ISBN 978-4-909675-46-0

Table of Contents
Guideline for Citation											Foreword											Abbreviation												

02
03
04

Session 1

05

How to Implement 5S Effectively?.................................................................

Summary of Discussion								
1-15S Implementation in Clinical & Para-clinical Departments: Results & Lessons Learnt		
1-2
Evaluation of 5S Implementation in National Hospital of Obstetrics and Gynecology		
1-3
Evaluation Report on 5S Implementation in Thai Nguyen Central General Hospital
1-4
Results of 5S Practice in Thai Binh Provincial General Hospital: Difficulties and Advantages
1-5
Challenges in 5S Implementation in Ha Dong General Hospital		

Session 2

How to Make Incident Reporting System Work?..........................................

Summary of Discussion							
2-1Initial Results of Implementing Incident Reporting System in Quy Hoa National Leprosy
and Dermatology Hospital
2-2
Failures in Operating Incident Reporting and Management System			2-3
The Incident Management Journey in Tu Du Hospital			Session 3

Signboards in Hospital...................................................................................

Summary of Discussion							Experience in Improving Hospital Signboard System						Session 4

How to Ensure Quality and Safety in Clinical Work?.....................................

Summary of Discussion						
4-1Surgical Safety in Bach Mai Hospital		
4-2Some Experience in Implementing Surgical Safety Checklist in Ha Tinh Provincial
General Hospital										
4-3Actual State of Applying Surgical Safety Checklist in Hue Central Hospital		
4-4Applying PDCA Cycle to Continuous Quality Improvement: an Example
in the Antimicrobial Stewardship Program in Cho Ray Hospital		

Session 5

47
50
56
58

66
66
67

73
73
76
82
88
95
101
102

The Role of Quality Management Department in Hospital........................... 110

Summary of Discussion					
6-1Procedure for Handling Healthcare Complaints and Denunciations in Division ofTechnical Medicine and Pharmacy, Medical Services Administration
6-2
The role of Quality Management Department						Session 7

47

How to Reduce Waiting Time?...................................................................... 101

Summary of Discussion				Acceleration of Specimen Collection and Sending Test Results to Doctors
within the First 24 Hours of Emergency Response		

Session 6

05
08
14
19
29
40

110
111
114

What Can the Hospital Director Do to Promote QM/PS?............................. 121

Summary of Discussion					
7-1Fulfilling the role of the hospital director to improve quality management and patient safety
7-2
The Role of the Hospital Director in Quality Management and Patient Safety		Forum Outline							Program								Organization											Hospital Tour Program		
List of Participants		

121
122
127
130
131
133
135
136

1

Guideline for Citation
How to cite this book:Nguyen HA and Murai S (Eds.). (2018). Practices in Hospital Quality Management andPatient Safety in Vietnam: Challenges and Achievements (Vol.2). Tokyo, Japan: National
Center for Global Health and Medicine (NCGM).

How to cite an abstract/presentation in this book (Example):
Le VN and Nguyen TTC. (2018). 5S Implementation in Clinical and Para-clinical Departments:
Results and Lessons Learnt. In Nguyen HA and Murai S (Eds.), (2018). Practices in Hospital
Quality Management and Patient Safety in Vietnam: Challenges and Achievements (Vol.2).
Tokyo, Japan: National Center for Global Health and Medicine (NCGM).

2

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Foreword
Healthcare is application of medicine into society1. To tackle quality in healthcare, it isessential to discuss “What are requirements of quality in healthcare in a society?”. Then
there comes another question: “Can an international cooperation project led by an outsider
help generate such discussion in one country and its localities?" This has been the theme
challenged in the project of “Strengthening Management Capability for Quality and Safety in
Healthcare” by National Center for Global Health and Medicine, Japan for three years from2015 to 2017.
Similar to other international cooperation projects, the project conducted trainings on
quality and safety in healthcare in Japan. The Project invited a total of 26 heads or vice headsof quality management departments in 25 hospitals in Vietnam, one person from UNICEF andtwo people from Ministry of Health, Vietnam. However, we can imagine such trainings alone
will only encourage individual hospitals to strengthen their practices of quality and safety inhealthcare. Therefore, the project created an opportunity for those who actually work on
Hospital Quality Management and Patient Safety (HQM/PS) to share practical experiences
and to discuss application of practices of HQM/PS. That was “Vietnam Forum on Hospital
Quality Management and Patient Safety”. It was an opportunity for graduates and others whoare in charge of HQM/PS to learn about practical experiences in other hospitals and to seek
for better approaches that are applicable in Vietnamese context.
In Vietnam, efforts and progress of HQM/PS still differ in different hospitals. If hospitals
with slow progress knew practical experiences in hospitals with rapid progress, it would
provide hints for them to progress faster. If certain approaches need more discussion on how
to apply them into hospitals in Vietnam, participants from several hospitals could discuss it
based on their practical experiences. We believe such wave of sharing and discussion amongpeople who are in charge of HQM/PS would contribute to significant advance in HQM/PS in
Vietnam.
Finally, as development partners, do we really know what efforts on HQM/PS are going on
in hospitals in Vietnam? As members of the project team, two editors of this book had several
opportunities to observe hospitals in Vietnam, to meet people in charge of HQM/PS, andto conduct trainings and to support Vietnam Forum on HQM/PS. However, when we study
the forum’s discussion, we still learned more about how wide and how deep application ofpractices on HQM/PS were discussed among practitioners in Vietnam.
So the research project “Visualization of progress of efforts on quality and safety inhealthcare in developing countries (27 Shitei 2)” summarized discussion in the Vietnam Forumon Hospital Quality Management and Patient Safety in English. We hope this book will help
development partners to know more about ongoing efforts in hospitals in Vietnam. When
we know efforts and difficulties in hospitals in Vietnam, we believe we could discuss andoffer better international cooperation in the field of Hospital Quality Management and Patient
Safety.
The research team of Visualization of progress of efforts on quality and safety in healthcare in developing countries

1.

All Japan Hospital Association (AJHA) 2016 What hospitals ought to be - Report of the Committee on the Future of Hospitals
2015-2016 http://www.ajha.or.jp/voice/arikata/2016/02.html, Access: 16 March, 20173

Abbreviation

4

AMS 		

Antimicrobial stewardship

CDC

Centers for Disease Control and Prevention (USA)CQI

Continuous quality improvement

DI		

Diagnostic imaging

DOH 		

Department of Health

DTMP		

Division of Technical Medicine and Pharmacy

EBM		

Evidence-based medicine

ENT		

Ear, Nose, Throat

FE		

Functional examination

GPD		

General planning department

IRS		

Incident reporting system

MOH		

Ministry of Health

MSA		

Medical Services Administration

OPD		

Outpatient department

OT		

Operation theater

PDCA 		

Plan – Do – Check - ActPS		Patient safety

QI		

Quality improvement

QM		

Quality management

QMD		

Quality management department

RCA		Root cause analysis

SOP		

Standard operational procedure

SSC		

Surgical safety checklist

SSI		

Surgical site infection

WHO 		

World Health Organization

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Session 1

Session 1 How to Implement 5S Effectively?
Summary of Discussion

Session 2

1.

Making Plans of 5S
1.

Purposes of 5S implementation should be identified and articulated, like in Thai Binh Provincial General Hospital.

2.

A preferred approach to 5S implementation is a pilot implementation before expanding it to a larger scale. This
helps Quality Management Department (QMD) staff learn how to apply 5S by themselves and how to collaborate

Session 3

with another department to help them apply 5S. A successful pilot can inspire other departments and successful
departments can help other departments apply 5S in the future. For example, the Infection Control Departmentin Thai Nguyen Central General Hospital is now a 5S learning venue for not only other departments in thehospital but also other hospitals. A successful pilot can also help QMD convince the hospital leaders, especiallythe director, to involve in and support more for 5S activities.
QMD itself is a good place to conduct a pilot implementation. Besides, since many QMD heads are also leaders

Session 4

3.

of other departments, usually a clinical one, they choose to do a pilot implementation in their clinical departments
as well. For example, the National Hospital of Obstetrics and Gynecology chose to do a pilot implementation
in QMD and Treatment Services Department because the QMD head is also the head of the other department.
Ha Dong General Hospital did a pilot in three laboratories because the QMD head is also a deputy head of one

Session 5

laboratory. Some other hospitals, such as Tu Du Hospital, chose to start with departments who were most willingto work with QMD to try applying 5S.
4.

Detailed division of work and labor in an activity plan is very important for implementers to know who does what
and where. For example, Thai Binh Provincial General Hospital developed an assignment chart to assign specificstaff to be in charge of specific areas: Mr. A in charge of room 1, Ms. B in charge of room 2, Mr. C in charge ofthe lobby on the 1st floor, Ms. D in charge of the lobby on the 2nd floor…

Session 6

2.

Training
1.

Hospitals usually conduct general trainings on 5S to introduce the concept and relevant theories. However, suchbasic trainings are not enough. Usually after this type of training, medical staff still do not know how to apply 5S.

2.

More detailed, hands-on trainings are necessary. This type of training can be developed after pilot implementation

Session 7

when QMD staff has more practical knowledge in their hospital context. This type of practical training should
show participants what specific things should be done in each step (each S). For example, in Thai Binh Provincial
General Hospital, the detailed trainings include showing how to organize an injection trolley and a drug cabinet
step by step.
3.

Tu Du Hospital’s QMD designed some sorting exercises and setting-in-order exercises based on the skills
needed for S1 and S2 and ask their training participants to do these exercises in the trainings. This helps

Annexparticipants imagine how to apply S1 and S2 in reality.
4.

Use of photographs and actual examples can make trainings more interesting to participants and attract theirattention.

5.

Since many people tend to resist change, introducing 5S as a new concept may make it difficult for hospital staff
to adopt it. Tu Du Hospital’s QMD often relate 5S activity to a familiar custom, which is cleaning the house before
new year.

3.

Application
1.

Some common things or places to start 5S application are working desks, document cabinets, drug cabinets,

5

injection trolleys, departments’ administrative rooms, and corridors.
2.

5S requires working on the details. For example, in National Hospital of Obstetrics and Gynecology, QMD
checked all contents of the drawers and cabinets they were to apply 5S, then categorized these contents to beable to sort (S1) and set things in order (S2).

3.

Applying S1 often requires storage to store broken equipment to be handled later, because handling suchbroken equipment usually must follow a procedure and it takes time.

4.

Applying S2 may requires more organizing boxes or shelves. Some hospitals can manage to buy new ones(e.g., National Hospital of Obstetrics and Gynecology, Ninh Binh Provincial General Hospital) while others may
craft some hand-made boxes from available materials while waiting for funding to buy better ones (Thai Binh
Provincial General Hospital).

5.

QM staff should work directly with department staff “at the field” to identify what should be done in each step.
In Thai Binh Provincial General Hospital, QM staff guides staff in other departments to think about: (i) At yourworking position, what is necessary for your work and what is not? (ii) For what is necessary for your work, whatis the quantity you need? (iii) Where should you put these necessary things? etc.

6.

A suggestion from Hue Central Hospital is that QMD works with each department, one by one. In Tu Du Hospital,
QMD works intensively with the first implementing departments and gradually reduces their supporting role forthe next implementing departments.

4.

Monitoring and Evaluation
1.

Monitoring helps keeping staff practice 5S regularly. Some relevant departments can help monitoring 5S
implementation. For example, the Nursing Department in Ha Dong Hospital often check whether injection trolleys
are organized in clinical departments, so compliance to 5S for injection trolleys is high. Quang Nam Central
General Hospital experienced decreasing compliance to 5S when they reduced monitoring.

2.

Some hospitals, such as Thai Nguyen Central General Hospital, Thai Binh Provincial General Hospital, Ninh
Binh Provincial General Hospital, use a checklist to score and evaluate 5S implementation. (The checklist wasdeveloped under NORRED project.1 )3.

Quang Nam Central General Hospital checks inventory in a featured pilot department (Pediatrics) before andafter 5S implementation to see the effectiveness of 5S.

4.

In Thai Nguyen Central General Hospital, QMD collaborates with some members of other departments (e.g.,
Nursing Department, Pharmacy Department) to go and check 5S implementation. Since some departments were
not cooperative, QMD invited a member of the hospital directing board to join and be the leader of the patrol team.

5.

Taking photos is helpful for providing evidence of 5S results and spread lessons learnt. In Quang Nam Central
General Hospital, some clinical departments take photos by themselves for self-monitoring.

5.

Participation and Engagement
1.

In departments that implement 5S, participation of department heads is the key to success. In some hospitals,
involvement of departments’ deputy heads and head nurses was not enough.

2.

In Thai Binh Provincial General Hospital, some department heads were attracted by 5S trainings and they
actively started 5S implementation in their departments while others were not.

3.

In many hospitals, other departments question the QMD’s roles and tasks and do not want to follow QMD. For
these cases, participation of the directing board, especially the director, in 5S activities can help. For example, inThai Nguyen Central General Hospital, QMD was successful in convincing their hospital director to chair the 5S
Steering Committee as well as in inviting a member of the directing board to lead the patrol team.

1.

6

Northern East and Red River Delta Regions Health System Support Project

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

4.

To win the director’s support, QMD should show some evidence, according to experience of Tu Du Hospital

Session 1

and National Hospital of Obstetrics and Gynecology. In National Hospital of Obstetrics and Gynecology, after
QMD reported their initial results of 5S implementation in QMD and Treatment Services Department, the hospital
director asked them to apply 5S to his office.

6.

Other Activities
1.

Quang Nam Central General Hospital asked all departments to submit their 5S improvement initiatives and2.

Session 2

departments generated many good ideas.
In Thai Binh Provincial General Hospital, QMD was successful in convincing the hospital director and the
Performance Evaluation Board to account 5S implementation into their evaluation system. For example,
departments who score 1-2 in 5S implementation will be rated B, those who score 3 and above will be rated A.2

7.

Practical Outcomes of 5S Implementation
In Pediatrics Department in Quang Nam Central General Hospital, the inventory reduces remarkably after 5S

Session 3

1.

implementation.
2.

In Thai Binh Provincial General Hospital, practices of 5S helped hospital staff learn to think about how to create
a convenient and rational working environment. For example, in a 5S exercise, staff were divided into different
teams and each team had to re-arrange an injection trolley. They came up with different ways to organize

Session 4

the trolley, different positions to put certain things. Then each team had to explain their organization and they
discussed which way was the best.
3.

In Bac Giang Provincial General Hospital, applying 5S made the hospital cleaner and helped attract morepatients and increase hospital’s income.

Session 5
Session 6
Session 7
Annex

2.

This ABC rating system affects the bonus each department receives monthly.

7

Session 1-1
5S Implementation in Clinical & Para-clinical
Departments: Results & Lessons Learnt
Le Viet Nho1, Nguyen Thi Thach Cam2
1. Vice Director, Quang Nam Central General Hospital
2. Quality Management Department, Quang Nam Central General Hospital

1.

Reason for choosing the topic
5S is a foundational quality management (QM)

program for continuous improvement, which helps control
visualization, make tools and materials visible, easy tofind, easy to get, and prevent troubles, damage andinadequacy when needed.

2. 5S itinerary at Quang Nam Central
General Hospital (2 PDCA cycles)
The program was initiated by Nursing Department inJune 2015. So far, the program has passed 2 evaluation
cycles.
Cycle 1: Warm up (From June to December 2015)- Nursing Department was the focal point to plan and

8organize 5S implementation in the nursing system. At
the beginning, some departments participated actively,
which generated some encouraging results. However,
the expansion afterwards was slow. Some departments
implemented perfunctorily, so their condition came backto square one after 1-2 weeks. In December 2015,
through quick monitoring and evaluation, we recognizedthat the staff felt that 5S implementation was like a burden
because it was time consuming and creating extra work.
The people in charge of 5S implementation of the hospitaland departments felt tired and discouraged.
- Finding and analyzing causes, we noticed three groups
of problems but human factors and management policies
are decisive. (Figure 1)

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

remarkably:

Cycle 2: Objectives adjustment, development of»»with 5 main solutions

Drugs: 5,142,198 VND reduced to 530,176
VND; Benefit: 4,612,022 VND- The scope of 5S implementation was narrowed to»»clinical and para-clinical departments

Consumables: 1,406,799 VND reduced to398,931 VND; Benefit: 1,007,868 VND- A 5S supporting group was established to support•

There were no old, expired, or damaged items.

3.2.

(QMD)

Results from a survey on 5S influence on

staff perceptions  

- Core staff, especially department/unit leaders, were

- With the question “Did 5S implementation increaselobbied and their support was used

work burden?”: 72.3% of the responders said that

- A 5S evaluation scale was developed consensually;

5S effectiveness but felt tired with 5S maintenance;

Evaluation scores were announced, with images of what/

No responders said that 5S implementation is time

where needs improvement; Timely support, rewards andconsuming, burdening and tiring; 9.6% had otherpraises were given to well-implementing departments andopinions (5S implementation creates self-discipline; itthose with improvement.

is difficult to maintain 5S).
- With the question “Has your department changed

Cycle 3: Expansion and enhancement of the program

after 5S implementation?”: 89.1% of the responders

effectivenesssaid that their departments had changed considerably,
being tidier, cleaner, faster work thanks to less timeevaluating comprehensively the effectiveness andfor finding things and less repetitions of work due

challenges of this program to plan for next steps in orderto mistakes; 7.2% said that their department had

to maintain 5S effectiveness and expand to the wholechanged slightly; 2.4% had other opinions (thehospital: involving functional departments, combining withdepartment had changed but sometimes things wereother quality improvement (QI) programs such as LEAN

not organized tidily due to staff’s overwork).  

management, etc.

3.3. Quantity and quality of improvement

Results- The number of improvement initiatives increased- From observations and photos: the faces ofremarkably in 2015. At present, there are 46

reception, operation room, to consumables andapplication (47.8%).

improvement initiatives, 22 of which are related to 5S

many departments have changed remarkably: fromequipment storage; from working desks, document

improved.

4.

Lessons learnt- For 5S implementation:•- Evaluation results using the 5S evaluation

division of work).
•determination. The results of 5S implementationor showed more progress as results of other routine orwill be better in departments whose leaders areunannounced evaluations.

supportive and determined and regularly remind- Results of inventory checking in Pediatrics

and encourage their staff. This is the mostDepartment:

The quantity of inventory items reduced

Commitment of leaders: the success of 5S
depends on departments leaders’ supports andEspecially, many departments maintained these scores•

There must be a specific action plan (with clear

Annex(88.9%) departments achieving more than 80 points.

Session 7- The quality of initiatives has also been graduallycabinets, forms, drugs cabinets, to tools cabinets.

scale: there was remarkable improvement, with 24/27

Session 6

initiatives increased remarkably

3.1. Direct effectiveness  

which facilitates work and avoids mistakes.

Session 5

Currently, Nursing Department and QMD are

logical labelling and marking, and clear identification,

Session 4- Integrate “improvement initiatives” in daily 5S tasks.  

arranged in a tidy, clean and convenient manner with

Session 3

5S is part of their daily work; 18.1% acknowledged

Monthly monitoring and support for implementation;

Especially, injection and emergency trolleys are always

Session 2

Nursing Department and Quality Management Department

3.

Session 1

intervention solutions (From January to October 2016):

important factor for successful 5S implementation.
•

Select an appropriate place for pilot

9implementation: 5S will be implemented smoothlyand successfully in departments whose leaders
are strongly committed and whose responsible•

5.

habits, therefore some staff consider it as a trend,

advantage for the 5S Committee to have time andnot as part of their daily work. Since they are not self-condition to support. The successful departments
provide guidance and share experience or errors

disciplined, monitoring takes time and effort.  

to be avoided. If the pilot implementation is not- Many doctors and departments leaders are not yet

successful, the adjustment will be easier, less timeinterested and do not understand the importance andconsuming and less costly. This is the second

benefits of 5S, thinking that it is the work of nurses orimportant factor for wide application of 5S.

their lower staff.  

Monitoring and support are essential activities- Many divisions think that 5S is necessary only

to help departments with difficulties infor clinical and para-clinical departments, not for

implementation or to praise and encouragewell-implementing departments. The 5S
Committee monitors and evaluates regularly andunannounced, using the evaluation scale, taking
pictures of well implementing places and thosethat need improvement, showing such pictures tomake people aware and improve...
•

Current challenges- 5S has not changed staff’s old perceptions andstaff is enthusiastic and knowledgeable. This is an•

For 5S implementers: be patient, do not rush.

Trainings should be provided and communication
activities should be conducted to make staff
understand 5S benefits and how to implement

functional ones and it is difficult to implement 5S here.

6.

Conclusions and recommendations
5S is not a costly QM program yet brings visible

and clear results, sowing the first seeds of quality
culture in hospital staff and serving as a foundation forother continuous QI programs. However, to ensure
success, implementation must follow a PDCA cycle andimplementers must always be patient. This program
should be implemented widely in hospitals across the

5S in their own departments (through training

country, especially where QM has just started. After that,materials, communication slogans, sharing amongit can be expanded, upgraded and combined with otherdepartments…)

QM programs.

5S  I+nerary  at  Quang  Nam  Central  General  Hospital
5S implementationin clinical & para-clinical departments:
Results & some lessons learnt
3 PDCA
cyclesDr. Le Viet Nho, MD, PhD –Vice Director of Quang Nam
Central General Hospital1

Warm-up(06/2015 - 12/2015)

2

Objectives adjustment,
development of intervention
solutions(01/2016 - 10/2016)3

Expansion and enhancement of
the program effectiveness(10/2016 - …)

Cycle  1:  Warm-­‐up  (From  6/2015  to  12/2015)	
  CONTENTS
5S Itinerary	
  Initial	
  results	  	  Active	
  involvement	
  of	
  some	  departments;	
  Results achieved
Lessons learnt
Current challenges	
  Initial	
  successes	
  achieved.	
  

	
  
	
  After	  some	  time	  of	
  implementation:	
  	
  The	
  expansion	
  progress	
  was	
  really	
  slow;	  	
  Conclusions	  Perfunctory	
  implementation;	
  	
  
	
  Staﬀ	
  were	  tired	  and	  disheartened	
  because	
  they	  felt	
  that	  they	  had	
  extra	
  work.	
  	
