization in the healthcare sector; solutions to
 mobilize financial and human resources in the context of limited resources to
improve hospital quality
- Round table exchanges on quality criteria for young managers
- satellite conferences are for specialty hospitalsin terms of scale and linearity.

Authorized by the President, Deputy Prime Minister Vu Duc Dam has awarded
the Labor Medal First Class gifts Health Care Administration.
10.Appendix
10.1 Presentation of the National Forum on the quality of hospital
10.2

Image

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