  

10

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Cause  analysis
Lack of understanding of
the benefits and importanceof 5S implementation
Not good training
and communication

The department headis not interested

Burden, extra time,
extra work

Lack of professors andregular support

Self-discipline
is not highHesitation to change

The most difficult
factor to change
Working environment
does not nurture
activeness, competition

Session 1

Human factors

INJECTION	
  TROLLEY	
  Financialpressure

No proper
reward policies

Causes	  Implementation plan not
clear and specific
Large scale implementation
without piloting

After 5S

Before 5S

Regulations/Policies

Environment

Figure 1: Causes of ineffective 5S implementation

5S IMPLEMENTATION IN PEDIATRIC DEPT.
FILE	  CABINET	  Focus	  :	  clinical	
  and	  para-­‐clinical	
  departments	  	
  Establishment	
  of	
  5S	
  supportive	  group:	
  nurses	
  +	
  QM	
  staﬀ	
  	
  	
  3. Mobilization	
  of	
  departments	
  leaders	  	
  4. Monitoring	
  +	
  Rewards	  	
  Session 3

Cycle  2:  Objec+ves  adjustment,  development  of  interven+on  solu+ons    	  Session 2

HabitsNo guidance
for training &evaluation

1.

2.

Session 4

Developing	
  5S	
  evaluation	  scale	  	  	
  Conducting	
  monthly	
  monitoring	
  and	
  providing	  support	
  	
  	
  
§ Releasing	  evaluation	
  scores,	
  showing	
  images	
  of	
  where	  improvement	
  is	
  needed	
  	
  	
  
§ Supporting	
  and	
  rewarding	
  well-­‐implementing	
  departments	
  and	  those	
  with	  improvements	
  	
  	
  
§
§

5.

Integrating	
  “improvement	
  initiatives”	
  in	
  5S	
  tasks	  	
  	
  Before 5S

After 5S

Improved 5S

Session 5

5S IMPLEMENTATION IN PEDIATRIC DEPT.
Storage	
  Session 6

After 5S

Improved 5S

Opera+on  Theater  Department  of  Anesthesia  &  Cri+cal  Care
Before	  5S	
  Reception	
  area	  Storage	  Shelves	
  for	  consumable	
  materials	
  and	
  test	  tubes	
  	
  	
  

Cabinets	
  
for	
  
ﬁles	
  
nd	
  drugs	
  
Tủ	
  hồ	
  
sơ,	
  
tủ	
  tahuốc	
  

Annex

1.1.	
  From	  direct	
  observation	  Session 7

Before 5S

After	
  5S	
  

11

1.2.	
  Evaluation	
  results	
  using	
  5S	
  scale	  	
  3.  Quality  and  quan+ty  of  improvement  ini+a+ves  increased  remarkably    	
  

100	
  

 Quantity	
  increased	
  remarkably	
  compared	
  with	  90	
  2015:	
  	
  

80	
  

 46	
  work	  improvement	
  initiatives	
  	
  	
  

70	
  

 22	
  initiatives	
  related	
  to	
  5S	
  (47.8%)	
  	
  

60	
  

 Quality	
  of	
  initiatives	
  also	  improved	
  	
  	
  

50	
  
40	
  
30	
  
20	
  
10	
  
0	
  

Comparison	
  of	
  monitoring	
  results	  Quarters	
  1,	
  2	
  of	
  2016	  	
  3.  Lessons  learnt

100	
  
90	
  
80	
  
70	
  
60	
  
50	
  

Quý	
  1	
  
Quý	
  2	
  

40	
  
30	
  
20	
  
10	
  
0	
  

1.3.  Results  of  inventory  checking  at  the  pilot  department  (Pediatrics):  	
  3.1.  Making  detailed  plans  with  clear  division  of  tasks	
  5S	
  division	
  of	
  tasks	  Gantt	
  Chart	  Before 5S
After 5S

Drugs

Consumables

Total

Here comes your footer ú Page 15

2.  Survey  results  on  impacts  of  5S    on  staﬀ  percep+ons	
  1.	
  Did	  5S	  implementation	  create	  more	  work	  burden?	
  5S aspart ofdaily work12

2.	
  Has	  the	
  department	
  changed	
  after	  5S	  implementation?	
  Many changes,
cleaner, moretidy, faster work

5S waseffective but tired
to maintain

Limited change

TimeConsuming

No change

Other
opinions

3.2. Leaders’ commitment and support
5S Committee’s enthusiasm and patience
Everybody’s participation

Other
opinionsThe	
  most	  important	
  factor	  

5S Committee: members → enthusiastic and have prestige in:• Hospital• Department

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

PEDIATRIC
DEPT.

The	
  second	
  
most	
  
important	
  factor	  	  	
  Training	
  Sustain	  

5S Objective 	  Standardize

5S tools
Repetitionof thefirst 3S

Standardize

Shine
Set

Sort
25

Session 3

3.4. Training - Communication-­‐ 5S:	
  improves	
  quality	
  continuously,	
  not	  costly,	  but	  is	
  eﬀective	  and	
  brings	
  visible	
  results.	
  -­‐ 5S	  should	
  be	
  applied	
  in	
  hospitals	
  	
  	
  
-­‐ 5S	
  implementation	
  →	  following	
  quality	
  improvement	
  procedure	
  (PDCA)	
  &	
  	
  
implementers	
  must	  keep	
  patience	  	
  Session 2

SHARING EXPERIENCE IN 5S
IMPLEMENTATION

5.  Conclusions

Session 1

3.3. Pilot first, expansion later

THANK YOUVERY MUCH
Session 4

Experience	  sharing	  Session 5

3.5. Monitoring, evaluation, supportscale§ (5S Committee)

Annex

4.  Current  challenges    (Prior  to  Cycle  3)

Session 7

Supporting and monitoring
regularly§ Collecting scores,
identifying (taking picturesof) areas where 5S
haven’t been implementedwell§ Showing pictures to makeeveryone aware andchangeSession 6§ Developing 5S evaluation

 Some	  doctors,	
  department	
  leaders	
  haven’t	
  paid	  enough	  attention	  and	
  understood	
  the	
  importance	
  and	  beneﬁts	  of	
  5S.	  	  	   Old	  perceptions	  and	
  habits	
  haven’t	
  been	
  changed,	  hesitation	
  to	
  change.	
  	   Considering	
  5S	
  just	  a	
  trend,	
  not	  as	  part	  of	
  work.	
  	  	   Other	
  people’s	
  (lower	
  staﬀ’)	
  work.	
   Self-­‐discipline	
  is	
  not	
  high.	
  	   Working	
  environment	
  has	  not	
  generated	
  motivations	  for	
  development.	
  	
  	
  

13

Session 1-2
Evaluation of 5S Implementation in National
Hospital of Obstetrics and Gynecology in 2016
Vu Van Du
Quality Management Department, National Hospital of Obstetrics and Gynecology

1. 5S implementation in National Hospital of
Obstetrics and Gynecology- Individual awareness of department orderliness is nothigh enough.

1.1. I n t ro d u c t i o n o f N a t i o n a l H o s p i t a l o f

1.3. Consequences

Obstetrics and Gynecology- Not good looking

Organization and activities (Decision No. 806/QDBYTdated March 12, 2013):- Waste of materials.

- Functional departments: 09- Risk of incorrect use of drugs, medical materials anddevices.

- Clinical departments: 14- Waste of time.

- Para-clinical departments: 09- Central departments: 07

1.4. Methodology

1.2. Actual state- Making plan for 5S implementation- Medical consumables, equipment, and nursing care

- Selecting some departments for 5S implementation

devices were not arranged in a tidy and clean manner- Implementing 5S

and not ready.

- Checking, monitoring- There were many consumables in stock.

- Evaluating, reporting- Medical consumables and equipment were notstandardized systematically.

1.5. Roadmap for implementation departments

Month

2/16

3

4

5

6

7

8

9

10

11

Department

1/17

2/1712/17

Quality Management
Department
Treatment Service Department
OPD, Gynecology Department
Clinical and para-clinicaldepartments
Administrative departments

14

12

Yellow color: training

Blue color: expansion

Green color: maintaining, monitoring

Red color: pilot implementation in small scale

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

2.

Advantages - Difficulties- Support and facilitation from the Directing Board.
- Determination of leaders of departments.
- Active collaboration between QMD and other3.

Experience and lessons learnt- Sharing knowledge to make staff recognize actual
benefits of 5S in their daily work.  
- Assigning specific tasks to each group withdeadlines.

2.2. Difficulties- Staff have limited perceptions of the meaning
and benefits of 5S. Staff’s self-discipline is not highenough.

- Pilot implementation of 5S before expansion.
- Regular checking and monitoring to maintain 5S.

Session 2

departments/units.

regular and continuous.

Session 1

2.1. Advantages- Checking and monitoring to maintain 5S are not- Standardizing the arrangement of medical equipment

planned. It takes much time to summarize proposals

and materials (documents, injection trolleys, drug
cabinets...)for procurement of materials.

Session 3- Teamwork skills and work progress are slower than

Session 4

Healthcare
Aide/Others

Professional
Degree in
Nursing
14%

Master
7%[CATEGORYNAME][PERCENTA
GE]
Pharmacist
3%
Other
Bachelor's
Degree8%

Bachelor's
Degree in
Nursing/
Midwifery/
Techniques
16%

Professional
Degree inMidwifery
17%

Presenter: Dr. VU VAN DU, MD, PhD
Chief of Quality Management Department

Outpatient treatment

Session 6

TREATMENT ACTIVITIESCONTENTS

Session 5

EVALUATION OF 5S
IMPLEMENTATION IN THE NATIONALHOSPITAL OF OBSTETRICS &GYNECOLOGY (2016)

Assoc. Prof.
PhD
1%Other 18%
Professional
Degree2%
Professional
Degree inTechniques
4%400000382300380697

380000353980360000344585340000320000318651300000280000
2011

2012

2013
2012

2014
2013

2014

2015

Session 7

2011

2015

Inpatient treatment
48000

45304

46000

43090

44000

42378

42000
40000

40985
40235

38000
36000
34000
32000
30000
2011

2012
2011

Organization and activities

2014
2013

2014

2015
2015

ORIENTATION-PLANØ Finalizing Buildings B – C
Ø Tentatively in Dec - 2016

Annex

NATIONAL HOSPITAL OF OBSTETRICS AND
GYNECOLOGY

2013
2012

ØInnovating Building D(2017)(Decision No. 806/QD-BYT dated
12/3/2013):

Functional departments: 09
Clinical departments: 14
Para-clinical departments : 09
Central departments
: 07

15

5S IMPLEMENTATIONPROCESS
Actual state

IMAGES OF QMD AFTER 5S
BeforeAfter- Medical materials, equipment andnursing care devices were not arranged ina tidy and clean manner and not ready touse.
- Considerable consumables were in stock.
- Medical equipment and materials were
not standardized systematically.
- Individual awareness of department
orderliness is not high enough.

5S IMPLEMENTATIONPROCESS

IMAGES OF QMD AFTER 5S

Consequences- Not good looking- Waste of materials- Risk of confusion related to: drugs, devices and medical materials- Waste of time
UnsafeMeeting to seek solutions

Consensus

5S as a tool for quality improvement.

5S IMPLEMENTATION PROCESSWORK MANAGEMENT ONCOMPUTER

Methods
Ø Planning for 5S
implementationØ Selecting some

IMAGES OF QUALITY MANAGEMENT DEPT AFTER 5S

departments for 5S
implementation
Ø Implementing 5SØ Checking, monitoringØ Evaluating, reporting

IMAGES OF QMD AFTER 5S
Before16

After

IMAGES OF QMD AFTER 5S
BeforePractices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2AfterSession 1 | How to Implement 5S Effectively?

IMAGES BEFORE AND AFTER 5S
After

Session 1

BeforeIMAGES BEFORE AND AFTER 5S
After
BeforeBefore5S FOR INJECTION TROLLEYS
Drawer of the injection trolley(Before)Drawer of the injection trolley(After)Session 4

-

After

Sorting
Setting in order
Labeling

Setting in order
Labeling-

Session 3

IMAGES BEFORE AND AFTER 5S

Session 2-

Sorting & setting
documents in order

Sorting
Setting in order

Session 5

IMAGES BEFORE AND AFTER 5S
After

BeforeSession 6

Before5S FOR INJECTION TROLLEYS
After

Changing labels intocolored ones

Session 7

Setting in orderand labeling

BeforeAfter

5S FOR DRUG CABINETS
BeforeAnnex

IMAGES BEFORE AND AFTER 5S

After

17

5S FOR DRUG CABINETS
BeforeAfter

EXPERIENCE- Sharing knowledge to make healthcare staff recognize actual
benefits of 5S implementation in their work.
- Assigning specific tasks to each group with deadlines.
- Pilot implementation of 5S before expansion.
- Regular checking and monitoring to maintain 5S.
- Standardizing the arrangement of equipment and medical materials(medical records, injection trolleys, drug cabinets...)ROADMAP FOR IMPLEMENTATIONIN ALL DEPARTMENTSADVANTAGESØ Support of the Directing BoardØ Determination of leaders of departments.
Ø Active collaboration between Quality
Management Department and otherdepartments/units.

DIFFICULTIES
Staff have limited perception of the meanings and benefits of 5S.
Staff’s self-discipline is not high enough.
Teamwork skills and work progress are slower than planned.
It takes much time to summarize proposals for à procurement ofmaterials.
Checking and monitoring to maintain 5S are not regular andcontinuous.

18

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Session 1

Session 1-3

Session 2

Evaluation Report on 5S Implementation in
Thai Nguyen Central General HospitalDang Hoang Nga
Quality Management Department, Thai Nguyen Central General Hospital

Session 3

1. Overview of 5S implementation in thehospital5.

collaborates with other departments to hang 5S
continuous implementation.

General Hospital started implementing 5S to all
departments/units in the hospital and obtained

6.

encouraging initial results.

monitor and evaluate 5S implementation in
departments using a 5S+1 checklist

Specific activities are as follows:

reported2.

Departments develop their own plans, assign
tasks, and implement 5S in their departments.

2.1. Survey tool: 5S+1 checklist

Departments disseminate information of 5S

2.2. Results

implementation in their departments.
4.

- The number of evaluated departments: 40

Commitment on 5S implementation signed

departments (7 departments were not evaluated due

between staff and leaders of departments, andto their moving to new places).

between leaders of departments with hospital- Obtained results:

director.

Center for Training and Direction of Healthcare Activities
General Planning Department
Personnel Department
Finance and Accounting Department
Nursing Department
Social Affair Department
Administration Department
Medical Equipment and Materials Department
IT Department
Pharmacy department
Neurosurgery Department
Orthopedics Department
Gastroenterology Surgery Department
Urology Surgery Department
Cardiothoracic Surgery Department
ENT Department
Emergency and Critical Care Department

S1
3.8
3.8
3.8
3.8
4
3.8
3.8
3.2
3.4
3.8
3.8
3.8
4.2
3.6
3.6
3.8
3.6

S2
4
3.6
3.6
3.8
4
4
4
3.2
3.2
3.8
3.8
3.6
4.4
3.8
3.8
3.8
3.6

S3
3
3
3
2.8
3.8
3
3
2
3
3
3
2.6
3.2
3
3
3.4
3

AVERAGE SCORES
S4
S5
4
4.75
2.83
3.75
3.67
4.5
3.83
4
4
4.5
3.83
4.25
3
4.25
2,83
3.17
3.17
3.23
3.83
4.47
3.67
3.93
2.67
3.5
4
4.75
3.83
4
3.83
4.25
4
4.6
4
4.17

S6
3
3
3
3
3
4
3
3.2
3.6
4.4
4
4
4.6
4
4
4.6
4

AVERAGE
3.84
3.34
3.65
3.61
4
3.76
3.53
2.93
3.26
3.9
3.7
3.33
4.16
3.7
3.76
4.03
3.73

Annex

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17

DEPARTMENT

Session 7

NO.

Results of 5S evaluation in August 2016

Session 6

3.

Results of 5S implementation in the hospital are

Session 5

7.

Guidance on 5S implementation was provided forleaders of departments: in August 20, 2015.

2.

QMD collaborate with some departments to

Session 4

slogans in departments to facilitate regular andFrom August 2015, QMD of Thai Nguyen Central

1.

5S slogans designed for departments. QMD

19

NO.
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39

DEPARTMENT

S1
3.4
3.4
3
3.2
3.6
3
3.6
3
4
3.6
3
3.8
4
3.8
3.6
4
3.4
3.6
3.8
3.8
3.2
3.6

Obstetrics Department
Oncology Center
Ophthalmology Department
Cardiovascular Internal Medicine Department
Gastroenterology-Urology Department
Endocrinology- Respiratory Department
Gerontology – Health Protection Department
Rheumatology Department
Tropical diseases Department
Mental Health Department
Neurology Department
Neonatal Pediatrics Department
Odonto-Stomatology Department
Traditional Medicine Department
Rehabilitation Department
Infection Control Department
Anesthesia Department
Outpatient Department
Examination Services Department
Dermatology Department
Nutrition Department
Emergency Department

S2
3.4
3.2
3
3.2
3.4
3
3.2
3.2
3.6
3.6
3
4
3.6
3.8
4
4
3.6
3.6
4
3.6
4
4.6

S3
2.4
2.8
2.8
2
3
2.6
3.2
2.4
3
3
3
3
2.8
3
3
4
3.4
3
3
3
3
3

AVERAGE SCORES
S4
S5
2.67
3
3
4.5
3
3
2.67
3.5
3
4
2.83
3.5
3.17
3.5
2.83
3.31
3.67
4.75
3.33
4
3.33
4
4
4
3.5
5
3
4.5
3.67
4.28
4
4.6
3.17
3.86
3.5
3.92
4
4.5
3.83
3.97
3.17
3.86
3.33
4.22

S6
4
2.6
2.6
3.2
3
3
3.8
4
4.2
3.6
3.6
4
3.8
4
3.6
4.2
4
4
4.4
3.8
4.2
4

AVERAGE
3.13
3.2
2.9
2.93
3.3
2.96
3.4
3.26
3.83
3.56
3.3
3.96
3.73
3.63
3.73
4.13
3.56
3.6
3.96
3.66
3.56
3.86

- General evaluation:
Level

Very bad(0-<1)Classification
S1
S2
S3
S4
S5
S6
Overall

0
0
0
0
0
0
0

0%
0%
0%
0%
0%
0%
0%

Bad
(1-<2)
0
0
0
0
0
0
0

Average(2-<3)
0%
0%
0%
0%
0%
0%
0%

2.3. Comments and recommendations for

improvement- Departments have actively implemented 5S- After one year of implementation, certain improvement
and results have been obtained. Staff practice 5S
regularly at their working space.
- Administration Department is tidy.

0%
0%
25%
17.5%
0
5%
10%

35
29
29
25
16
18
32

87.5%
72.5%
72.5%
62.5%
40%
45%
80%

Very good
(4-5)
5
11
1
8
24
20
4

12.5%
27.5%
2.5%
20%
60%
50%
10%

are still weak.
- 5S is not maintained regularly.
- Staff do not follow procedures and regulations
properly: waste bins not over ¾ full; waste bins musthave covers- Patients and their families do not collaborate
well with medical staff and do not follow hospital- Logical arrangement of documents with labels toregulations properly.

ease recognition and work, avoiding mistakes.

2.5. Solutions for 5S implementation- 5S has been applied well to drug cabinets in- Establishing 5S Steering Committee in the hospital

departments. However, it should be maintained to
avoid drug dispensing errors.

20

0
0
10
7
0
2
4

Good
(3- <4)(Director is the chairman, Head of QMD a permanent
member)- Most of patient wards have implemented 5S well.

- Each department develops its own 5S plan at the

2.4. Some problems to overcome and cause

beginning of the year and send it to QMD

analysis- Using the tool 5S + 1 (6S) Checklist in the whole- Division of tasks and monitoring in some department

hospital.

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

- Departments have plans for regular inter nal
monitoring and evaluation.

- QMD collaborate with other departments to monitor
and support their 5S implementation.

- Proper compliance to procedures and regulations on
ensuring PS, pharmaceutical safety…
- Regularly reminding patients and their families to- Infection Control Department re-train otherdepartments how to arrange tool cabinets with aseptic
principle.

- Departments have basically started implementing
5S. The facilities look more tidy and bright despite
limited infrastructure. However, besides current basic
5S practices, there are problems to overcome.
- 5S is one important content, a precondition for QI of

Session 2

follow regulations of wards, departments and hospital.

2.6. Conclusions

Session 1

monitoring and evaluation besides the hospital‘sarrangement, safe injection procedures…  

each department as well as the whole hospital.

- Clinical pharmacists group provide instructions andwith drug use regulations and procedures.

- 5S implementation (LEAN management) aims at
reducing costs and risks and enhancing quality, patientsatisfaction, quality and prestige of each department- Administration Department add more beds, bed
cabinets, and lockers for lacking departments.

and the whole hospital.

Session 3

monitor departments’ drug cabinets in accordance- There should be further collaboration in 5S
implementation among departments, between clinicalin departments about regulations for injection trolley

departments and functional departments.

Session 4- Nursing Department evaluate and re-train nurses

Session 5• Guidance for 5S implementation provided for leaders of

Session 6

THAI NGUYEN CENTRAL GENERAL HOSPITAL

departments/units: Aug 20, 2015
• Departments/units make plans and assign tasks for 5S

implementation in their departments/units.

Session 7• QMD evaluates 5S in departments/units.
• Results of 5S implementation in the hospital arereported
Presenter: Dr. Dang Hoang Nga, MD, MSc, 2nd Degree Specialist
Head of Quality Management Department
P. Quản lý chất lượng HO

3

Annex

1. OVERVIEW OF 5S IMPLEMENTATION
IN THE HOSPITAL

2. EVALUATION ACTIVITIES

3. RESULTSCONTENTS
4. COMMENTS AND RECOMMENDATIONSFOR IMPROVEMENT

5. CAUSE ANALYSIS

6. SOLUTIONS FOR 5S IMPLEMENTATION

P. Quản lý chất lượng HO

2

P. Quản lý chất lượng HO

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P. Quản lý chất lượng HO

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5

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P. Quản lý chất lượng HO

7q Evaluators: Staff of QMD, Nursing Dept.,

Infection Control Dept., Pharmacy Dept.,
Administration Dept., and Social Affairs
Dept.

5S Slogan(Pathology Department)q Implementation period: Aug 2015 to Aug

EVALUATIONACTIVITIES

2016q Evaluation time: Aug 2016q Number of evaluated departments.: 40(7 departments were not evaluated as they
had recently moved to new places and not
totally re-settled yet)q Tool: A checklist was developed under theguidance of NORRED ProjectManagement Committee with 30 criteria
and 6 score levels (from 0 to 5)

P. Quản lý chất lượng HO

22

17/09/08

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Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

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12

Session 1 | How to Implement 5S Effectively?

5S CHECKLISTAVERAGE SCORESDEPARTMENT

S1

S2

S3

S4

S5

S6

11

Neurosurgery Department

3.8

3.8

3

3.67 3.93

4

Average
3.7

12

Orthopedics Department

3.8

3.6

2.6

2.67

3.5

4

3.33
4.16

Gastroenterology Surgery
Department

4.2

4.4

3.2

4

4.75

4.6

14

Urology Surgery Department

3.6

3.8

3

3.83

4

4

3.7

15

Cardiothoracic Surgery
Department

3.6

3.8

3

3.83 4.25

4

3.76

16

ENT Department

3.8

3.8

3.4

4

4.6

4.6

4.03

17

Emergency and Critical Care
Department

3.6

3.6

3

4

4.17

4

3.73

18

Obstetrics Department

3.4

3.4

2.4

2.67

3

4

3.13

19

Oncology Center

3.4

3.2

2.8

3

4.5

2.6

3.2

20

Ophthalmology Department

3

3

2.8

3

3

2.6

2.9

P. Quản lý chất lượng HO

NO.

AVERAGE SCORESDEPARTMENT

S1

S2

S4

S5

S6

Average

Cardiovascular Internal
Medicine Department

3.2

3.2

2

2.67

3.5

3.2

2.93

22

Gastroenterology-Urology
Department

3.6

3.4

3

3

4

3

3.3

23

Endocrinology-Respiratory
Department

3

3

2.6

2.83

3.5

3

2.96

24

Gerontology – HealthProtection Department

3.6

3.2

3.2

3.17

3.5

3.8

3.4

25

Rheumatology Department

3

3.2

2.4

2.83 3.31

4

3.26

26

Tropical Diseases
Department

4

3.6

3

3.67 4.75

4.2

3.83

27

Mental Health Department

3.6

3.6

3

3.33

4

3.6

3.56

28

Neurology Department

3

3

3

3.33

4

3.6

3.3

29

Neonatal Pediatrics
Department

3.8

4

3

4

4

4

3.96

30

Pediatrics Department

4

4

3

4.17

5

4.2

4.03

S1

S2

P. Quản lý chất lượng HO

Session 4

S3

21

Session 3

5S CHECKLIST

Session 2

13

Session 1

NO.

Session 5

5S CHECKLIST
NO.

S5

S6

4

3.6

2.8

3.5

5

3.8

3.73

32

Traditional Medicine
Department

3.8

3.8

3

3

4.5

4

3.63

33

Rehabilitation Department

3.6

4

3

3.6
7

4.2
8

3.6

3.73

34

Infection Control Department

4

4

4

4

4.6

4.2

4.13

35

Anesthesia Department

3.4

3.6

3.4

3.17 3.86

4

3.56

36

Outpatient Department

3.6

3.6

3

3.5

3.92

4

3.6

37

Examination Services
Department

3.8

4

3

4

4.5

4.4

3.96

38

Dermatology Department

3.8

3.6

3

3.83 3.97

3.8

3.66

39

Nutrition Department

3.2

4

3

3.17 3.86

4.2

3.56

40

Emergency Department

3.6

4.6

3

3.33 4.22

4

3.86

Very bad(0-<1)AVERAGE SCORES
S1

S2

S3

S4

S5

S6

Average

Center for Training andDirection of Healthcare
Activities

3.8

4

3

4

4.75

3

3.84

General Planning Department

3.8

3.6

3

2.83 3.75

3AverageP. Quản lý chất lượng HO

Bad(1-<2)

Average(2-<3)

Good(3- <4)

Very good
(4-5)

S1

0

0%

0

0%

0

0%

35

87.5%

5

12.5%

S2

0

0%

0

0%

0

0%

29

72.5%

11

27.5%

0

0%

0

0%

10

25%

29

72.5%

1

2.5%

3.34

3

Personnel Department

3.8

3.6

3

3.67

4.5

3

3.65

S3

4

Finance and Accounting
Department

3.8

3.8

2.8

3.83

4

3

3.61

S4

0

0%

0

0%

7

17.5%

25

62.5%

8

20%

5

Nursing Department

4

4

3.8

4

4.5

3

4

S5

0

0%

0

0%

0

0

16

40%

24

60%

6

Social Affairs Department

3.8

4

3

3.83 4.25

4

3.76

7

Administration Department

3.8

4

3

3

4.25

3

3.53

S6

0

0%

0

0%

2

5%

18

45%

20

50%

8

Medical Equipment andMaterials Department

3.2

3.2

2

2,83 3.17

3.2

2.93

Overall

0

0%

0

0%

4

10%

32

80%

4

10%

9

IT Department

3.4

3.2

3

3.17 3.23

3.6

3.26

10

Pharmacy Department

3.8

3.8

3

3.83 4.47

4.4

3.9

P. Quản lý chất lượng HO

Annex

2

S4

Odonto-Stomatology
Department

Session 7

1

DEPARTMENT

S3

31

Session 6

NO.

AVERAGE SCORESDEPARTMENT

P. Quản lý chất lượng HO

23

Before 5S

P. Quản lý chất lượng HO

Before 5S

17/09/08

After 5S

P. Quản lý chất lượng HO

17/09/08

P. Quản lý chất lượng HO

21

17/09/08

25

P. Quản lý chất lượng HO

17/09/08

27

P. Quản lý chất lượng HO

17/09/08

28

After 5S

P. Quản lý chất lượng HO

22

BeforeBefore 5S

P. Quản lý chất lượng HO

17/09/08

23

After 5S

After

P. Quản lý chất lượng HO

24

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Session 1

29

P. Quản lý chất lượng HO

17/09/08

33

17/09/0830

P. Quản lý chất lượng HO

17/09/08

34

Session 3

17/09/08

Session 2

P. Quản lý chất lượng HO} Bed cabinets were nottidy} Patients did not lie

Session 4

orderly} Patients’ belongings

were put everywhere

P. Quản lý chất lượng HO

Session 5

P. Quản lý chất lượng HO

Annex

ICU

P. Quản lý chất lượng HO

Session 7

P. Quản lý chất lượng HO

Session 6

ICU

P. Quản lý chất lượng HO

25} Departments have actively implemented 5S.
} After 1 year, certain results and improvements have beenobtained. Staff practice 5S regularly at their working
space.
} Administration Department is tidy.
} Logical arrangement of documents with labels to easerecognition and work, avoiding errors.
} 5S has been applied well to drug cabinets. However, it
should be maintained to avoid drug dispensing errors.
} Most of patient wards have implemented 5S well.

26

P. Quản lý chất lượng HO

17/09/08

37

P. Quản lý chất lượng HO

P. Quản lý chất lượng HO

17/09/08

38

P. Quản lý chất lượng HO

P. Quản lý chất lượng HO

P. Quản lý chất lượng HO

P. Quản lý chất lượng HO

P. Quản lý chất lượng HO

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

1. Leaders’ commitment

Session 1

FINANCE} Division of tasks and monitoring in somedepartments are still weak.
} 5S is not maintained regularly.
} Staff do not follow procedures and regulations

properly: waste bins not over ¾ full; waste bins musthave covers…
} Patients and their families don’t collaborate well withhealthcare workers and don’t follow hospital
regulations.

MANPOWER

49

P. Quản lý chất lượng HO

Session 2

TIME
P. Quản lý chất lượng HO

Session 3

2. Everybody’s participation} Establishing 5S Steering Committee in the hospital(Director is the chairman, Head of QMD a permanent
member)} Each department develops its own 5S plan at the beginningof the year and sends it to QMD} Using the tool 5S+1 (6S) checklist in the whole hospital

Session 4} Departments have plans for regular internal monitoringand evaluation besides the hospital’s monitoring andevaluation} Compliance to procedures and regulations on ensuring

patient safety, pharmaceutical safety…
} Regularly reminding patients and their families about

following the hospital’s and departments’ regulations

P. Quản lý chất lượng HO

50

P. Quản lý chất lượng HO

Session 5

3. Continuous improvement} Infection Control Department re-train other departments

P. Quản lý chất lượng HO

•
•
•
•
•

Always seeking inconveniences to improve.
Always seeking untidy working places to improve.
Seeking unsafe working areas to improve.
Seeking unsafe and unclean working places to improve.
Seeking wastefulness to remove.

51

P. Quản lý chất lượng HO

Annex

4. 5S advertised as a product1. Leaders’ commitment• Communicating 5S to people around• Organizing competitions for 5S
initiatives in departments• Adding 5S information in hospital’s
LAN, website…

III	
  2. Everybody’s participation

The keys tomaintaining
5S

3. Continuous improvement

Session 7

monitor departments’ drug cabinets in compliance withdrug use procedures and regulations.
} Administration Department add more beds, bed
cabinets, and lockers for lacking departments.
} Nursing Department evaluate and re-train nurses indepartments about regulations for injection trolleyarrangement, safe injection procedures…
} QMD collaborate with other departments to monitor andsupport their 5S implementation.

Session 6

how to arrange tool cabinets with aseptic principle.
} Clinical pharmacists group provide instructions and

5S
5S

5S

4. 5S advertised as a product5. Regular internal evaluations

6. Acknowledgement of contributions

P. Quản lý chất lượng HO

48

P. Quản lý chất lượng HO

52

27

5. Internal 5S evaluation• Evaluation aims at:- Assessing the validity and relevance of the system- Seeking opportunities for improvementà EVALUATION IS NOTPUNISHMENT

P. Quản lý chất lượng HO

53

6. Acknowledgement of contributions• Acknowledgement of individual and collective
contributions is cultural and a momentum for
COMMITMENT – FAITHFULNESS - DEVELOPMENT

P. Quản lý chất lượng HO

54

P. Quản lý chất lượng HO

28

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Tran Thi Quynh Anh

Session 2

Results of 5S Practice in Thai Binh Provincial
General Hospital: Difficulties and Advantages

Session 1

Session 1-4

Quality Management Department, Thai Binh Provincial General Hospital

Session 3

1.

organized for 100% hospital staff:  

- To develop a rational, convenient, and clean working»»

Course 1: Mar 14, 2016»»

Course 2: Mar 18, 2016»»

Course 3: Mar 25, 2016»»

Course 4: Apr 1, 2016»»

Course 5: Apr 8, 2016environment.
- To reduce waste time and spend more time forprofessional activities.
- To limit medical incidents related to irrational working

2.

Objective•

3 advanced 5S courses organized:»»

By 30 September 2016, 100% of departments

step guidelines for 5S implementation,practice 5S

3.

arrangement of injection trolleys and drug

Action plan
Preparation stage: March 2016
Planning

4.2. 5S practice results»»

Establishing a 5S taskforce- 5S Steering Committee and task force were»»Developing procedures and training materials

established.

»»

Developing an evaluation checklist- 5S task force develop template 5S plans, practice»»Training

Implementation stage:
Stage 1: Pilot implementation from May 1 to»»Stage 2: Expansion from August 1 to
September 30, 2016»»

Stage 3: Comprehensive implementationfrom Nov 1 to Dec 30, 2016

Results
4.1. Training results
Results of trainings on 5S knowledge: courses

materials, diagrams for division of work, evaluation
checklists, labels, regulations for arrangement of
injection trolleys, drug cabinets, and working places,
and instruct departments to implement.
- Departments signed 5S commitment papers with thehospital director.
- Departments’ staff basically understood 5S

Annex

June 30, 2016•

Training time: July 27, 28, 29, 2016

»»

»»

4.

»»

Session 7•

cabinets, and experiencing 5S results.

Session 6•

Tr a i n i n g c o n t e n t s i n c l u d e : s t e p - b y -Session 5

environment.

Session 4

Purpose of choosing 5S practiceknowledge; departments developed 5S plans,
assigned tasks to staff, and started sorting, setting,and shining step.
- Departments’ working environment has encouraging
initial changes:•

Unnecessary things removed, only useful things

29

kept in the working areas.
•

Working rooms, administrative rooms, emergency
rooms, drug storage, laboratories, medical waste
areas, injection trolleys, on-duty drug cabinets
were rearranged; labels applied to storage

Areas have basically become cleaner than before.

- Some initiatives for organizing working areas:
Old cardboard boxes are divided, numbered
and labeled to contain drugs and consumablematerials.
Pharmacy Department: old cardboard boxes areused to contain unboxed drugs, labels are madefrom old drug boxes; different levels are createdfor newly-made boxes containing unboxed drugs
for easy recognition, convenient dispensing, andavoiding errors.
Injection trolleys are arranged in the same way,with clear regulation on where to put what.
•

departments on 5S implementation.

- The hospital has a small budget for 5S trainings.

looking) ensured•- Hospital leaders’ interest and directions towalking, easy for use, easy for transportation),, and aesthetic principles (tidy, clean and nice-•5.1. Advantages- QMD’s enthusiasm and activeness in 5S practice.

to take, easy to see, easy to check, easy to clean)•

Advantages – Difficulties

positions; safety principles (3 easy: easy forconvenience principles (5 easy: easy to find, easy•5.

On-duty drug cabinets are arranged in thesame way, with clear regulation on whereto put narcotics, psychotropics, and normal
drugs. Different types of drugs are labeled withdifferent colors. The drug lists are printed withcorresponding colors for easy recognition andminimizing errors.

- 5S practice as one content of hospital campaigns
has contributed greatly to the success of 5S practicein the hospital.
- The 5S task force is enthusiastic and active in
instructing and monitoring departments.
5.2. Difficulties- Departments are not really active and self-disciplined
in implementing 5S. Leaders of departments have notfully understood the purpose, meanings, and benefitsof 5S therefore have not invested adequately in 5S.  
- Budget for 5S implementation is still limited, with noallowances for buying necessary things for renovating
and replacing old and downgraded infrastructure andequipment.  
- Shortage of manpower, overload of patients and lackof collaboration from patients and their families aresome difficulties to 5S practice.  
- Healthcare workers hesitate to change their old
working habits.
- Some staff show non-collaborative attitude.  
- Very few staff have good knowledge of 5S therefore
it is difficult to instruct and monitor 5S implementation.  

RESULTS OF 5S PRACTICE– DIFFICULTIES AND ADVANTAGES
DR. TRAN THI QUYNH ANH, MD, 1ST DEGREE SPECIALIST –DEPUTY HEAD OF QUALITY MANAGEMENT DEPARTMENT,THAI BINH PROVINCIAL GENERAL HOSPITALRESULTS OF 5S PRACTICE DIFFICULTIES AND ADVANTAGES
Dr. Tran Thi Quynh Anh, MD, 1st Degree Specialist
Quality Management Department –Thai Binh Provincial General Hospital

30

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

ACTUAL STATE BEFORE IMPLEMENTING 5SACTUAL STATE BEFORE IMPLEMENTING 5S

Session 4- To remove wastefulness- To minimize redundant activities- To develop a working environment with
continuous improvement spirit- To improve patient safety

Session 3

PURPOSE

Session 2

1.Purpose and objectives of 5S practicein the hospital
2. Actual state of the hospital before
implementing 5S
3. Implementation plan
4. Results
5. Difficulties and advantages

Session 1

CONTENTS

Hospital Quality

Session 5

OBJECTIVESACTUAL STATE BEFORE IMPLEMENTING 5S

Session 6

By 30th September 2016, 100%
departments in the hospital practice 5S

Session 7

ACTUAL STATE BEFORE IMPLEMENTING 5S

Annex

ACTUAL STATE BEFORE IMPLEMENTING 5S

31

ACTUAL STATE BEFORE IMPLEMENTING 5SACTUAL STATE BEFORE IMPLEMENTING 5SACTUAL STATE BEFORE IMPLEMENTING 5S

REASONS FOR 5S PRACTICEACTUAL STATE BEFORE IMPLEMENTING 5S

REASONS FOR 5S PRACTICEACTUAL STATE BEFORE IMPLEMENTING 5S

ACTION PLAN

ACTION
PLAN

32

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Preparation
stage
Implementation
stage

Session 1 | How to Implement 5S Effectively?

Preparation
stage

5S
practice
results

Stage 2: implementation in
the whole hospital, from
01/08/2016 to 30/09/2016

5S
practice
results+ Departments basicallycomprehended 5S knowledge,
developed action plans, assigned
tasks to staff, and started sorting,setting, and shining steps.
+ Departments’ working environment
has encouraging initial changes.

Session 4

Implementation
stage

Stage 1: pilot
implementation, from01/05/2016 to 30/06/2016

RESULTS

Session 3

ACTION PLAN

+ 5S Steering Committee and task force
established+ 5S template action plans, materials,
diagrams for division of work, evaluation
checklists, labels, regulations forarrangement of injection trolleys, drug
cabinets, and working space… developed;
implementation guidance provided for
departments.
+ Departments signed 5S commitment
papers with the hospital director.

Session 2

Ø Time: March-April 2016
Ø Activities:- Planning- Establishing a 5S task force- Developing procedures andtraining materials- Developing evaluation
checklists- Training

Session 1

RESULTSACTION PLAN

Session 5

RESULTSRESULTS

5S
practice
results

5Spractice
results

Annex

Training
results- Advanced trainings on 5S
organized:
ØClass 1: 27/7/2016
ØClass 2: 28/7/2016
ØClass 3: 29/7/2016- Training contents: step-by-step
instructions for 5S implementation,
arrangement of injection trolleys
and drug cabinets, and experiencing
5S results.

RESULTS

Session 7

RESULTS

Session 6

Training
results

Trainings on 5S basic knowledgeorganized for hospital staff:ØClass 1: 14/03/2016
ØClass 2: 18/03/2016
ØClass 3: 25/03/2016
ØClass 4: 01/04/2016
ØClass 5: 08/04/2016- Unnecessary things removed, only useful things
kept at the working area.
- Working rooms, administrative rooms,
emergency rooms, drug storage, laboratories,
medical waste areas, injection trolleys, on-duty
drug cabinets were rearranged; labels applied tostorage positions; safety principles (3 easy: easy
for walking, easy for use, easy for transportation),convenience principles (5 easy: easy to find, easy
to take, easy to see, easy to check, easy to clean) ,and aesthetic principles (tidy, clean and nicelooking) ensured- Areas have basically become cleaner than
before.

Some initiatives for organizing working
areas:- Old cardboard boxes are divided, numbered
and labeled to contain drugs and consumablematerials.
- Pharmacy Department: old cardboard boxes
are used to contain unboxed drugs, labels are
made from old drug boxes; different levels
are created for newly-made boxes containing
unboxed drugs for easy recognition,
convenient dispensing, and avoiding errors.

33

RESULTS

5S
practice
results- Injection trolleys are arranged in the sameway, with clear regulation on where to put
what.
- On-duty drug cabinets are arranged in thesame way, with clear regulation on where to
put narcotics, psychotropics, and normal
drugs. Different types of drugs are labeledwith different colors. The drug lists are
printed with corresponding colors for easy
recognition and minimizing errors.

ADVANTAGES	
  -­‐	
  DIFFICULTIES	
  	
  

Advan
-tagesØ Hospital leaders’ interest and directions
Ø QMD’s activenessØ The hospital has a small budget for 5S
trainings
Ø Participation of the Hospital Competition
and Reward CommitteeØ Departments’ commitment
Ø The 5S task force’s activeness andenthusiasm

5S PRACTICE

RESTRAININGFORCES IN 5S
PRACTICE?

RESTRAINING	
  FORCES
1. Why do I have to remove and clean things

when it’s not my job?
2. How can we spend time for patients if wehave to add 5S to our work?
3. We have been doing this for many years?
4. We are too busy for 5S?

ADVANTAGES	
  -­‐	
  DIFFICULTIES	
  	
  DifficultiesØ Great expectations from hospital leadersØ Departments are not really active in
implementing 5SØ Departments leaders have not recognizedthat “5S practice is for themselves”,
therefore have not invested adequately in
5SØ Old and degraded infrastructureØ Some departments’ working places are
subject to changeØ Old and unsystematic equipment,
lacking equipment

ADVANTAGES	
  -­‐	
  DIFFICULTIES	
  	
  Difficulties

34

REMARKABLE
INITIALRESULTSINITIAL RESULTS OF 5S PRACTICEØ No funding for procurement of necessary
things for 5S practice, infrastructure
renovation, and upgrading equipment
Ø Shortage of manpower, overload ofpatients
Ø Patients and their families don’tcollaborate in 5S practiceØ Hesitation to change old working habitsØ Some staff show non-collaborative
attitudeØ Very few staff have good knowledge of
5S

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

Session 2

INITIAL RESULTS OF 5S PRACTICE

Session 1

INITIAL RESULTS OF 5S PRACTICE

Session 3
Session 4
Session 5
Session 6
Session 7
Annex
35

36

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INTITIAL RESULTS OF 5S PRACTICE

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

Session 2

INITIAL RESULTS OF 5S PRACTICE

Session 1

INITIAL RESULTS OF 5S PRACTICE

Session 3
Session 4
Session 5
Session 6
Session 7
Annex
37

38

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

INITIAL RESULTS OF 5S PRACTICE

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Session 1

INITIAL RESULTS OF 5S PRACTICE

Session 2
Session 3

INITIAL RESULTS OF 5S PRACTICE

Session 4
Session 5

INITIAL RESULTS OF 5S PRACTICE

Session 6
Session 7
Annex

INITIAL RESULTS OF 5S PRACTICE

39

Session 1-5
Challenges in 5S Implementation in Ha Dong
General Hospital
Nguyen Thi Huong Lien
Quality Management Department, Ha Dong General Hospital

At present, departments are implementing “Hygienic
Hospital”. Three laboratories (Hematology – Blood
Transfusion, Biochemistry, Microbiology) have been
implementing 5S since December 2015. However, there
are still some untidy arrangements. Therefore, 5S should- 5S trainings were provided to leaders of departments.
2. From departments:- The three laboratories have developed their 5S
implementation plans.

be maintained to ensure effective work and comfortable

2.

Challenges: 2 groups

working environment.

1.

The Steering Committee and the guiding group1.

Advantages

1.

From the hospital:- Hospital leaders decided that 5S must be implemented
in the hospital.
- 5S Steering Committee had been established and was(QMD, QM Network): are unexperienced and lacktrainings.

- Departments are not monitored and evaluated regularly.
- Hospital budget does not prioritize 5S activities.
2.

In laboratories:

reinforced in January 2016 with 20 members, including:- It takes time to change habits.

Hospital Director as the chairman, heads of functional,- 5S is being implemented under existing conditions: noclinical, and para-clinical departments.
- The Steering Committee has developed a 5S
implementation plan, targeting three laboratories.

HANOI DEPARTMENT OF HEALTHHA DONG GENERAL HOSPITAL

budget allocated (equipment, stationary, etc.), lack andchange of working rooms.
- Insufficient and unstable manpower.  

Introduction of Ha Dong General Hospital• A 1st level hospital under Hanoi Department of Health

CHALLENGES
IN 5S IMPLEMENTATIONIN HA DONG GENERAL HOSPITAL• 570 beds. 700 outpatients/day. 670 inpatients/day.
• 40 departments: 09 functional departments, 20 clinicaldepartments, 10 para-clinical departments and 03 units(Oncology, Clinical Hematology, Vaccination).
• 647 staff (19 PhDs & 2nd degree specialists; 28 masters;
40 doctors, pharmacists, & 1st degree specialists; 337

Dr. Nguyen Thi Huong Lien, MD, MSc, 2nd Degree Specialist
Head of Quality Management Department

40

nurses, midwives, & technicians)

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

QM Network’s meeting

Quality Management System

Session 1• 7/2014: QM
Unit(3 members)• 11/2015: QMD(5 members)

Session 2“Hygienic Hospital” campaign

Session 3

Opening ceremony of

Quality Management System• QM Council: 43 members, including the Directing Boardand chiefs of departments/units in the hospital.
• QM Network: 1-2 staff/department (total: 69 members).

Session 4• The Council and the Network meet every 3 months.
QI plan has been developed and implemented.

Session 5

QM Council’s meeting

Implementing “Hygienic Hospital”

Current state of Ha Dong General Hospital• Departments are implementing “Hygienic Hospital”.

Annex

QM Network’s meeting

Spend	  5	  minutes	
  a	
  day,	  	
  1	
  hour	  every	
  Friday	
  	
  
for	
  a	
  green	
  –	
  clean	  –	
  beau<ful	
  hospital	  	
  Session 7

Implemen<ng	
  5S	
  

Session 6• Time: from May 2015
• Establishing 5S Steering Committee• From December 2015: Pilot implementation of 5S in 3
laboratories: Hematology – Blood Transfusion, Biochemistry,
Microbiology.
• 3 laboratories keep implementing 5S yet there are still some
untidy arrangements.
=> Therefore, 5S should be maintained to ensure effective workand comfortable working environment.

41

5S evaluation checklist for clinical departmentsBảng kiểm đánh giá 5SĐánh giá viên:Ngày đánh giá:Vị trí

TTBuồng hành chínhBuồng tiêm,buồng thủ thuật

Kho lưu
trữĐánh giáNội dung đánh giáMụcAdvantages
1. Hospital leaders: “5S implementation is really important andKhoa, phòng:Đ

Bàn/Ghế

2

Tủ

3

Hồ sơ bệnh án, phim XQ, sổ sách, giấy tờ, vănphòng phẩmCó sạch sẽ, lưu trữ, xếp đặt ở vị trí hợp lýkhông?

4

Máy tính, máy in, điện thoại, dây điện, dâymạng, và các thiết bị khác

Có sạch sẽ, xắp xếp gọn gàng, phù hợpvà được giữ gìn tốt không?

5

Bóng điện, điều hòa, quạtCó sạch sẽ, an toàn và được bố trí hợp lýkhông? Còn sử dụng tốt hay không?

6Tường, cửa sổ, sàn, trầnCó sạch sẽ và được giữ gìn tốt không?

7

Các bảng thông tin, giấy dán trên tường

8

Xe tiêm

examination and treatment”.
2. In January 2016, 5S Steering Committee was reinforced(with 20 members) including: Hospital Director as thechairman; chiefs of functional, clinical and para-clinicalCó sạch sẽ và bố trí hợp lý, cập nhậtkhông?
Có sạch sẽ và được bố trí gọn gàng, hợplý không?

9

Tủ thuốc

Có sạch sẽ và được dán nhãn phân loạikhông?

10

Tủ, giá để đồ, dụng cụ

Có sạch sẽ và được dán nhãn phân loạikhông?

11

Các thiết bị y tế

Có sạch sẽ, xắp xếp gọn gàng, sử dụngtốt không?

12

Bóng điện, điều hòa, quạtCó sạch sẽ, an toàn và được bố trí hợp lýkhông? Còn sử dụng tốt hay không?

13Tường, cửa sổ, sàn, trầnCó sạch sẽ và được giữ gìn tốt không?

14Xắp xếp các vật dụngCác vật dụng trong kho có được xắp xếphợp lý dễ tìm, dễ lấy không?

15

Các vật thừa, hỏng, không sử dụngCó được lưu trữ tách biệt, xắp xếp hợp lývà dán nhãn đỏ theo quy định không?

necessary, which contributes to improved quality ofKĐ

Có sạch sẽ và được sắp xếp gọn gàngkhông?
Có sạch sẽ và được dán nhãn chú thíchrõ ràng không?

1

departments.
3. The Committee has made 5S implementation plan, startingwith 3 laboratories and administrative rooms in all clinicaldepartments.
4. 1/3 of hospital staff have been trained on 5S.

5S evaluation checklist for laboratoriesBuồng/phòng XN	  Vị trí	  B. phát máu	   B. XN cơ bản 1	
  

T	
  
T	
  

Mục/ND đánh giá	
  

Đ	
  

KĐ	
  

Đ	
  

KĐ	
  

B. XN cơ bản
2	
  
Đ	
  

KĐ	
  

Ghi chú	  P. pha hóa chất	
  
Đ	
  

KĐ	
  

Tường, cửa sổ, sàn, trần: Có sạch sẽ và được giữ gìn tốt không?	
  1	
  Bóng điện, điều hòa, quạt: Có sạch sẽ, an toàn và được bố trí hợp
2	
  

3	
  
4	
  
5	
  
6	
  

lý không? Còn sử dụng tốt hay không? 	
  Bàn/Ghế: Có sạch sẽ và được sắp xếp gọn gàng không?	
  Tủ: Có sạch sẽ và được dán nhãn chú thích rõ ràng không?	
  Ổ cắm điện: cao hơn nền phòng 40cm, không gần vòi nước	  Chỗ để quần áo và đồ dùng cá nhân: có tiện lấy không?	
  TTB phòng cháy chữa cháy: hoạt động tốt không? Sắp xếp hợp lý

7	
  
8	
  
9	
  

không?	
  Chất độc hại: có biển báo không?	
  Phân loại rác đúng qui định? ( vị trí, màu sắc, phân loại…)	
  10	
   TTB có sắp xếp gọn gàng, sạch sẽ không?	
  TTB có đầy đủ thông tin ( tên, số seri, ngày đưa vào sử dụng, lý11	  lịch máy, hướng dẫn sử dụng…) có rõ ràng không?	
  12	
   TTB có nhật ký sử dụng máy không?	
  5S evaluation checklist for Biochemistry Department

Pharmacy  Department
	

5S evaluation checklist for Microbiology Department

42

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Difficulties

Some pictures of the hospital

The Steering Committee and guiding group(QMD and QM Network):

Session 1

1.

- Are unexperienced and lack trainings. Most ofthem have other roles.
- Departments are not monitored and evaluatedregularly.
- Hospital budget does not prioritize 5S activities.

Session 2

5S actual state of the hospital

Session 3

Difficulties

Session 4

2. In laboratories:- Manpower: People have not recognizedadvantages of 5S implementation. Shortage ofmanpower leads to each person taking different
positions.
- Facilities: Lack of rooms, narrow laboratories,change of rooms and position, no cabinets nor
shelves for documents, etc.
- Environment: Untidy arrangements, many
unnecessary things at the working space.
=> It takes time and money to change habits.

Session 5

Solutions

Actual state in Hematology - Blood Transfusion Dept.

Session 6

Making detailed 5S implementation plans forlaboratories and some departments in the hospital:- Establishing 5S monitoring groups in laboratories
and Pharmacy Department.
- Training members who involves in monitoring
activities.
- Monitoring as planned.

Actual state in Hematology - Blood Transfusion Dept.
	

Annex

Some pictures of the hospital

Session 7- Implementing 5S at administrative rooms in clinicaldepartments.

43

44

Hematology - Blood Transfusion Dept. implementing 5S

Biochemistry Dept. implementing 5S

Hematology - Blood Transfusion Dept. implementing 5S

Biochemistry Dept. implementing 5S

Microbiology Dept. implementing 5S

Biochemistry Dept. implementing 5S

Microbiology Dept. implementing 5S

Biochemistry Dept. implementing 5S

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 1 | How to Implement 5S Effectively?

Vaccination Unit of
Ha Dong General Hospital

Biochemistry Dept. implementing 5S	  RECEIVING JAPANESE TEAMWAITING AREA FOR PATIENT FAMILY

Japanese visitors at ICU

Vaccination Unit of
Ha Dong General Hospital

Workshop on Patient Safety andSession 1

Biochemistry Dept. implementing 5S	  Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Annex

Infection Control45

  THANK  YOU  !
	

	
  	
  

46

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 2 | How to Make Incident Reporting System Work?

Summary of Discussion
Purposes for Incident Reporting System
1.

An incident reporting system (IRS) is expected to be a more systematic approach to collect information about

Session 2

1.

Session 1

Session 2 How to Make Incident Reporting
			System Work?

incidents and therefore generate measures to increase patient safety in the hospital. Before establishing the
IRS, a hospital may have been applying different single methods to ensure patient safety. For example, before
following three activities to ensure patient safety in the hospital:
a. Applying surgical safety checklist;

Session 3

IRS, Quy Hoa National Leprosy - Dermatology Hospital (hereafter referred to as Quy Hoa Hospital) relied on theb. Double-checking medications before giving them to patients; andc. Checking technical procedures
In Quy Hoa Hospital, IRS is expected to help (i) prevent near misses before occurrences of incidents that actuallyaffect patients in the future or (ii) solve consequences of incidents that already affected patients.
3.

2.

Session 4

2.

Tu Du Hospital’s motto for IRS is “One’s incident is a lesson for another one”.

Establishing IRS
1.
2.

An official decision by the hospital director to approve the establishment of IRS in the hospital.

Session 5

In order to establish IRS, usually the following components are needed:

Working bodies and staff in-charge. In Vietnam, the Ministry of Health (MOH) recommends that each hospitalestablishes (i) a QM council, (ii) a QM department/unit, and (iii) a QM network. Besides this common structure,3.

A reporting form, which hospital can use a paper-based form, electronic form or both of them. The form should
contain headings to help the reporter know what information is needed, usually very basic information.

4.

Session 6

some hospitals, e.g., Tu Du Hospital and Cho Ray Hospital appoint one QMD staff to be specifically in charge of
IRS management.

Different channels to receive incident reports, such as: direct delivery to QMD, an email exclusively used to5.

An incident handling form for QMD staff.

6.

Procedures of how to report and handle an incident.

7.

General training for hospital staff so that they know what they should report, to whom a reporter should submit a

Session 7

receive reports, LAN, a phone line…

report, when, and how.
Training for QMD staff so that they know how they should receive and handle incident reports, and what theyshould do after receiving an incident report.

3.

Annex

8.

Barriers to Run IRS
1.

Hospital staff do not want to share that they committed mistakes. Some are afraid of punishment.

2.

Many hospital leaders are concerned about confidentiality of incident reports. They are afraid that if some
information is revealed to a journalist, they may face public pressure for letting incidents happen in their hospitals.
Therefore, hospital leaders may limit their support for IRS development.

3.

The reporting system might not be convenient for reporters, therefore the system itself discourages hospital staff47

to report. For example, in Tu Du Hospital, many clinical and para-clinical departments did not have printers sosometimes they did not have paper forms to fill in. Another barrier for handing paper reports was that QMD is on
the 3rd floor with no elevator and not located in the same building with many departments.

4.

How to motivate hospital staff to report?
1.

At the beginning, QMD staff can directly look for incidents and ask other staff to report these incidents. It is
like helping other staff to practice reporting incidents. For example, in Tu Du Hospital, when QMD staff walkaround the hospital to check regular activities and detect an incident in a department, they inform a staff in thatdepartment about the incident and ask this staff to submit a report.

2.

The hospital director can remind hospital staff to report incidents in hospital regular meetings, especially inweekly meetings with department leaders.

3.

In Cho Ray Hospital, QMD staff attend head nurses’ meetings to remind and encourage them to report incidents.

4.

Praises from hospital leaders for departments that submit incident reports can encourage their staff to reportincidents. In Tu Du Hospital, one department head was not happy to know that somebody in his department had
submitted an incident report to QMD. However, before he could blame his staff, the hospital director gave him
praise for his department’s submission of incident reports in the next meeting. After that, this department headstarted encouraging his staff to report incidents; sometimes he reports by himself.

5.

In return, QMD should motivate hospital leaders to involve in and support IRS activities. In Tu Du Hospital, QMD,
on behalf of the QM network, gives honor awards to their hospital leaders to thank them for their companion andsupports for IRS and other QM activities.

6.

In An Giang Provincial General Hospital, submission of incident reports is counted in the hospital’s performanceassessment mechanism, which may affect the bonus a department can receive.

7.

Hospitals can nurture a safety and learning culture by:a. Conducting a patient safety culture survey to identify intimidating factors of the hospital environment.
b.   Organizing trainings on soft skills for hospital staff to enhance mutual understanding, communication, andteamwork among them.

8.

In Tu Du Hospital, trainings play an important role in motivating hospital staff to report incidents. At the beginning,
the hospital’s committed director required all hospital’s key staff (i.e., department heads and deputy heads, headnurses…) to attend trainings. However, because the trainings were interesting and practical, these key staff wereencouraged to motivate their staff to follow, with further support from QMD. Please see below for more details.

5.

Training(Mainly from Tu Du Hospital’s experience)
1.

Tu Du Hospital’s QMD adopts some engaging and interactive training techniques from soft skills trainings
previously organized in the hospital by outside trainers. QMD staff work with these trainers to integrate QM/
PS contents into the trainings and gradually become trainers, being able to design and conduct trainings bythemselves.

2.

Sometimes, especially at the beginning, inviting outside trainers may make the trainings more convincing tohospital staff even though QMD staff can conduct trainings by themselves.

3.

Gameshow and competition formats can excite participants and engage them in training. With IRS-related
knowledge built in the games, participants can practice recognizing and categorizing incidents, which are somenecessary skills for reporting incidents.

4.

A common format used in Tu Du Hospital is that of “The Path to Olympia Peak” gameshow, in which competing
teams earn scores by answering multiple-choice questions. Wrong answers are opportunities for discussion
among participants and can help them memorize the knowledge better.

5.

48

Since it may be difficult to involve every staff in trainings, trainings of trainers (TOT) might help. In Tu Du Hospital,

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 2 | How to Make Incident Reporting System Work?

QMD organize trainings for key staff first, then assist some of them to organize trainings for their staff in their6.

Analyzing incidents
1.

For hospitals at early stages of development of IRS, analysis of incidents is not easy. In Quy Hoa Hospital, it took

Session 1

departments.

them a whole day to discuss three incidents with no clear final conclusions.
2.

The depth of analysis depends on the severity and complexity of the incident. For more simple incidents,

chaired by the hospital director or a vice director.
3.

Session 2

analysis can be conducted by a small group of relevant staff. For more complex incidents and those with serious
consequences, analysis may require a longer meeting and discussion among experts from different departments,
In Tu Du Hospital, an intensive root cause analysis (RCA) is conducted if the incident is either (i) a sentinel event,or (ii) related to several departments, or (iii) high chance of recurrence. Usually they organize one RCA meeting
director or a vice director, and always involve representatives from QMD, General Planning Department, andNursing Department, besides relevant departments.

7.

Session 3

every week; each RCA meeting analyzes two incidents. Their RCA meetings are always chaired by the hospital

Preventive measures
Tu Du Hospital found that 90-95% of their reported incidents were due to systematic errors. 80% were due toAdjust procedures;b.

Organize trainings and provide information for hospital staff;c.

Provide warnings to hospital staff

Sharing lessons and confidentiality
1.

After analyzing incidents, one important activity is to summarize lessons learnt and share with hospital staff.
Lessons learnt should be shared as anonymous stories to (i) protect reporters and (ii) avoid possible public/

Session 5

8.

a.

Session 4

miscommunication. Then they often employ three preventive measures as follows:

media pressure due to misunderstandings.
2.

Lessons learnt can be shared via newsletters, intranet, etc.

Session 6
Session 7
Annex49

Session 2-1
Initial Results of Implementing Incident Reporting
System in Quy Hoa National Leprosy andDermatology Hospital
Nguyen The Toan
General Planning Department, Quy Hoa National Leprosy and Dermatology Hospital

INTRODUCTION

to patients. However, error/incident management was

Necessity of establishing an incident reporting
system in the hospitalnot systematic. there were no voluntary reports, cause
analysis, and proposed solutions to minimize errors/

1. Necessity of establishing an incident
reporting system (IRS)

Quy Hoa National Leprosy and Dermatology Hospital as

Healthcare is a high-risk environment, where medical
errors can occur any time from diagnosis to treatment.
It can be certain that every step of examination andtreatment contains risks to patients. Moreover, physiciansin healthcare settings are constantly under pressure
due to overwork and psychological stress. Therefore,
adverse events are unavoidable and sometimes out of

incidents. For this reason, we have established an IRS infollows:- Decision on establishing a system to report, summarize,
analyze, and fixing medical and other professional errors/
incidents in the hospital;- Regulations on reporting medical and other professional
errors/incidents;- Procedures for recognizing, handling, and reporting

control. When adverse events happen, both doctors andmedical errors/incidents;

patients are victims. Especially, affected patients suffer- Incident reporting form;

consequences influencing their health, temporary or
permanent disabilities, or even death.

2. Rationale for establishing a hospital QM
systemPART TWO
Initial results of inplementing IRS- Circular no. 19/2013/TT-BYT dated July 12, 2013 by

After establishing the IRS in August 2016, the hospital

the Minister of Health guiding QM of examination andconducted trainings for head nurses of departments, who

treatment in hospital;- Decision no. 4858/QD-BYT dated December 3, 2013 by
the Minister of Health issuing hospital quality standards.   

are members of the IRS. Since then, there have been
three reports.
Comments:- The IRS must include a member of the Directing Board

PART ONE
Actual state of the hospital's IRS
Hospital has been following regulations on reporting
errors/incidents. There are checklists in operation
theaters and procedure rooms; regulations on checking

to preside and push implementation.
- In weekly meetings of managers, hospital leaders
encourage staff and chiefs of departments to reportincidents.
- No punishment when incidents occur.

drugs before distributing to patients; checking technicalprocedures to avoid serious errors/incidents happening

50

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 2 | How to Make Incident Reporting System Work?

PART 1: CONTENTS OF THE INCIDENT REPORT

Affected person

This item can be skipped.

Full name:
Position: Healthcare worker

Title:

 Patient

Department:

 Patient family

Session 2

Full name:

Session 1

Reporter Other:………………..
Venue of incident

Date, time of report:(Please write down specific bed, ward, department.)

Session 3

Time of incident

Date, time incident occurred:
Session 4

Briefly describe incident

Session 5

Consequences (at present and expected in the future)
Session 6

Immediate response
Session 7

WAYS TO REPORTManagement

directly

toQuality

Department(Mobile:0905186525)
2. Email to:baocaosuco.bvqh@gmail.com
Or LAN: \\192.168.1.115à Common dataof 2 networks à General Planning
Department à Baocaosuco

Annex

1. Send/call

WAYS TO RECEIVE FEEDBACK

1. Via phone: …………………………
2. Via document: ……..............................
Note: Please write down telephone
number/email/address to receive feedback
document.

51

PART 2: FORM FOR STAFF OF QUALITY MANAGEMENT DEPARTMENT

1. Near missType of incident

2. Variance
3. Sentinel event

Level of harm to patient

0

1

2

3a

3b

4

Fields related to incident
1. Examination and treatment procedures

6. IT system

2. Professional errors, medical incidents

7. Medical equipment and materials

3. Safety in drug use

8. Security, fire safety

4. Infection control

9. Accident, fall

5. Medical record

10. Others: ……………………………….

Root cause analysis

Solutions (improvement actions)v Short-termv Long-term

Monitoring improvement actions and evaluating (their effectiveness)

52

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 25

Session 2 | How to Make Incident Reporting System Work?

No approach topatient

Onsite emergency
response

Report to chiefof department

Verify the incident
Give new direction
Analyze root causes
Organize review meeting
Write in “Classification andassessment of professional
incidents” Notebook

Verify, record theincident
Analyze root
causesOrganize review
meetingKeepmeeting
minutes

Session 6

Handle, adjust
Report to the Directing
Board, GPD, QMD

Session 5

Emergency response
Report to the Directing Board,
General Planning Department(GPD), QMD

Session 4

GPD,
QMD

Approach patient

Session 3

Chief ofdepartment

Classify
incident

Session 2

Medicalstaff

Session 1

Detectincident

Session 7
Annex

DirectingBoard

Approve andimplement proposal
Chair review
meetings53

2. Actual state of the IRSMINISTRY OF HEALTH
QUY HOA NATIONAL LEPROSY - DERMATOLOGY HOSPITALv Hospital has reports on errors/incidents:- Using checklists in operation theaters and procedure rooms

INITIAL RESULTS OF IMPLEMENTING
INCIDENT REPORTING SYSTEMIN QUY HOA NATIONAL LEPROSY AND
DERMATOLOGY HOSPITAL	  	
  - Regulations on checking drugs before distributing to patients- Checking technical proceduresv Limitations:- No separate system to manage errors/incidents- No voluntary reports- No reports assessing errors/incidents- No analyses of patterns and causes of errors/incidents; no

Presenter: Dr. Nguyen The Toan, MD, PhD

proposed solutions to minimize errors/incidents

Da Nang, September 2016

Contents
1

3. Establishment of the IRS
IRS in Quy Hoa National
Leprosy and Dermatology Hospital

Necessity of establishing an IRS in thehospital
Actual state of the IRS

2

3

Establishment of the IRS

4

Results of implementation

Decision on
establishing a system forreporting, summarizing,
analysing, and fixing
medical and professional
errors/incidents
in the hospital

Regulations on reporting
medical and otherprofessional errors/incidents
Procedures for recognizing,handling, and reporting
medical errors/incidents
Incident reporting form	  1. Necessity

Incident Reporting Form
ReporterThis item can be skiped

Error prone environment
Examination &treatment
procedures

Diagnosis

Healthcare
environment

Full name:Workingpressure
Psychologicalpressure
Overwork

Treatment

Affected person
Full name:Healthcare worker

Position:

Title:

Patient

Department:

Patient familyOthers:………………..
Time of incident

Date, time of report:

Venue of incident(write down specific bed, ward, department)

Date, time incident occurred:
Describe incident briefly
Consequences (at present and expected in the future)

Serious consequences forpatients and doctors

Immediate response:

Incident reporting system

2. Email to: baocaosuco.bvqh@gmail.com
Or LAN: \\192.168.1.115à Common data of 2
networks à General Planning Department àBaocaosuco

Rationale for establishing theincident reporting system (IRS)

WAYS TO REPORT

WAYS TO RECEIVE FEEDBACK

1.Send/call directly to Quality Management
Department (Mobile number: 0905186525)
1. By phone: …………………………
2. By document: ……..............................
Note: Write down phone number/email/address to receive feedback document

FORM FOR STAFF OF QUALITY MANAGEMENT DEPARTMENT
1. Near missType of incident

2. Variance
3. Sentinel eventv Circular no. 19/2013/TT-BYT dated 12/07/2013 by the
Minister of Health guiding quality management of
examination and treatment in hospitalsv Decision no. 4858/QD-BYT dated 03/12/2013 by the
Minister of Health issuing Hospital Quality Standards

Level of harm to patient

0

1

2

1. Examination and treatment procedure

3b4

6. IT system

2. Professional errors, medical incidents

7. Medical equipment and materials

3. Safety in drug use

8. Security, fire safety

4. Infection control

9. Accident, fall

5. Medical record

10. Others:……………………………….

Root cause analysis
Solutions (improvement actions)Short-termLong-term
Monitoring improvement actions and evaluating (their effectiveness)
  

54

3a

Fields related to incident

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 25

Session 2 | How to Make Incident Reporting System Work?

Procedure for detecting, handling, and reporting serious medical incidents
Detect incident

Approach  the  pa,ent

No approach to the patient

On-site emergency
response
Report to dept. chief

Report to dept. chief

Handle, adjust
Report to the Directing Board,
GPD, QMDEmergency response, reportto the Directing Board, GPD,QMD for direction

CHIEF OF
DEPT

Keep
minutes ofmeeting

Verify, record incidents
Analyze root causes
Organize review meetings

Approve andimplement proposal
Chair review
meetings

DirectingBoardv Time of system establishment: August 2016

Session 3

4. Results of implementing IRS

Session 2

Verify the incident
Give new direction
Analyze root causes
Organize review meetings
Write in “Classification and assessmentof professional incidents” Notebook

GPD, QMD

Session 1

HEALHCARE  WORKERSClassify theincidentv Activities: Trainings for head nurses who are members of
the IRSv Results: 03 incident reports- The Directing Board must take charge and push
implementation- Encouraging staff and chiefs of departments to report

Session 4v Lessons learnt:

incidents in meetings of managers.
- No punishment when incidents occur

Session 5

Some pictures of activities

Session 6
Session 7
Annex

THANK YOU VERY MUCH!

55

Session 2-2
Failures in Operating Incident Reporting andManagement System
Phan Anh Phong1, Tran Thi Ngoc Hoa2
1. Vice Director, Ha Nam Provincial General Hospital
2. Quality Management Department, Ha Nam Provincial General Hospital

1.

Reasons for choosing the topic

three SOPs have been developed: SOP forblood transfusion, SOP for taking and sending

Ha Nam Provincial General Hospital established asamples, and SOP for sending severe patients for

medical incident reporting and management systemintervention procedures.

in August 2015 to help the hospital control medical

6.

incidents happening in hospital in terms of level, quantity,

2016.

warnings and solutions to minimize them.

Implementation plan

3-b.

1.

Providing information and training on the benefits- 1-2 incident reports are received every day.

of reporting medical incidents to all hospital staff;  

- A book documenting medical incidents in the hospital is

Designing the reporting form, developing

made.

consistent procedures for reporting and handling

4.

2.

2.

reports;

Objectives

Causes analysis- The biggest obstacle is that staff hesitate to report,

3.

Establishing the reporting system;

4.

Implementation.

punishment.

3-a.

Current state- Focal people of the system are passive, not active.

1.

Key hospital staff - the Directing Board, chiefs

Solutions and actual implementation-

However, only few have changed their perceptions.

The reporting form was designed and procedures
for reporting and handling reports developed.

3.

The incident reporting system was established.

4.

Implementation: we receive an average of 5
reports per month. Most of them are mandatory
reports or come from issues discussed inprofessional meetings.

5.

5.

hospital manpower) – have received information
incidents. The hospital director shows interest.
2.

daren’t to reveal their mistakes, and are afraid ofand vice chiefs of departments, head nurses (1/6
and training on the benefits of reporting medical

After reports are received, root cause analyses
are conducted, then feedback is given, and56

6A seminar on promotion of incident reportingand management system was organized in Julyratio, frequency, causes… and therefore give feedback,-

The Directing Board and key staff received information.
The incident reporting system and relevant procedures

were established. However, the system is not operating
as effectively as expected.  
-6.

There is positive feedback to received reports.

Effectiveness and solutions- Only some mandatory reports yet positive feedback havebeen received. Therefore, it is necessary to strengthencommunication and training, encourage focal points to be
more active, analyze causes of reported incidents, protect
reporters, and give feedback and warnings so that people
recognize the benefits of reporting.  

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 2 | How to Make Incident Reporting System Work?

- Maintaining the director’s interest.
- There must be a staff in charge, who has knowledge on
incident reporting system and is enthusiastic.
- Encouraging focal people to work actively.

8.

Lessons learnt- It is not difficult to establish an incident reporting system.
- It is not simple to make the system work effectively
and bring benefits. It requires enthusiasm, patience andactiveness.

Session 2-Being active in communication, training, and proving thesystem’s effectiveness.

Session 1

7. Solutions to maintain and develop thesystemSession 3
Session 4
Session 5
Session 6
Session 7
Annex
57

Session 2-3
The Incident Management Journeyin Tu Du HospitalTran Nguyen Nhu Anh
Quality Management Department, Tu Du HospitalIn the 5-year journey (from 2011 to present), withdepartments via Safety Newsletter, LAN, or hospital grandthe commitment and determination of leaders and staff,

meetings. Every such activity always goes with the mottos

our Tu Du Hospital has built a safety and quality culture,“One’s incident is a lesson for someone else”, “Prevent

expecting that “Good hospital becomes better”.

incidents from repeating”, or “Keep moving forward”.

We act together with a belief in victory and overcoming
ourselves so that “today is better than yesterday”.  
We understand deeply that there are many things

path we are taking with blaming culture, punishment

to do for a safe and quality healthcare environment. As

culture, and collective silence culture standing in the way

Professor Domingo, a quality expert, said “Hospital is

to trust, safety culture, and quality culture. We have madea perfect environment to create errors” and “To err ishuman”, people make mistakes because “No one isperfect”. Perhaps all healthcare workers before their firststep in the healthcare career feel very proud, moved,and determined to fulfill the Hippocratic Oath “First do
no harm”. No one working in healthcare wants to harm
patients; therefore, errors or incidents (if any) happen
because there are too many risks and traps surroundingus, as if they are waiting for their “opportunity”. So whatshould we – all hospital staff – do to develop a safer andbetter quality environment for ourselves?  
With these perceptions and messages, we develop
and standardize an incident management procedure. Staff
share their perspectives, high-risk factors, their incidents
and errors or those of their colleagues by reporting
incidents to QMD. Then, the staff in charge in QMD sets
up a GO–SEE group to study the details of the incidents.
What actually happened? After that, we meet with relevant
departments to study the root causes and propose
appropriate solutions. Later, we implement the solutions
and evaluate their effectiveness. All these activities follow
the PDCA cycle. PDCA cycles keep going one by one in ajourney that has a starting point but no end.  
Besides, we provide information of these stories– incidents, causes, ways for improvement – to all 35

58

Managing incidents in the hospital with 2,500 staff and
1,900 actual beds, we deeply understand the challenging

breakthroughs in creating a PS playground. For example,“The Way to the Olympia Peak” gameshow format is
employed in our training courses on incident managementwith laughter filling the hall. We introduce active teaching,learner-centeredness, group work, connection, love,

and alliance to attract people to seemingly dry QM/PS
activities. In all activities, we always encourage, praise,and reward groups with good results as well as set criteria
to honor well-implementing departments.
From glamourous activities, we gradually grow deeper
by working effectively to meet what departments expect
when they report incidents: we DO what we SAY. Whentrust is built, people gradually BELIEVE and accompany
us. Besides, with issues we are not able to handle at the
moment, we always share information, explain why it is
not possible at this moment, and ask for their sympathy.
With information shared and with our efforts, ourcolleagues show sympathy and keep accompanying us.
Our successes have been supported by the
Directing Board by soft skill training courses such as“Change management – team building”, “Personal skills
development”, and “Understand ourselves – accompany
patients”, which promotes understandings “who am

I; what is my mission?” as well as “what values do

I bring to myself and others?” Self-understanding

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 2 | How to Make Incident Reporting System Work?

helps materialize ourselves in our work, interact well with

been holding our hands and work together from one single
incident on the first day operating the system (despite highpatients and colleagues, and devote ourselves to work.

prize) to more than 500 voluntary reports at present. The

Programs such as “Process map”, “Job instruction”, andspirit of incident reporting is highly appreciated because it“Mistakes proofing” also help building a safer environment.

helps create a safer healthcare environment for ourselves

Yes, each individual becomes a change agent to makeand patients, our special clients.

Session 1

ourselves, balance work and family, interact better with

our life better. And when healthcare workers are happierSession 2

in their life, their work will be more effective and patients
will be happier.
TRUST – LOVE – CONNECTION – INFORMATIONSHARING - SYMPATHY have created an environment
where we – hospital staff - love and belong. We have

Session 3

INCIDENT REPORTS
2013 – 8/2016

Session 4

INCIDENT MANAGEMENTTU DU HOSPITALDA NANG – 28/9/2016

Session 5

Dr.	
  Tran	  Nguyen	
  Nhu	
  Anh,	
  	
  
MD.,	
  MSc.

INCIDENT MANAGEMENT

CLASSIFICATION OF INCIDENT REPORTS

Variance

Sentinel event

GROUPING  INCIDENT  REPORTS

Yearly incident reports

GROUPING INCIDENT REPORTS 2014/2015

Annex

INCIDENT REPORTS
2013 – 8/2016

Session 7(8 months)

Near missSession 6

CLASSIFICATION  OF  INCIDENT  REPORTS

OthersEquipment
Incorrect information
Infection control
Pharmacy
Para-clinical
Clinical(8 months)

59

GROUPING  INCIDENT  REPORTS
2016

OthersNursing
TreatmentIT
EnvironmentPara-clinicalEquipment
Patient fall
Incorrect information
Infection control
Pharmacy
Surgical safety

REPORTERS  WHO REPORT INCIDENTS

Dr.

Midwives,
technicians,
nursesOthersINCIDENT  REPORTING	
  Incident  repor:ng  form

INCIDENT  REPORTING	
  Repor:ng  via  intranet  60

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 2 | How to Make Incident Reporting System Work?

Session 1
Session 2
Session 3

Patient Safety Newsletter
QM system

QM Council

Session 4

5 committees
QM network

Incident
management

Procedure
management

5S…

Soft skills

Session 5

Patient Safety Newsletter

Session 6

2011

Session 7

DO NOT THINK THAT“I WILL NEVER BE LIKE THIS”

Annex

2012

61

2013	
  

2014

62

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 22015

Session 2 | How to Make Incident Reporting System Work?

Session 1

Session 2

Session 3

Session 4

Session 5

Session 6

Session 7

Annex

63

39	
  

43	
  

SURVEY ON
PATIENT SAFETY CULTURE

40	
  (The story of the eagle)41	
  TO CHANGE OR NOT TO BE
HAPPY PATIENTS MAKE FOR HAPPY DOCTORS.
BLAMINGCULTUREPURNISHMENTCULTURESAFETY CULTURE
VĂN HÓA
COLLECTIVE
SILENCEQUALITY

64

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 2 | How to Make Incident Reporting System Work?

Session 1

Session 2

Session 3

Session 4

Session 5

Session 6

Session 7

Annex

65

Session 3 Signboards in Hospital
Summary of Discussion
1.

Necessity
1.

Indicator A1.1 in MOH’s Hospital Quality Standard assess whether “patients are clearly instructed, well received
and logically and specifically guided”. A good hospital signboard system can provide helpful instructions forpatients to navigate easily in the hospital.

2.

Difficulties in navigation in the hospital contribute to patients’ dissatisfaction. A helpful signboard system can help
increase patient satisfaction.

2.

The Roles of QMD in Improving Hospital Signboard System
1.

In many hospitals in Vietnam, the Administration Department is in charge of managing the hospital signboard
system. QMD can work together with this department to improve the system. In Thu Duc District Hospital, QMD
asked the hospital director for them to take charge of this duty. They still collaborated with the Administrative
Department to fulfill the task.

2.

Normally QMD works with the administrative department as well as an external design company to develop asystem that meet the hospital’s needs. QMD should review and study the existing system, then present theirideas of a new system to the design company. Information that QMD needs to collect is a complete list of current
signboards (including papers temporarily hung on the wall), different types of signboards, how they are used,
contents of each signboard…

3.

Implementation
1.

Usually a hospital does not change the whole system at the same time. It may take some time to change
gradually.

2.

Implementation depends on the hospital budget. Usually the design company will provide different options ofmaterials and sizes of signboards with different prices for the hospital to choose.

3.

Some hospitals are concerned about English names for departments, since MOH requires that hospital
signboards must be in both Vietnamese and English whereas there is no glossary for hospitals to follow. Thu
Duc District Hospital learnt from the naming systems of UK’s National Health Services (NHS) and some hospitals
in USA and Taiwan. In addition, some doctors who had years of experience working in a hospital abroad helps
name departments in English.

4.

While a hospital may adopt a leading color for their signboard system (e.g., sky blue in Thu Duc District Hospital),
they should follow some universal principles such as using red color for emergency. Scientific research showsthat red is a top eye-catching color, so it is usually used for emergency cases.

5.

Some hospitals, such as Bach Mai Hospital, are implementing Corporate Identity Program so their signboards
follow some designing rules under this program.

6.

Hospitals in Vietnam are often required to put some health communication posters on the wall but when such
communication posters are put beside the hospital signboard, it looks like the hospital is less professional.
Therefore, some hospitals put separate bulletin/information boards to hang these posters.

7.

There can be different ways to number patient beds, but normally it should be from left to right, up to down
according to one’s common way of reading in Vietnam.

66

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 3 | Signboards in Hospital

Experience in Improving Hospital Signboard System

Session 2

Huynh My Thu, Hoang Thi Oanh, Hoang Thai Phi Long, Tu Huynh Hoang Tu, Nguyen Thi Nhuan

Session 1

Session 3

Quality Management Department, Thu Duc District Hospital

Reasons for choosing the topic
Thu Duc District Hospital is a 1st level general hospitalNO.

ACTIVITIES

8

Adjust (if necessary)

9

Report progress

inpatient beds, 3,500–4,000 turns of outpatients perday. There are more than 1,200 staff, young and active.
With limited facilities undergoing many renovations andcrowded flows, provision of information and guidancefor patients, patient family members, and visitors is one

4. Actual state
An outpatient survey in Thu Duc District Hospital in
Quarter 1 of 2016 shows that only 65% were satisfied
with the signboards.

and treatment, reduce moving time, and increase patient

5.

2.

Cause analysis- The signboard system was not systematic andTargeted users

Session 5of the core tasks to improve the quality of examination
satisfaction.

TIME
Week 4 - September
2016
Week 4 - September
2016

Session 4

located in the northeast of Ho Chi Minh city, with 800

Session 3

1.

consistent.

Session 6- People who visit the hospital the first time for
examination and treatment;- Patients who came to the hospital before but change
their departments of visit (2nd time or more);- Patient family members;- New healthcare workers who do not know well how tonavigate the hospital.

3.

4
5

Calculate the number of signboards
neededIdentify positions, quantity, and sizes
neededDesign standard signboard of eachtype
Collect comments and generateconsensus

6

Ask the designer to complete

7

Approve and confirm the designed
boardsTIME
Week 3 - July 2016
Week 4 - July 2016

Annex

3

positions.

Implementation planNO.
ACTIVITIES
1 Make detailed action plan2

- Many boards are temporarily placed in inappropriate

Session 7- Visitors or business partners;

Week 4 - July 2016
August 2016
Week 1 - August 2016
Week 2 - September
2016
Week 3 - September
2016

67

- The colors were not eye-catching and attractive toreaders.

9.

Difficulties and solutions  

a.

Difficulties- Designs of signboards were not attractive andinformative enough to readers.
- Designing and installation of signboards in the hospital
met many difficulties such as too many contents in a
signboard, difficulty in management and calculation,
unsystematic and inconsistent placing of signboards;- The buildings in the hospital are very close to one
another, so visitors may find it difficult to identify theirvenue if they follow the signboards without checking themap.
b. Solutions- Attract readers by mixing color in consideration of light,
contrast, using easy-to-read pastel colors (the key colors
are blue, orange yellow, white and brown, except the

6.

Objective
Provision of information and instructions in the hospitalis improved, with more than 70% of hospital visitors
understand and know how to navigate in the hospital.

7.

Action plan
Review documents; visit and learn about the design

and installation in some hospitals;
Based on the hospital’s infrastructure, design somesample signboards and consider their suitability;
Assign a focal person for management; bantemporarily hung boards; boards contents must be sent
to QMD for approval;
Collect comments on draft and complete designs from
hospital leaders and departments.

8.

68

maps depending on building colors, which may include
other colors besides the four key colors). The signboards
include both English and Vietnamese, as well as icons for
illiterate people and those with eyesight problems.
- In places that have so many things to guide, install anumber of signboards where necessary; or first put thename of the main technique, then those of the specificones.
- Instructions are given by block. Each block must haveits name board and its own color. Signboards and maps
are designed for each block and use the block’s color. All
must use symbols, have specific size, and be installed atleast 1.2m above the ground.
- Show the position of the reader in all the maps in thehospital with detailed explanation.

Results

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 3 | Signboards in Hospital

ACTUAL STATE

EXPERIENCE
An outpatient survey in Thu Duc
District Hospital in Quarter 1	
  of	  2016 shows that only 65% weresatisfied with the signboards.

IN IMPROVINGHOSPITALSIGNBOARD SYSTEM

Session 1

5

HUYNH MY THU, MSc.

Session 2

CHIEF OF QUALITY MANAGEMENT DEPARTMENTTHU DUC DISTRICT HOSPITAL, HO CHI MINH CITY

1

CONTEXT

6

CAUSES

Session 3

2v The  signboards were not systematic andv 1st level hospitalconsistent.

v 10 functional departments andSession 4

36 departmentsv 800 INPATIENT bedsv Outpatient: 3,500 – 4,000
visits/dayv Manpower: 1,280 staff(31/12/2015)

Session 5

3

TARGETED USERS

7

CAUSES

Session 6v Many signboards were placed temporarily ininappropriate positions, causing difficulties inmanagement and calculation.

Patients, patientfamily members
Visitors

New staff

Session 7

IMPLEMENTATION PLANNO.

CONTENTS

8CAUSESTIME

1Make detailed action plan

Week 3 - July 20162

Calculate the number of signboards needed

Week 4 - July 2016

3

Identify positions, quantity, and sizes needed Week 4 - July 2016

4

Design standard signboard of each type

August 2016

5

Collect comments and generate consensus

Week 1 - August 2016

6

Ask the designer to complete

Week 2 - September 2016

7

Approve and confirm the designed boards

8

AdjustWeek 3 - September 2016
Week 4 - September,
Week 1 October 2016

9

ReportAnnex

4v The colors were not eye-catching and attractive
to readers.

Week 2 – October 2016

69

9

AIM

13

1. Reader oriented and reader centered

Font• Bold  monospaced  lowercase  (Arial,	
  Tahoma…)• First  le6er  capitalized

2. Highly aesthetic, easy to see, and easy to read signboard system
3. Suitable to different hospital visitors
4. Shorten time for moving between areas• Proportional text (Time New
Roman, VNI-Times...)• Text that is italic, too bold, or
shaded5. Easy for management and adjustment when there arechanges or damage.

10

OBJECTIVE

Provision of information and instructionsin the hospital is improved, with more than
70% of hospital visitors understand andknow how to navigate in the hospital.

14

Contentsv No more than 5 destinations in a signboard (grouping the areas,
simplifying)v Information must be clear, easy to read, visualized, and vividv Boards should show functional areas and directions systematically andlogicallyv Standardize marginsv Insert space between lines

11

Action plan

15

Colors16

Symbolsv Review documents; visit and learn about the design andinstallation in some hospitals;v Design some sample signboards and consider theirsuitability;v Assign a focal point for management, ban temporarily hungboards, boards contents must be sent to QMD for approval;v Collect comments on draft and complete designs from
hospital leaders and departments.

12

TYPES OF HOSPITAL SIGNBOARDS
a. Mapb. Organizational chartc. Direction board to areas/blocks anddepartments
d. Department name board
e. Information board, rules and regulations board
f. Nameplates of healthcare workers

70

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2v Contrast colorsv Red background, white characters:
urgent statusv Avoid too many colors

Session 3 | Signboards in Hospital

21

PositionsHanging board: ceilingmore than 2.5 m high2m

Session 1

17 View

Wall board

1m2

Outdoor board

22 Maps

ArrowsTurn left

Turn right

Turn right up

Turn left down

Up

Down

Turn rightdown

Session 4

Turn left upv Not detailed enoughv No street namesv No entrances shownv The reader’s position not identified (no “you are here”)

Session 3

18

Session 2

Normal board

Session 5

19

Positions

23

RESULTS

Session 6v Boards should follow thedirection of approachv Boards should be hung on the left wallof the door or within the reader’s viewv Do not hang above the door

24

Annex

20 Positions

Emergency light box

Session 7

Examination procedure for outpatients withhealth insurance

RESULTS

Maps

71

25

RESULTS

Direction boards

26

RESULTSCONCLUSIONS

1. Results arechanges
2. Good àstandardize
3. Not good à
PLAN

1. Audit,inspection…
2. Evaluate results.

ACT	
  

PLAN	
  

CHECK	  DO	
  1. 5 W 1 H – 2 C –5H
2. PEST analysis

1. Pilot
implementation
2. Analysis
3. Solutions
4. Indicators
5. …

THANK YOU72

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

Summary of Discussion
Application of Surgical Safety Checklist (SSC)1.

A number of hospitals in Vietnam have been applying WHO SSC (with modifications) to enhance their surgicalsafety, under the leadership of QMD (e.g., Ha Tinh Provincial General Hospital, Hue Central Hospital) or General

Session 2

1.

Session 1

Session 4 How to Ensure Quality and Safety			in Clinical Work?

Planning Department (e.g., Bach Mai Hospital).
Some hospitals may need to modify WHO SSC for easier and better application in their contexts. In such cases,
pilot implementation and feedback from practitioners (surgeons, anesthetists, nurses, technicians and other staff
involved in surgery work) is helpful. Ha Tinh Provincial General Hospital involved practitioners when modifying thechecklist and discussing how to use it. This resulted in high compliance of application of SSC.
3.

Session 3

2.

Generally, modifications should only add more necessary contents to the original SSC and should not removea.

Hue Central Hospital specifies the checklist on which checks should be done by whom, and the surgeon’s
parts are colored.

b.

Session 4

any original contents. Some practical modifications in Vietnamese hospitals include:

Ha Tinh Provincial General Hospital assigns the anesthetist to take charge of filling the checklist, whichworks better than assigning this task to a nurse previously. When a nurse was in charge of this task, somec.

The surgeon, the anesthetist, and the scrub technician/nurse are required to sign and give full name at thebottom of the checklist. In Ha Tinh Provincial General Hospital, the surgeon is required to check lastly andSession 5

doctors were not cooperative.

give signature in the checklist.
d.

Some categories of surgery type (program surgery, emergency surgery, major surgery, medium surgery…)

4.

Training is necessary for practitioners before applying the checklist. In Bach Mai Hospital, application without
trainings resulted in 32% of surveyed staff meeting difficulties in filling the checklist and 93% expressing they

Session 6

are added to the checklist for QMD to collect more data for research and review.

need training. In Ha Tinh Provincial General Hospital, QMD organized separate trainings for doctors and nurses/
technicians.
It is not easy to convince surgeons who are excellent, highly respected and usually have strong personality toapply the checklist. In Ha Tinh Provincial General Hospital, the head of QMD talked to these surgeons individually
about use of the checklist in a soft yet determined manner.
6.

Session 7

5.

One concern for practitioners is time spent for filling the checklist. QMD can measure the time for (i) reduction(improvement) if it’s too long and (ii) showing evidence to convince hesitating staff to apply the checklist. In Hung7.

Monitoring the compliance is necessary, yet some QMDs hesitate to send staff to the surgery room for its direct

Annex

Vuong Hospital, after practice for some time, the average time for filling the checklist is one minute now.
monitoring. However, some others managed to do this, e.g., Ha Tinh Provincial General Hospital and Hung
Vuong Hospital.
a.

In Ha Tinh Provincial General Hospital, at the beginning, the head of QMD, who is also a surgeon himself,
performed this task and gradually train his QMD staff, who are not surgeons, to do the job. It is importantthat QMD staff shows that their presence is not only to supervise the operating team but more about
checking how the checklist is applied in reality, whether there are difficulties for practitioners, and looking
for improvement opportunities. QMD staff usually discuss with the operating team about application of the73checklist right after the surgery. QMD staff came to monitor the operating team and receive a lot of helpful
feedback to improve the checklist as well as its application.
b.

In Hung Vuong Hospital, the monitoring team are carefully trained for the job and required to attend thesurgery from the beginning to the end. They also developed a separate checklist to check compliance to
the SSC. This checklist is different from the SSC. The presence of QMD staff in the surgery room is also
important to promote the operating team to comply to the SSC, especially at the beginning.

8.

One participant proposed using camera for monitoring the surgery without sending monitoring staff to thesurgery room. However, this practice is not common. In some hospitals, including those in Japan and some in
Vietnam, although cameras are installed in surgery rooms they are mostly for education and consultation, not formonitoring. One doctor expressed ethical concern about using camera for monitoring.

9.

An indirect way to check compliance to SSC is checking the checklist that had already been filled, preferably
after the patient’s moving to the postoperative room and before sending their medical record including thechecklist to General Planning Department. Bach Mai Hospital and Hue Central Hospital apply this practice.
Although the check may involve errors, such as the operating team may check what they did not perform or not
check what they did perform, this data analysis may still reveal some improvement opportunities, such as theitems practitioners tend to skip most.

10. There are two different thoughts about applying the SSC in emergency surgeries. Some think that it isacceptable to skip filling the SSC in emergency cases. For example, some patients in critical situations who weretransferred directly from Emergency Department to Surgery Department must be and in fact were operated rightaway before their medical records were sent there.
11. However, some doctors and data show that it is easier to commit mistakes in emergency surgeries than in nonemergency surgeries. Therefore, hospitals should think about how to apply the SSC without affecting specificrequirements of emergency surgeries.
12. Although most people agree that elective surgeries should apply the SSC, some are concerned about whether
the surgery can go on if the operating team refuse to apply the SSC. Some think that in such cases the surgery
must be postponed while some others think that the surgeon has the right to conduct the surgery with orwithout filling the SSC, because what the surgeon receives for not filling the SSC (e.g., punishment) is separate
from his/her right to do an operation.

2.

Antimicrobial Stewardship(Mainly from Cho Ray Hospital’s experience)1.

In order to encourage doctors to employ antibiotic prophylaxis, in September 2015, Cho Ray Hospital issued adocument requiring that all surgeries must assess risks of surgical site infection. The surgery plans without suchassessment or without mentioning about use of antibiotic prophylaxis will not be approved. QMD monitors thispractice by sending staff to a surgery approval meeting and having medical records checked by clinical pharmacists.

2.

Doctors are usually concerned about surgical site infection if they do not prescribe antibiotics after the surgery.
Therefore, QMD measures surgical site early infection rates and found that even if doctors employed antibiotic
prophylaxis or doctors did not prescribe antibiotics after surgery, surgical site early infection rates did not increase.

3.

Beneficiaries of reducing unnecessary antibiotics after surgery include: patients, medical insurance agencies,
communities (due to decreased antimicrobial resistance), and pharmacy companies as well. In the short term,
they would sell less antibiotics but in the long term they can prolong the lives of the antibiotics they produce.

4.

Support from hospital leaders, especially the director, is very important. In Cho Ray Hospital, the hospital leaders
show their support not only in words but also in action. For example, they always attend regular meetings of theantimicrobial stewardship program, give comments, and remind staff/departments who have not complied well.

3.

QMD’s roles in ensuring clinical safety
1.

74

QMD does not produce clinical quality in a hospital. However, they can contribute their part to ensure andPractices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

enhance safety in clinical work.
Setting short-term S.M.A.R.T objectives is practically helpful because in a short time it can bring results andsense of achievement, which helps motivate staff to keep up with improvement activities.
3.

Technically, QMD should measure some necessary indicators to provide evidence for quality improvement
opportunities and effectiveness of quality improvement measures, such as time needed for filling the SSC or

Session 1

2.

surgical site infection rates in relation with antibiotic uses. This evidence will help convince other departments as
4.

Knowing how to work with other departments is essential. QMD may meet resistance from clinical departments,
but they should express a cooperative attitude instead of opposing attitude, supporting instead of fault-finding.
If clinicians do not comply to a safety practice, QMD should first check whether the practice is convenient andSession 2

well as the leaders to support and comply to safety practices.

feasible for application.
Sharing information of improvement projects progress and results to collaborators from other departments is
helpful because it makes everyone feel they are part of the project. The project results should be presented asachievements of everyone, not those of QMD alone.
6.

Providing safety trainings to clinical staff is helpful. However, it is not easy to attract them to such trainings. An

Session 3

5.

experience in Cho Ray Hospital was organizing trainings before the day many staff had an exam/test. In suchcase, they attended more and even recorded the lecture for self-study later.

Session 4
Session 5
Session 6
Session 7
Annex
75Session 4-1
Surgical Safety in Bach Mai Hospital
Nguyen Thi Huong Giang
Quality Management Department, Bach Mai Hospital

1.

Reasons for choosing the topic
Medical errors, especially those related to surgery andprocedure, not only affect surgical quality but also prolong
treatment and hospitalization, decrease patients’ income,increase treatment cost, morbidity and mortality rates,
patients’ pains, denunciations and legal problems.
Medical incidents related to surgery and procedure
are common, which according to some studies accountfor more than 50% of all incidents. According to Joint
Commission International, there were 116 wrong-site
surgeries in the United State in 2008. In Viet Nam, big
hospitals are always overcrowded with patients and havehigh work pressure, especially in surgery and anesthesia

hospital in Nghe An Province and in July 2016, wrongleg surgery happened in Viet Duc Hospital. Under suchcircumstance, the hospital’s Directing Board required thatall surgery departments apply SSC in operation theaters.

3. Objective
SSC is applied in surgery departments in the hospitalin August 2016.

4. PlanContents
of work Jul Aug

A

Develop
SSC

GPD
Nursing
Department

B Apply SSC

GPD
Nursing
Department

departments. Many adverse events happen due tomistakes during preparation and control before, during
and after surgery. These events can be controlled orminimized if there is a strict controlling process. Surgicalsafety checklist (SSC) is considered an effective tool toprevent medical incidents and errors related to surgery
and procedure in Vietnam’s context.

2.

Actual state in Bach Mai Hospital
Bach Mai Hospital is a general hospital with 1,900

beds. It has 8 surgery departments: Cardiovascular
Surgery, General Surgery, Neurosurgery, Orthopedics,
Obstetrics and Gynecology, Ophthalmology, ENT, andOdonto-stomatology. There are 12 operation theaters
with 210 staff (including surgeons, anesthesiologists,
anesthesia technicians, scrub nurses, nurses, etc.). The
hospital performs about 14,000 surgeries a year.
By July 2016, the SSC had not been appliedconsistently in surgery departments and surgical incidents
had not been fully recorded.
In June 2016, a wrong-arm surgery happened in a

76

Time
Sep

No.

C

Evaluation

Developplan andsurveytools
Deliver
perception
2
surveyforms
Collect
data
relatedto the3
practicefrommedicalrecords
1

1/9 15/9 25/9 30/9

Oct

Department
in charge

QMD

QMD

QMD

QMD

Reportresults and4
proposesolutions

QMD
GPD
Nursing
Department

ImplementDsolutions

QMD
GPD
Nursing
Department

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

INTRODUCTION OF SSC IN BACH MAI HOSPITAL

Session 1

Make plan to apply
SSC

Apply

SURGICAL SAFETY
IN BACH MAI HOSPITAL

Evaluate theapplication

Adjustwww.themegallery.com

www.themegallery.comBẢNGKIỂM AN TOÀN PHẪU THUẬT
SSC
DEVELOPMENT

Đơn vị Gây mê hồi sức -………………………

Họ và tên người bệnh: …………………………………….. …………..Tuổi:……… Giới:…....Ngày phẫu thuật: …………………………………
TRƯỚC GÂY MÊ

Bác sỹ gây mê và kỹ thuật viên gây mêKỹ thuật viên gây mêTRƯỚC KHI RẠCH DA

TRƯỚC KHI NGƯỜI BỆNH RỜI PHÒNG PHẪU THUẬT

Phẫu thuật viên, bác sỹ gây mê,điều dưỡng viên –kỹ thuật viênPhẫu thuật viên, bác sỹ gây mê, điều dưỡng – kỹ thuật
viênĐiều dưỡng – Kỹ thuật viên ghi lại:Tên cách thức phẫu thuật:……………………………………………………….
……………………………………………………….
Kỹ thuật viên dụng cụPhẫu thuật viên:1.□ Người bệnh/GĐNB xác nhận và nhận 1. □ Xác nhận các thành viên tham gia phẫu thuật
dạng NB, phương pháp phẫu thuật, xác nhận và nhiệm vụ.
được BS gây mê và PTV giải thích.
2. □ Xác nhận chính xác người bệnh; □ Vị trí
2. □ NB cam kết đồng ý phẫu thuật, gây mê phẫu thuật; □ Cách thức phẫu thuật dự kiến.
3. □ Hoàn thành kiểm tra thuốc và các thiết 3. Sử dụng kháng sinh dự phòng:bị gây mê, đặt nội khí quản:□ Có□ Không áp dụng.
4. □ Kiểm tra phiếu chuẩn bị và bàn giao 4. Hiển thị chẩn đoán hình ảnh không?
NB trước phẫu thuật.
□ Không.

5. □ Đánh giá các dấu hiệu sinh tồn của □ Có. …………………………………………….
người bệnh theo monitor theo dõi.
5. Tiên lượng và dự kiến thời gian phẫu thuật:Bác sỹ gây mê□ Tiên lượng diễn biến xấu:1. Nguy cơ hô hấp:…………………………………………………......
□ Không.
□ Tiên lượng mất máu: …………………………...
□ Có, chuẩn bị các thiết bị hỗ trợ.
……………………………………………… □ Thời gian phẫu thuật:..........................................
Bác sỹ gây mê:
2. Có dự trù máu□ Không.
□ Có, máu và chế phẩm máu:……………………………………………
…………………………………………….

BS gây mêPhẫu thuật viên□ Hoàn thành kiểm tra vật tư, gạc phẫu thuật.
Danh mục
Gạc toGạc nhỏ
MercheChỉ khâu
Kim khâuTrước mổSau mổ

Dụng cụ khác:…………………………………………..

□ Dán nhãn và gửi bệnh phẩm (nếu có).
Kiểm tra dụng cụ□ Có□ Không…………………………………………………………..
Bàn giao phòng Hồi sức:(PTV, BS GMHS, KTV)Những vẫn đề chính về phục hồi và xử trí người bệnh:……………………………………………………….
……………………………………………………. ……………………………………………………….
Điều dưỡng dụng cụBệnh án: …..……..tập
□ Xác nhận tiệt trùng dụng cụChế phẩm máu: ………………………………………..
Thuốc:………………………………………………….
Chẩn đoán hình ảnh: …………….phim.
KTV gây mê
KTV dụng cụĐiều dưỡng hồi sức

Session 4

I forgotthescissors
in your
belly!

- Medical errors, especiallysurgical ones, not only
affect surgical quality but
also increase treatment
costs and time,complication and mortality
rates, patients’ pains, aswell as denunciations andlegal problems.
- Many studies show thatusing surgical safety
checklist (SSC) helps
reduce surgical incidentsBỆNH VIÊN BẠCH MAI

Session 3

INTRODUCTION

Session 2

Nguyen Huong Giang, MD., MSc.
Chief of Quality Management Department
Bach Mai Hospital□ Vấn đề đặc biệt liên quan đến người bệnhSession 5

BACH MAI HOSPITALSSC APPLICATION

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EVALUATION OF THE APPLICATION
Perceptions ofhealthcare workers
in relevant
departments about
the checklist

Actualcompliancewith checklist
use

Annex

SURGICAL SAFETY IN OTHER HOSPITALS

Session 7- Organize meetings todevelop the checklist- Introduce and apply
the checklist- The hospital sent
documents to require
departments to use
the checklist from
August 15, 2016

Session 6

Bach Mai is a general
hospital with 1,900
beds. It has 8
departments that
conduct surgeries:
Cardiovascular Surgery,
General Surgery,
Neurosurgery,
Orthopedics, Obstetrics
and Gynecology, ENT,
Odonto-Stomatology.
There are 14 OTs with
210 staff, and about
14,000 surgeries every
year.

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77

PERCEPTION OF HEALTHCARE WORKERSEVALUATION OF CHECKLIST APPLICATION- Venue: 8 surgical departments that applied the SSC

Are the contents and division of tasks in the checklist
appropriate?

- Time: 16-23/09/2016

Percentage ofappropriatenessContents(%)

Division of tasks(%)

Sign in

96.67

97.78

Time out

95.65

95.6

Sign out

97.78

97.78

All stages

96.7

97.05

- Evaluation methods:+ Evaluation of staff perception: questionnaires sent to
staff+Evaluation of practice: contents of checklists attached
to medical records were studied.
- Subjects: 103 healthcare workers who involved insurgeries in the 8 departments and 144 medical recordsof patients who underwent surgeries (records inpostoperative rooms)

PERCEPTION OF HEALTHCARE WORKERSStagesPERCEPTION OF HEALTHCARE WORKERS
Difficulties in applying the SSC?

Are you aware of the surgical safety checklist?
No difficulties

Yes
No

It takes long time
to complete thechecklist
I didn’t know how
to fill somecontents in the
checklist

PERCEPTION OF HEALTHCARE WORKERS

The checklist should be filled by?

Is the SSC really necessary for PS?

Agree

PERCEPTION OF HEALTHCARE WORKERS

One staff fills thechecklist independently
with the surgical teamDisagreeOne staff collaborates
with the surgical team tofill the checklist

Members of the surgicalteam fill the checklist bythemselves, withassigned tasks

PERCEPTION OF HEALTHCARE WORKERSPERCEPTION OF HEALTHCARE WORKERS
The checklist can be filled any time before medical
records are sent to the GPD

Are the surgical phases divided appropriately
according to the checklist?

Agree
DisagreeStrongly
disagreeDisagreeDon’t know
Agree
Strongly agree

78

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

EVALUATION OF PRACTICEPERCEPTION OF HEALTHCARE WORKERS
Sign inSession 1

Anesthesiologist:

Disagree
Agree
Surgical teams
should be trained
how to fill thechecklist

Communication
among the surgicalteam should bemaintained during
the operation

Did not perform

The department
had effective
solutions toprevent errors

Performed

Blood preparationassessment

Time out“Inemergency
cases,
surgeons
have no time
to fill thechecklist”

Surgeon:Session 3

EVALUATION OF PRACTICEPERCEPTION OF HEALTHCARE WORKERS
Evaluate
surgicalsafetylevelin your
department:Đánh giá themứcđộ an toàn
phẫu
thuật
tại đơn
vị anh/chịcông tác:

Session 2

Respiratory
riskrisk
Respiratory
assessment
assessment

Excellent

Checking
identificationof eachsurgical teammember andhis/her tasks

Acceptable

Not safeenoughChecking
patient
identification

Checking
confirmation ofsurgicalsite

Checking
confirmation of
expected
operation
methodPerformed

Session 4

Did not
perform

Good

Session 5

EVALUATION OF PRACTICE“There shouldbe punishment
and reward for
applying thechecklist”

Time out“Follow WHO
recommendation: implementing
the checklist
verbally, not only
on paper”

COMMENTSFOR THECHECKLIST

Performed“”Scrub technicians“confirm device
sterility” is not enough.
It should be “Aresurgical devices
sufficient? Do they
work? (e.g., suction
device, electricknife…)”

Checking
Checking
display of
expected
diagnostic
use ofprophylactic imaging
antibiotics

EVALUATION OF PRACTICE

Sign inKẾT QUẢ KHẢO SÁTTime out

Anesthesia technicians:

Anesthesiologist:
Did not
perform

Annex

EVALUATION OF PRACTICE

Checking Checking Checking
estimation estimation confirmaof
oftion ofpotential bleeding operation
bad
risk
time
outcomes

Session 7“The checklist
should be
tailored foreach specialty”

Did not
perform

Session 6“Patient posture
before skinincision should
be added”(cont’d)Surgeon (tiếp):Assessing and noting special issues
related to patients

Performed

Performed
Did not perform
Confirming
patient’s identityand operation
methods, with
explanation
fromanesthesiologist
and surgeon

Confirming
patient’s
consent forsurgery andanesthesia

Confirmingthat drugs
andanesthesia& intubation
deviceswerecheckedChecking
patient
handoverandpreparation
form before
surgery

Checking
patient’s vital
signs viamonitor

79

EVALUATION OF PRACTICEEVALUATION OF PRACTICE

Activities healthcare workers often didn’t mark in the checklist

Time out
Nurse/Scrub technician:Checking the confirmation of sterilizationof devices and tools
Did not
perform

Performed

Performed
Did not performed
Checking AnestheCheck-ing Check-ing Check- Checking Checking Checking
major
siologist
surgeon ing drug surgeon
handovernurse/
scrub
issuesnotingestimating hand- estima-ting of blood
scrub
technician
about
special technicipotential
over in bleeding products incounting
patient
issuesbadresuscianrisk
resuscita- materials
recovery related to labeling outcomes tation
tion room
and
room
and
patient
andgauzessending
handling
specimen(if any)

EVALUATION OF PRACTICE

CONCLUSIONS

Sign out
Nurse/Scrub technician:Checking the completion of counting materials and gauzes• A certain number of healthcare workers
do not understand the helpfulness of thechecklist and how to fill it• The compliance rates with checklist use
are still low in some items

Performed
Did not perform• Most (92.71%) of healthcare workers want
to be trained how to use the checklist.
• Some information in the checklist should
be adjusted to be more appropriate

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EVALUATION OF PRACTICESOLUTIONS

Sign out• Revise part of the checklist

Nurse/Scrub technician:Did not perform
Performed
Checking thelabeling andsending ofspecimen(if any)• Organize trainings on how to use thechecklist for healthcare workers who
involve in surgeries, especially for thegroups and items in the checklist
whose/of which compliance rates arelow• Design visualized reminding boards toincrease the compliance of healthcare
workers

Checking thecounting ofdeviceswww.themegallery.com

EVALUATION OF PRACTICE
Sign out
Handover to Resucitation Room

Major
issuesabout
patient
recoveryandhandling

MedicalrecordBloodproducts

Drugs

Diagnostic
imaging

Not included

Includedwww.themegallery.com

80

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

Session 1
Session 2

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Session 3
Session 4

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Session 5

THANK YOU!

Session 6
Session 7
Annex
81Session 4-2
Some Experience in Applying Surgical Safety
Checklist in Ha Tinh Provincial General Hospital
Hoang Song Hao
Quality Management Department, Ha Tinh Provincial General Hospital

1.

Overview
Surgery is a medical technique applied for diagnosis,

treatment, orthopedics…, which is common in healthcare. However, errors or incidents may occur any time
during the operation process. Adverse events may occur
before, during or after the operation, or even years after
the patient discharges hospital, affecting both physicaland mental health for a long time. Consequences not
only affect surgical quality but also prolong treatment
and hospitalization, decrease patients’ income, increase
treatment cost, morbidity and mortality rates, patients’pains, denunciations and legal problems.
According to a report by World Health Organization(WHO), there are about 230 million surgeries performed in
the world annually. Life-threatening complications accountfor 16% (7 million cases), 10% of which causing patients’“Safe, friendly, hospital for people”, safety in treatment
has always been our top priority. In the past years, there
have been many ways to help make surgeries safe forpatients. However, there are no tools that address thesurgical process comprehensively. Therefore, in 2015,
the Directing Board decided to apply the WHO surgicalsafety checklist (SSC) in the hospital. However, likeother hospitals in the country, before introducing thechecklist, we modified and improved it so that it suits our
hospital. We apply it consistently and effectively in surgicaldepartments, three specialized departments, and Surgery– Anesthesia Department.
1.

Difficulties at the beginning- Most surgeons, anesthesiologists, technicians... felt that
this created more work and burden, some people didn’t

deaths (1 million cases) were related to surgeries in grandtake it seriously;

operation theaters.

- The application at the begining was limited because the

In Viet Nam and the world in recent years, many
surgical errors adversely affected patients’ health. For
example, organ transplantations were conducted fromchecklist was not compatible with actual clinical settings,
such as no administrative part, no signature part, which
made it difficult to identify who is responsible if errors

an HIV infected patient to 5 people in Taiwan in 2011,

occur;

a 21-month boy was wrongly cystectomized in Cam- The procedure was not clear, causing more difficulties

Ranh City Hospital (Khanh Hoa Province), and wrong
nephrectomy in Can Tho Central Hospital...

2. Implementation of safety surgery checklist
in Ha Tinh Provincial General Hospital
Ha Tinh Provincial General Hospital is a 1st levelprovincial hospital with 38 departments/units, including:
08 functional departments, 23 clinical departments, 06
para-clinical departments, and 01 committee. The total
number of staff is 723. There are 500 planned beds
and 1,200 actual beds. There are 800-1,200 inpatients82

and 12,000–14,000 surgeries per year. With the motto

for implmentation;- There was no specific division of tasks, so there weresome perfunctory implementers, some checklists wereeven completed after surgeries...
2. Improvement and application
After some time of checklist use, it showed some
limitations, therefore improvement was necessary. The
hospital decided to improve it comprehensively:- The QM Council assigned the QMD to develop a

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

new draft checklist and implementation procedure by
studying the WHO checklist and those used in otheranesthesiologists, technicians...
- After that, the draft was sent to surgical departments,
3 specialized departments, and Anesthesia & Surgery

At present, Patient & Staff Safety Committee’s
checking and monitoring results show that the checklist is
implemented strictly and properly. However, inspections
also reveal some issues to be improved, such as:
some columes were left blank, lack of signature, lack ofdiagnosis information...

- QMD collected and summarized comments.

5. Lessons learnt
To implement the checklist and maintain the practice,meetings to discuss and reach consensus on how to

we need:improve the checklist and implementation procedure- The Directing Board’s support and intensive direction.

implementing, checking and monitoring...
- QMD summarized comments and finalized the checklist
before the director approved and issued it. The number of
items in the checklist increased from 16 to 23.
trained on surgical safety, the necessity of using thesurgical checklist recommended by WHO, and the revisednecessity of checklist use in surgeries so that surgeons,anethesiologists, anesthesia technicians... understandthat this practice is their responsibility and also benefit.  
- Encouragement and supportive environment forpeople to give comments during implementation andrevision. Respect everyone’s opinions. Listen and revise ifcomments are suitable, with the motto “Always listening,

implementation procedure.

always understanding”.  

- The checklist has been implemented in Surgery- The SSC is only one step in ensuring safety for patientsd e p a r t m e n t s : O p t h a l m o l o g y, E N T, a n d O d o n t o Stomatology.
- Compliance of the checklist is checked monthly andunannounced.

•- Surgeons, the leader of the whole surgery, fromanesthesia through the end of the surgery, benefit
the most in checklist use. Therefore, while Surgery Anesthesia Department is responsible for implementation,
surgeons must be the last to check and sign the checklist,
after the completion of gauze count, device check, drainof surgical patients in the meeting hall, checkinsertion, and prognosis after the surgery.

medical records in GPD;

- Strengthen checking, monitoring, and daily reminding.

Unannounced check: direct check in Surgery- Anesthesia Department by comparing the checklist andthe on-going surgical process (instantaneous).
3. Good points in implementation after improvement

Dicipline must be applied to individuals or surgical teams
that do not implement well, such as: blame or reduced
bonus. Checking and monitoring are really important tomaintain checklist use in surgery.
6.

- Surgeons, anethesiologists, nurses, scrub nurses
implementation in surgery and procedure.

Current difficulties
After some time of checklist use, some surgeons,especially excellent ones and those with strong
personality, seem to be less serious and skip some items- High consensus among surgeons, anesthesiologists,in the checklist.

nurses, and scrub technicians because they had

3.

opportunities to give comments for improvement andwere trained carefully.

Annex

understand the necessity and importance of checklist

Session 7•

Regular check: daily check of medical records

preparation, operation, to post-operative care.

Session 6- Types of check:in a long treatment process, from reception, pre-operative

Session 5- A n es th es i a Dep artment and three sp ec ia liz e dSession 4- Surgery - Anesthesia Department and surgeons were

- To organize trainings several times, emphasizing the

Session 3

as well as on which departments are responsible for

Session 2

Department to collect comments.

- QM Council and leaders of relevant departments had

Session 1

hospitals as well as collecting comments from surgeons,

4. Results

Conclusions
Using SSC in hospitals is really necessary. To maintainthis work, it requires intensive direction from the Directing- Surgery - Anesthesia Department was assigned as

Board and checking and monitoring to be conducted boththe leader, in which the anesthesiologist takes main

regularly and unannounced. To keep this practice effective

responsibility, which facilitates implementation.

in the long term, Surgery - Anesthesia Department plays83

a really important role, together with consensus among
surgeons, anesthesiologists, anesthesia technicians onserious implementation of this checklist.

I.	
  Overview
 According	   to	   a	   WHO	
   report,	
   there	
   are	   about	   230	
  million	  surgeries	
  performed	
  in	
  the	
  world	
  annually.	
  	
  	
  

 Life-­‐threatening	
   complications	
   account	
   for	   16%	
   (7	  million	
  cases),	
  10%	  of	
  which	
  caused	
  patients’	
  deaths	  (1	  million	
  cases).

HA	
  TINH	  DEPARTMENT	  OF	
  HEALTH	  HA	  TINH	  PROVINCIAL	  GENERAL	  HOSPITAL

I.	
  Overview
 In	
   Viet	
   Nam	   and	   the	   world	
   in	
   recent	
   years,	
   many	  Some	
  experience	
  in	
  	
  

implementing	  Surgical	
  Safety	  Checklist	
  in	
  	
  
Ha	
  Tinh	  Provincial	
  General	
  Hospital

surgical	
   errors	
   adversely	
   aﬀect	
   patients’	
   health	
   and	  prestige	
  of	
  hospitals	
  and	  the	
  health	
  sector.	
  	   Organ	
  transplantations	
  were	  conducted	
  from	  an	
  HIV	
  infected	
   patient	
   to	   5	   people	
   in	
   Taiwan	
   in	
   2011,	
   a	
   21-­‐
month	
   boy	   was	   wrongly	
   cystectomized,	
   or	
   wrong	  nephrectomy...	
  Dr.	
  Hoang	  Song	
  Hao	  	
  Chief	  of	
  Quality	
  Management	  Department	
  
	
  Ha	
  Tinh	  Provincial	
  General	
  HospitalI.	
  Overview
 Surgery	
   is	   a	   medical	
   technique	
   applied	
   for	   diagnosis,	
  treatment,	
  orthopedics…,	
  which	
  is	
  common	
  in	
  health	
  care.	  	
   However,	
   errors	
   or	
   incidents	
   may	   occur	
   any	   time	  during	  the	
  operation	
  process.	
  	
  	
  
 Its	  consequences	
  aﬀect	  the	
  surgery’s	
  quality,	
  increase	
  patients’	
   costs,	
   length	
   of	
   stay,	
   morbidity,	
   mortality,	  denunciations	  and	
  legal	
  problems.	
  	
  

84

Implementation	
  of	
  SSC	
  in	
  	
  
Ha	
  Tinh	  Provincial	
  General	
  Hospital Ha	
   Tinh	
   Provincial	
   General	   Hospital	
   is	   a	   1st	   level	
  provincial	
   hospital	
   with	   38	
   departments/units,	
  including:	
   08	
   functional	
   departments,	
   23	
   clinical	
  departments,	
   06	
   para-­‐clinical	
   departments,	
   and	   01	  Committee.	
  	
  	
  
 723	
   employees.	
   500	
   planned	
   beds	
   and	   1,263	
   actual	
  beds.	  	  	   800-­‐1,200	
   inpatients	
   and	   12,000–14,000	
   surgeries	
   per	  year.	  	
  Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

 With	
   the	   motto	
   “Safe,	
   friendly,	
   hospital	
   for	   people”,	
   QM	
  Council	
  and	
  leaders	
  of	
  relevant	
  departments	
  had	  meetings	
  to	
  discuss,	
  reach	  consensus,	
  and	  divide	
  tasks...	
  	   QMD	  summarized	
  comments	
  and	
  ﬁnalized	
  the	
  checklist	
  before	
  the	
  Director	
  approved	
  and	
  issued	
  it.	   Surgery	
  -­‐	
  Anesthesia	  Department	
  and	
  surgeons	
  were	  trained	  on	
  surgical	
  safety,	
  the	
  necessity	
  of	
  using	  the	  surgical	
  checklist	
  recommended	  by	
  WHO,	
  and	  the	
  revised	
  implementation	
  procedure.
 The	  checklist	
  has	  been	
  applied	
  in	
  the	
  whole	  hospital.

How	
  to	
  maintain?

 Most	  surgeons,	
  anesthesiologist,	
  technicians...	
  felt	   Strengthen	
  checking	
   Regular	
  and	
  unannounced	
  check	
  -­‐	
  Regular	
  check:	
  daily	
  check	
  of	
  medical	
  records	
  of	
  surgical	
  patients	
  in	
  the	
  meeting	  hall,	
  check	
  medical	
  records	
  in	
  GPD	
  
	
  	
  	
  	
  -­‐	
  Unannounced	
  check:	
  direct	
  check	
  in	
  Surgery	
  -­‐	
  Anesthesia	  Department	
  by	
  comparing	
  the	
  checklist	
  and	
  the	
  on-­‐going	
  surgical	
  process	
  (instantaneous).	
  Session 4that	
  this	  created	
  more	  work	  and	
  burden,	
  some	  people	
  didn’t	  take	  it	
  seriously.	
  	   The	  application	
  at	
  the	  begining	
  was	
  limited	
  due	
  to	
  
lack	
  of	
  experience	
  and	  the	
  checklist	
  contents	
  were	  still	
  poor;	
   The	  procedure	
  was	  not	
  clear,	
  causing	
  more	  diﬃculties;	
  	   There	
  was	  no	
  speciﬁc	
  division	
  of	
  tasks,	
  so	
  there	
  were	  some	
  perfunctory	
  implementors,	
  some	  checklists	  were	
  even	  completed	
  after	  surgeries...	
  Session 3

Diﬃculties	
  at	
  the	  beginning

Session 2

safety	  in	
  treatment	
  has	
  always	
  been	
  our	
  top	
  priority.	
  	
  	
  
 In	
   the	   past	
   years,	
   there	
   have	
   been	
   many	   ways	
   to	
   help	
  make	
  surgeries	
  safe	  for	
  patients.	
  However,	
  there	  are	  no	  t o o l s	
   t h a t	
   a d d r e s s	
   t h e	
   s u r g i c a l	
   p r o c e s s	
  comprehensively.	
  	
  	
  
 Therefore,	
   in	
   2015,	
   the	   Directing	   Board	
   decided	
   to	  apply	  the	  WHO	
  SSC	  in	
  the	
  hospital.	
  	
  Improvement	
  and	
  application

Session 1

Implementation	
  of	
  SSC	
  in	
  	
  
Ha	
  Tinh	  Provincial	
  General	
  Hospital

Session 5

Improvement	
  and	
  applicationGood	
  points	
  in	
  implementation	
  after	
  improvement	  	
   Surgeons,	
  anesthesiologists,	
  nurses,	
  scrub	
  technicans	
  

Annex

Steps	  before	
  applying	
  the	  	
  revised	  version	
  Session 7

limitations,	
  therefore	
  improvement	  was	
  necessary.	
  The	
  hospital	  decided	
  to	
  improve	
  it.	  	
   The	
  QM	
  Council	
  assigned	
  the	
  QMD	  to	
  develop	
  a	
  new	  draft	
  checklist	
  and	
  implementation	
  procedure.	
   After	  that,	  the	
  draft	  was	
  sent	  to	
  surgical	
  departments,	
  3	
  specialized	
  departments,	
  and	  Surgery	
  -­‐	
  Anesthesia	
  Department	  to	
  collect	  comments	
  =>	
  showing	
  democracy	
  and	  respect	
  to	
  implementers.	
   QMD	  collected	
  and	  summarized	
  comments.	
  	
  Checking,	
  monitoring	
  and	
  direct	  discussion	
  to	
  learn	
  from	  experiences

Session 6

 After	
  some	  time	  of	
  checklist	
  use,	
  it	
  showed	
  some	  understand	
  the	
  necessity	
  and	
  importance	
  of	
  checklist	
  
use.	
  
 	
  High	  consensus	
  among	
  surgeons,	
  anesthesiologists,	
  nurses,	  and	
  scrub	
  technicians	
  because	
  they	  had	
  opportunities	
  to	
  give	  comments	
  for	
  improvement	
  and	  were	
  trained	
  carefully.
 Surgery	
  -­‐	
  Anesthesia	  Department	  was	
  assigned	
  as	
  the	
  leader,	  in	
  which	  the	
  anesthesiologist	
  takes	  main	  responsibility,	
  which	  facilitates	
  implementation.	
  	   QM	
  Council	
  assigned	
  me	
  to	
  monitor	
  implementation	
  
=>	
  an	
  advantage

85

Results
 At	  present,	
  Patient	
  &	
  Staﬀ	
  Safety	  Committee’s	  Current	
  diﬃculties

checking	
  and	  monitoring	
  shows	
  that	  the	
  checklist	
  is	
  implemented	
  strictly	
  and	
  properly.	
  	   However,	
  inspections	  also	  reveal	
  some	  issues	
  to	
  be	
  
improved,	
  such	  as:	
  some	  columes	
  were	  left	  blank,	
  lack	  of	
  signature,	
  lack	  of	
  diagnosis	
  information...	
  	   Sometimes,	
  some	  departments	
  had	  to	
  be	
  asked	  to	
  pay	  more	
  attention.	
  	   After	
   some	
   time	
   of	
   checklist	
   use,	
   some	
   surgeons,	
  Lessons	  learnt

Conclusions	
  

	
  To	
  implement	
  the	
  checklist	
  and	
  maintain	
  the	
  practice,	
  it	
  needs:	
   The	  Directing	  Board’s	
  support	
  and	
  intensive	  direction	   Trainings	
  to	
  be	
  organized	
  several	
  times,	
  emphasizing	  the	
  necessity	
  of	
  checklist	
  use	  in	
  surgeries
 Encouragement	
  and	
  supportive	
  environment	
  for	
  people	  to	
  give	  comments	
  during	
  implementation	  and	
  revision.	
  	
  	
  
 Respect	  to	
  everyone’s	
  opinions.	
  Listen	  and	  revise	
  if	
  comments	
  are	
  suitable,	
  with	  the	  motto	  “Always	
  listening,	
  always	
  understanding”.	
   The	  SSC	  is	
  only	  one	
  step	
  in	
  ensuring	
  safety	
  for	  patients	
  during	
  their	
  stay	  in	
  the	
  hospital.	
  	   Surgeons,	
  the	
  leader	
  of	
  the	
  whole	  surgery,	
  from	  anesthesia	
  through	
  the	
  end	  of	
  the	
  surgery,	
  beneﬁt	
  the	
  
most	
  in	
  checklist	
  use.	
  	  	   Therefore,	
  while	  Surgery	
  -­‐	
  Anesthesia	  Department	
  is	
  responsible	
  for	
  implementation,	
  surgeons	  must	  be	
  the	
  
last	
  to	
  check	
  and	
  sign	
  the	
  checklist,	
  after	  the	
  completion	
  of	
  gauze	
  count,	
  device	
  check,	
  drain	
  insertion,	
  and	
  prognosis	
  after	  the	
  surgery.

especially	
   excellent	
   ones	
   and	   those	
   with	   strong	
  personality,	
   seem	
   to	
   be	
   less	
   serious	
   and	   skip	
   some	  items	  in	
  the	
  checklist.	
  	
   Using	
  SSC	  in	
  hospitals	
  is	
  really	
  necessary.	
   To	
  maintain	  this	
  work,	
  it	
  requires	
  intensive	  direction	
  

from	
   the	   Directing	   Board	
   and	   good	
   collaboration	  among	
  relevant	
  departments.	
  	
   Checking	
   and	   monitoring	
   must	   be	
   conducted	
   both	  regularly	
  and	
  unannounced.	
  Conclusions	   Timely	
   direction	
   from	
   QM	
   Council.	
   Comments	
  

from	
  Surgery	
  -­‐	
  Anesthesia	  Department,	
  surgeons,	
  technicians,	
  etc.	
  should	
  be	
  listened.
 To	
   keep	
   this	   practice	
   eﬀective	   in	
   the	   long	
   term,	  Surgery	
   -­‐	
   Anesthesia	
   Department	
   plays	
   a	
   really	
  important	
   role,	   together	
   with	   consensus	
   among	  s u r g e o n s ,	   a n e s t h e s i o l o g i s t s ,	   a n e s t h e s i a	
  technicians	
   on	   serious	
   implementation	
   of	
   this	  checklist.	
  	
   Strengthen	
  checking,	
  monitoring,	
  and	
  daily	  reminding.	
  Dicipline	  must	  be	
  applied	
  to	
  individuals	
  or	
  surgical	
  teams	
  that	  do	
  not	
  implement	
  well,	  such	  as:	
  blame	  or	
  reduced	
  bonus	
  	
   Checking	
  and	  monitoring	  are	
  really	
  important	  to	
  maintain	
  checklist	
  use	  in	
  surgery.	
  86

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

SURGICAL	  SAFETY	
  CHECKLIST

Session 1
Session 2
Session 3

Sign	
  in	
  

(before	
  induction	
  of	
  anesthesia)

Session 4
Session 5Time	
  out	
  Session 6(before	
  skin	
  incision)

Session 7
Annex

SIGN OUT

87

Session 4-3
Actual State of Applying Surgical Safety Checklist in
Hue Central Hospital
Phan Hai Thanh, Nguyen Thanh Xuan, Tran Le Bao Tram, Dang Duy Quang, Pham Nguyen Da Thao, Tran
Thi Thuy Phuong, Tran Huu Nhat Duy, Le Ho Xuan Thinh
Quality Management Department, Hue Central Hospital

1.

Introduction

communication difficulties.  

Surgical adverse events are incidents that

2.2. Methodology

unexpectedly harm patients. Incidents of any levels andwith any causes can seriously affect the patient‘s physical- A prospective, descriptive, cross-sectional study

and mental health. Annually, there are about 234 million

2.3. Tool

surgeries in the world, 0.4-0.8% of which cause mortality,- An SSC (revised from WHO SSC 2009 to suit Hue

3-16% have complications, and 7 million with permanent
injuries. A study on medical incidents in Canada (2004)
and others in the world show that more than 50% of theCentral Hospital)- Medical records

incidents relate to surgery and related complaints are very

2.4. Evaluation steps

costly. In Viet Nam, big hospitals are always overcrowded- “Before induction of anesthesia” (7 questions)and suffer high work pressure, especially in surgery andanesthesia departments. Many adverse events happen
due to mistakes during preparation and control before,
during and after surgery. These events can be controlled
or minimized if there is a strict controlling process. Hue- “Before skin incision” (10 questions)- “Before patient leaves operating room” (5 questions)2.5. Evaluation indicators

Central Hospital has applied an SSC since September- Emergency and planned surgeries

2011. There were many difficulties at the beginning.

- Rates of filling the checklist at each point of time  

However, after 5 years of implementation, healthcare
workers are more and more self-disciplined andresponsible in complying to implementing the checklist.
In Viet Nam, there is no study which evaluates theapplication of SSC. The study evaluates the actual state- Rates of filling each question at different points oftime- Rates of completing the checklist- Compliance rates of surgeons, anesthesiologists,

of applying SSC in Hue Central Hospital.

nurses

2. Subjects and methodology- Analyze reasons why checklists were not completed

2.1. Subjects

3. Results- 841 patients who underwent surgeries in Anesthesia- Emergency surgeries/planned surgeries: 244/597

Department A, Hue Central Hospital, from June 1 to

- Rates of filling the checklist at each point of time  

July 1, 2016•

- Patients with emergency or planned surgeries(gastroenterology, orthopedics, neurosurgery, urology)- Excluding people with comma, deaf, mute, or

88

Before induction of anesthesia: emergency
surgery 72.52%, planned surgery 84.14%•

Before skin incision: emergency surgery 70.03%,
planned surgery 76.1%

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

•

Before patient leaves operating room: emergency
surgery 83.35%, planned surgery 87.14%•

Emergency surgery: 69.85%•

Planned surgery: 75.46%- Compliance rates of surgeons, anesthesiologists, nurses
Surgeons: 72.12%•

Nurses: 91.8%

Conclusion
The research results show that the compliance ratesof healthcare workers are not high. It is concerned thatsurgical errors may occur in the future and it requires
higher awareness of healthcare workers in implementing
SSC as well as effective ways to monitor this activity.  

Session 3

ACTUAL STATE OFAPPLYING SURGICAL SAFETY CHECKLISTIN HUE CENTRAL HOSPITAL

Session 2•

4.

Anesthesiologists: 78.56%

Session 1- Rates of completing the checklist•

Beforesurgery

DuringsurgeryAftersurgery

Session 4

MedicalIncidents

Long term…
cause
consequences

Phan Hai Thanh
Chief of Quality Management Department
Vice Chief of Abdominal Surgery Department

Session 5

Introduction
The 2nd Global Patient Safety Challenge

Hue Central Hospital-Checklist:
September 2011

Session 7

1. Weiser, TG. Lancet 2008
2. Gawande, AA. Surgery 1999
3. Kable AK. Int J Qual Health Care 2002

• 234 million surgeries
every year (in the world)• Mortality 0.4-0.8%2,3• Complications 3-16%2,3• 7 million complications
with permanent injuries

Purpose:Annex

Medical–Surgical Incidents (Canada)• Study on medical incidents in Canada (Baker et al.
2004)Ø More than 50% medical incidents related tosurgery.
• In 7-8 years:
Ø Complaints about surgical incidents cost $27
million, 40% of them could have been avoided
with checklist use ($10 million).
Ø Complaints:

Session 6

Prevent,
limit…

 “To evaluate actual state of applying
surgical safety checklist in Hue
Central Hospital”• 210 retained foreign bodies after surgery;• 94 wrong-site surgeries;• 9 wrong-patient surgeries.
6

89

RESEARCH SUBJECTS AND METHODOLOGY

Checklist - Content 2
Before skin incision7

Subjects:

Exclusion:üSurgical patients inAnesthesia Department AüJune 1–30, 2016
üEmergency or planned
surgeries(Gastroenterology,
Orthopedics, Neurology,
Urology)• Patients with coma, deaf or
mute• Patients with
communication difficulties…

Time out

Before operation
starts•Nurse,
anesthesiologist,
surgeon• Members of surgicalteam introduce nameand tasks• Prophylactic antibiotics• Surgeons/prognosis• Anesthesia/prognosis?
• Nurse/tools, devices,
drugs, asepsis…

www.ngoaibung.com

Tool

Checklist - Content 3
Before patient leaves operating room

Sign out
What to complete
before patient leaves
operating room:• Counting: needles, gauzes,
tools• Tool problems?
• Labeling specimen (if any)
• Drains• Checking resuscitation safety• Nursing care

Nurse, anesthesiologist, surgeon

3 checks• Before induction ofanesthesia (Sign in):
7 Questions• Before skin incision(Time out): 10
questions• Before patient leaves
operating room (Signout): 5 questions

Sign in• Theremust beat least anurse andananesthesiologist

90

www.ngoaibung.com• Emergency and planned
surgeries• Rates of filling thechecklist at each point oftime• Rates of filling eachquestion at different
points of time
• Rates of completing thechecklist• Compliance rates ofsurgeons,
anesthesiologists, nurses• Analyze reasons why
checklists were notcompleted.

Checklist - Content 1
Before induction of anesthesia
After patient enters
operating room andbefore induction ofanesthesia

13

Research

Results
SSC application (01/6/2016 to 30/6/2016)• Confirmation ofpatient identity,
surgical site, andsurgical method• Mark the surgical site
• Drug and anesthesia
devices• Pulse oximeter• Allergy, airway

Classiﬁca(ona.  Emergency  surgeries	  b.  Planned  surgeries	
  Total:	  Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

N

Percentage  
%

244	
  

29.02	    597

70.98  

841

100

Session 4 | How to Ensure Quality and Safety in Clinical Work?

Completion rates“Before skin incision”

Completion rates“Before induction of anesthesia”

Contents

Not  checkedCheckedNot  checked

N

N

%

N

%

N

%

87.43	
  75

12.57	
  505 84.58	
  92

15.42	
  
8.55	
  

%

190 77.86	
  54

22.14	
   522

2. Is surgical site marked?

183

75	
  

61

25	
  

201 82.37	
  43

91.45	
  17.63	
   546

51

Contents

CheckedNot  checked

N

N

%

N

%

N

%

193 79.09	
  51

20.91	
   47379.22	
  124 20.78	
  5. Length of operation

187 76.63	
  57

23.37	
   46177.21	
  

136 22.79	
  

6. Anticipation of bloodloss

178 72.95	
  66

27.05	
   49082.07	
  107 17.93	
  

7. Patient’s issues thatneed special attention

171 70.08	
  73

29.92	
   46077.05	  137 22.95	
  Emergency  (n  =  244)

Planned  (n  =  597)
CheckedNot  checked

N

N

N

%

N

%

Contents

CheckedN

4. Is pulse oximeterattached to patient anddoes it work?

191 78.27	
   53

21.73	
   53289.11	
  65

10.89	
  5. Patient has allergy
history

195 79.91	
   49

20.09	
   55392.62	
  

44

7.38	
  

8. Are devices and tools
aseptic?
9. Are there any problems
with equipment (quality)?
10. Are diagnostic imaging
results displayed?

Planned  (n  =  597)

Not  checked%CheckedNot  checkedN%N

223 91.30	
  

21

8.70	
  

549 91.95	
  

%

N

%

48

8.05	
  

210 86.06	
  34

13.93	
   52087.10	
  77

12.90	  

188 76.04	
  56

22.96	
   47980.23	
  

118 19.77	
  Session 4

Not  checked%%Completion rates“Before skin incision”

Checked%Not  checkedSession 3

Contents

Checked

4. Assessing potential
abnormalities?

Completion rates“Before induction of anesthesia”
Emergency  (n  =  244)

Planned  (n  =  597)

Session 2

Checked1. Has patient confirmed his/
her identity, surgical site,surgical method and agreed
to surgery?

3. Drugs and anesthesia
devices have been checked
fully

Emergency
  (n  =  244)

Planned  (n  =  597)

Session 1

Emergency  (n  =  244)

Session 5

Completion rates

Completion rates“Before induction of anesthesia”

Contents

6. Patient has breathingdifficulty and risk ofchoking

Planned  (n  =  597)

Emergency  (n  =  244)

CheckedNot  checkedCheckedNot  checked

N

N

N

%

N

%

%

%

22.54	
   54591.28	
  

52

8.72	
  

7. Risk of losing 500ml
or more of blood (7ml/kg 184 75.41	
   60
in children)

25.59	
   52287.43	
  75

12.57	
  Completion rates“Before skin incision”

Not  checkedCheckedNot  checked

N

N

N

%

N

133 22.28	
  171 70.08	
   73

29.92	
   46477.72	
  

176 72.13	
   68

27.87	
   45876.71	
  177 72.54	
   67

Not  
checked

N

%

N

%

N

234

95.90	
  

10

4.10	
  

576 96.48	
  

%

N

%

21

3.52	
  

207

84.83	
  37

15.17	
   531

88.94	
  66

11.06	
  

231

94.67	
  

13

5.33	
  

572 95.81	
  25

14.19	  Annex

1. Members of surgicalteam introduced theirname and tasks
2. Reconfirm patient’s
name, surgical site andmethod
3. Has prophylactic
antibiotics been given in
the last 60 minutes?

Planned  (n  =  597)%

CheckedCompletion rates

Checked%

1. Completion of counting
gauzes and surgical tools
2. Are there any instrument
problems that need to besolved
3. Labeling specimen (readaloud labels, including
patient’s name)Not  checked“Before patient leaves operation theater”

Emergency
  (n  =  244)

Contents

Checked27.46	
   45476.04	
  Emergency  (n  =  244)

Contents

4. Ensure that drains aresafe and aseptic (if any).

Planned  (n  =  597)

CheckedNot  checkedCheckedNot  checked

N

N

N

N

%

%
%

%

%

Session 7

189 77.46	
   55

Contents

Planned  (n  =  597)

Session 6

Emergency  (n  =  244)

“Before patient leaves operation theater”

205 84.01	
   39

15.99	
   537 89.94	
  60

10.06	
  212 87.60	
   32

12.40	
   535 89.61	
  62

10.39	
  139 23.29	
  143 23.96	
  

5. Major issues about
resuscitation andpostoperative care91

Results
Rates of full completion of the surgical safety checklist

Classiﬁca(ona.  Emergency  surgeries	  b.  Planned  surgeries	
  NPercentage  %170/24469.85

  450/597

75.46  

Surgical safety will avoid:• Mortality, surgical errors• Surgical site infection• Poor communication among teams• Threatening legal problems

WHO SSC

Results
Compliance rates of surgeons, anesthesiologists, nurses

Classiﬁca(ona.  Surgeons	  b.  Anesthesiologists	
  c.	
  Nurses	  NPercentage  
%

607

72.12

  661

78.56  

772

91.8An international pilot study
Nearly 8,000 patients (8 cities)

Checklist in the health sector?
• In 2001, a doctor in John Hopkins Hospital tried a checklist
to prevent infection during minor surgeries• A 5-step checklist was introduced and nurses wererequested to observe the doctor’s performance according to
the checklist• In 2004, about 230 million of major surgeries wereconducted in the world; as a result, 7 million people
suffered from injuries and more than 1 million people died.
• In 2006, WHO started a global program to reduce injuries
and mortality• A “Surgical Safety Checklist” was developed, including 3
stages:- Before induction of anesthesia- Before skin incision- Before patient leaves operation theater

PAHO I

Toronto, Canada

EURO

EMRO

London, UK

Amman, Jordan

WPRO I

Manila, Philippines

PAHO II

Seattle, USA

WPRO II

Auckland, NZ
AFROIfakara, Tanzania

SEARO

New Delhi, India

Operation Theater Checklist?
• Ensuring safe andeffective working
teams• Successful
operations...utilization of surgical safety
checklist reduces more than
1/3 of postoperativecomplications and deaths!
Haynes et al. A Surgical Safety Checklist to Reduce Morbidity
and Mortality in a Global Population. New England Journalof Medicine 360:491-9. (2009)92

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

Results:

Checklist

3,733

3,955

P value

-

Death

1.5%

0.8%

0.003

Any Complication

11.0%

7.0%

<0.001

SSI

6.2%

3.4%

<0.001

Unplanned
Reoperation

2.4%

1.8%

0.047

Change inmortality rateHighincome10.3% -> 7.1%*

0.9% -> 0.6%

Low andaverageincome11.7% -> 6.8%*

2.1% -> 1.0%*

Haynes et al. A Surgical Safety Checklist to Reduce Morbidity
and Mortality in a Global Population. New England Journalof Medicine 360:491-9. (2009)¹ Webb, Anaesthesia and Intensive Care, 1993.

Checklist benefits? (cont’d)• Reduction of infection risks:– Use antibiotics 1 hour before skin incision
reduced 50% of infection risks ¹, ²

Session 4* p<0.05

Change incomplication rate

– An analysis of 1,256 incidents related to generalanesthesia in Australia shows that about 82% of theincidents related to SPO2 measure (pulse oximeter).¹

Session 3

Changes in complication and mortality rates
by income• Safety for anesthesia andresuscitation

Session 2

Haynes et al. A Surgical Safety Checklist to Reduce Morbidity
and Mortality in a Global Population. New England Journalof Medicine 360:491-9. (2009)

Checklist benefits? (cont’d)Session 1

Baseline

Cases¹ Bratzler, The American Journal of Surgery, 2005.
² Classen, New England Journal of Medicine, 1992.

Session 5

Survey on physicians’ attitude towards checklist
implementation (n = 229)

Safety in operation theater improved

79.0%Time consuming to complete

18.3%

Communication improved

84.3%

Contribution to prevent incidents in operation
theater

78.2%

Expect to use checklist

92.6%• Effective teamwork¹,2,3¹ Joint Commission, Sentinel Event Statistics, 2006.
² Makary, Joint Commission Journal on Quality and Patient Safety, 2006.
³ Altpeter, Journal of the American College of Surgeons, 2007.

• Correct patient, correct surgery
and correct surgical site

Checklist benefits? (cont’d)• Effective teamwork¹,2,3

Annex

Checklist benefits?

Session 7

78.6%

Session 6

Easy to use

Checklist benefits? (cont’d)– 1,500-2,500 wrong-site surgeries a year in the
US.¹– A survey of 1,050 surgeons: 21% performed
wrong-site surgery at least once in theircareer²¹ Seiden, Archives of Surgery, 2006.
² Joint Commission, Sentinel Event Statistics, 2006.

¹ Joint Commission, Sentinel Event Statistics, 2006.
² Makary, Joint Commission Journal on Quality and Patient Safety, 2006.
³ Altpeter, Journal of the American College of Surgeons, 2007.

93

Checklist benefits? (cont’d)• Effective teamwork¹,2,3¹ Joint Commission, Sentinel Event Statistics, 2006.
² Makary, Joint Commission Journal on Quality and Patient Safety, 2006.
³ Altpeter, Journal of the American College of Surgeons, 2007.

Evidence

EVALUATION OF CHECKLISTIMPLEMENTATION• The Directing Board of Hue Central Hospitalrequested the application of an SSC in allanesthesia-resuscitation departments, targeting all
surgical patients and attaching the checklist to
medical records to minimize surgical errors.
• Checklist implementation has not been paid enoughattention: the rates of checked items were not high.
From 1st-30th June 2016, there were 841 surgeries
in Anesthesia-Resuscitation Department A but only
69.85% of emergency surgeries and 75.46% ofplanned surgeries completed checklists.

The Publication – January 15th2009

EVALUATION OF CHECKLISTIMPLEMENTATION• Checklist completion rates were higher inplanned surgeries.
• Nurses checked more items than doctors.

Results

Thank you very much!
Da Nang September 29, 201694

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

Ton Thanh Tra

Session 2

Applying PDCA Cycle to Continuous Quality
Improvement: an Example in the Antimicrobial
Stewardship Program in Cho Ray Hospital

Session 1

Session 4-4

Quality Management Department, Cho Ray Hospital

Introduction
PDCA stands for Plan, Do, Check, Action. PDCA

Edwards Deming in 1950’s. At the beginning, he called it
Shewart Cycle in memory of doctor Walter A. Shewart – aobjectives must be SMART, which is:  
- Specific  
- Measurable

pioneer in checking quality by statistics in the United State- Achievablein late 1930s. However, Japanese people usually call it- Realistic

Deming Cycle.
follows:
Plan: Make plan, setting objectives, scope, resources for
implementation, time and methods to achieve objectives.  

Check: Check implementation results based on the plan.
Action: From obtained results, adjust to start anothercycle and new input information.

2. Application in the antimicrobial stewardship(AMS) program
AMS in the hospital is necessary, which helps minimize
antibiotic overuse, which increases antibiotics resistance,
length of hospital stay, and treatment costs. However, thisis a quite big program that requires much time and effort.
If we don’t have a detailed plan and clear (short term andSession 6

Do: Put the plan into operation.

- Timely

Session 5

Contents of the cycle’s stages are summarized as

Session 4

cycle was introduced to the Japanese by doctor W.

knowledge of the areas that need improvement and theSession 3

1.

long term) objectives, it will be easy to fail. With many
objectives set in this program, we apply the PDCA cycle
initial results of the pilot program, we selected prioritizedissues to tackle. I would like to share our objectives for
AMS in surgery.

Session 7

to make it work effectively. After observing and studying

Reasons for selection:

thanks to using prophylactic antibiotics only.
http://hirayamavietnam.com.vn/wp-content/uploads/cai-tienchat-luong-lien-tuc-voi-PDCA.png

PDCA cycle starts with planning. The improvement
plan must be clear and detailed. Setting objective is a very
important part, which requires that quality people have

Annex

- Every year, there are about 40,000 surgeries in Cho Ray
Hospital, 50% of which were clean and uncontaminated- Surgeons have a habit of indicating antibiotics manydays before and after the surgery.
- Scientific evidence and guidelines show that using
antibiotics for many days after surgery is not beneficial.  
We started applying PDCA cycles for continuous
improvement to minimize improper antibiotics uses:

95

Plan: The program is one year, aiming at minimizing
improper antibiotics uses in surgery.

COMPLIANCE RATES

Objectives for:The first 6 months- All planned surgeries’ risks of surgical site infection (SSI)
are classified- Prophylactic antibiotics are indicated before surgeries
Rate of post-operative rational AB usage

The next 6 months

Rate of compliance for AB usage guideline of
hospital- Compliance rates to guidance of prophylactic antibiotics
use in surgery increase by 10% each month.
- Compliance rates to appropriate antibiotic use after
surgery increase by 10% each month.
Do: The AMS committee meets every month. A clinicalpharmacists group participate in randomly checking

medical records in surgery departments. Regularly review
antibiotics use in medical records. Provide guidelines
on antibiotic use and practice tools (e.g., application on
smartphone)

Results show that compliance rates increased
remarkably over time. The number of days of antibiotics
use and the quantity of antibiotics used decreased while
the rates of SSI did not change.
Act: Each monitoring round is a PDCA cycle withincreased compliance rate objectives. Once we achieve

one cycle’s objectives, we set higher objectives andcontinue to improve.
Conclusions: PDCA cycle is an effective tool for

C h e c k : To i n c re a s e c o m p l i a n c e r a t e s , b e s i d e scontinuous quality improvement (CQI) with the objective

studies to provide scientific data to show safety and

Applying PDCA cycles bring short term and long term

strengthened monitoring, the monitoring group conduct
effectiveness of prophylactic antibiotic use.

to enhance compliance rates of healthcare workers.
results and help CQI keep going.

AC T

PL AN
Customer
Satisfaction

CHECK

DO

C
A


S T A N D A R D I S E 	
   D O ,C H E C K ,	   A C T

I N VE S T I G AT EN

R E V I E W 	
   F E E D B A C K 	
   &
M A K E 	   C O R R E C T I O N SAC O R R E C T    &S T AN D AR D I S E



L

T

P

APPLYING PDCA CYCLE TO
CONTINUOUS QUALITY IMPROVEMENT An example in the antimicrobial
stewardship program in Cho Ray Hospital

C L A R I F Y 	
   O B JE C T I V E SI D E N T I F Y 	
   P O S S I B L E 	
   C A U S E S
B E N C H M A R K 	
   B E S T 	
   P R A C T I C E
I D E N T I F Y 	
   T E A M 	
   R O L E S
I M P L E M E N T 	
   Q U I C K 	
   F I X

Dr. Ton Thanh Tra
Head of Quality Management Department
Cho Ray Hospital

PILOT STUDY SOLUTION
TO VERIFY DATACOUNTERMEASURE
TRAININGCH

COMMUNICATION

E
K

PL

T

D E T E R M I N E    N E E D S

PILOT TRAINING
PROGRAMFEEDBACKDI A GN O S T I C:ØR E V I E W    C U R R E N T
PR A C T I C E S .



BE N C H MA R K I N G :ØS U M M A R I S E    A N D
C O M PA R E    B E S T
PR A C T I C E S .

Purpose: To assess actual state, set
objectives (SMART)DEFI N E
R E S PO N S I B I L I T I E S :               W H Y ,    W H A T    &   H O WØØRE CO GN I T I O N .
               R E C O G N I S E       T H E
               C O N T R I B U T I O N    O F                  O T H E R S .

C
H
E
K

D

C

Plan – Do - Check - Act in

I D E N T I F Y    P O S S I B L E
SOL UT I ON S

E N L I G H T E N    &I M PL E M E N T

E V A L U A T E    &   V A L I D A T E

A N A L Y S E    D A T A    T OU N D E R S T A N D    H O W
P R O B L E M   O C C U R SOCAS T A N D A R D I S E 	
   D O ,C H E C K , 	
   A C T

N

Walter Shewhart

R E V I E W 	
   F E E D B A C K 	
   &
M A K E 	   C O R R E C T I O N SAI N V E S T I GA T E

C O R R E C T    &S T A N DA RDI S E

C A R R Y    O U T    T R I A L S    T OP R O V E    C A U S E S

DCWhat is PDCA?

E N L I G H T E N    &I MPL E ME N TOE V A L U A T E    &    V A L I D A T E"Statistical Method From theViewpoint of Quality Control“ inPILOT TRAINING
PROGRAMFEEDBACKCHEDI A GN O S T I C:ØR E V I E W    C U R R E N T
PR A C T I C E S .



BE N C H MA R K I N G :ØS U M M A R I S E    A N D
C O M PA R E    B E S T
PR A C T I C E S .

DEFI N E
R E S PO N S I B I L I T I E S :               W H Y ,    W H A T    &   H O WØRE CO GN I T I O N .
               R E C O G N I S E       T H E
               C O N T R I B U T I O N    O F                  O T H E R S .

CKrevised and disseminated in Japan:

ØDeming Cycle (Plan, Do, Study,
Act).

96

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

O

W. Edwards Deming : In 1950s,

I N V E S T I GA T E

D E T E R M I N E    N E E D S

E N L I G H T E N    &I M PL E M E N T

DCA

S T A N D A R D I S E 	
   D O ,C H E C K , 	
   A C TN

R E V I E W 	
   F E E D B A C K 	
   &
M A K E 	   C O R R E C T I O N SAC O R R E C T    &S T A N DA RDI S EE V A L U A T E    &   V A L I D A T E

PL

T

1939

Purpose: To find solutions,human resource, and otherresources to implement the plan
(SWOT)

R E V I E W 	
   F E E D B A C K 	
   &
M A K E 	   C O R R E C T I O N S
S T A N D A R D I S E 	
   D O ,C H E C K , 	
   A C T

D E T E R M I N E    N E E D S
DI A GN O S T I C:ØR E V I E W    C U R R E N T
PR A C T I C E S .



BE N C H MA R K I N G :ØS U M M A R I S E    A N D
C O M PA R E    B E S T
PR A C T I C E S .

E N L I G H T E N    &I M PL E M E N T



PILOT TRAINING
PROGRAMØ

FEEDBACKHOW DO I APPLY PDCA CYCLE

Session 1

E V A L U A T E    &VA LI DA T E

DEFI N E
R E S PO N S I B I L I T I E S :               W H Y ,    W H A T    &   H O W

HØ
RE CO GN I T I O N .
               R E C O G N I S E       T H E
               C O N T R I B U T I O N    O F                  O T H E R S .

D

E

O

C

I N V E S T I GA T E

C O R R E C T    &S T A N DA RDI S E




N

A

A
PL

C

Purpose: To monitor
implementation, evaluate
effectiveness. Measurement
and monitoring methods.

T

Session 4 | How to Ensure Quality and Safety in Clinical Work?

C Assessing actual stateK Setting objectives



FEEDBACKDI A GN O S T I C:ØR E V I E W    C U R R E N T
PR A C T I C E S .



BE N C H MA R K I N G :ØS U M M A R I S E    A N D
C O M PA R E    B E S T
PR A C T I C E S .

E N L I G H T E N    &I M PL E M E N T

HECSession 2CØ
RE CO GN I T I O N .
               R E C O G N I S E       T H E
               C O N T R I B U T I O N    O F                  O T H E R S .

 Measuring results
 Expansion

DEFI N E
R E S PO N S I B I L I T I E S :               W H Y ,    W H A T    &   H O WØOPILOT TRAINING
PROGRAMD E T E R M I N E    N E E D S

D

A

C

S T A N D A R D I S E 	
   D O ,C H E C K , 	
   A C TNR E V I E W 	
   F E E D B A C K 	
   &
M A K E 	   C O R R E C T I O N SE V A L U A T E    &   V A L I D A T E
I N V E S T I GA T E

AC O R R E C T    &S T A N DA RDI S E

PLT Implementation
Purpose: To implement widely,
expand activities, develop new
objectives.

K Setting new objectives

NUMBER OF PATIENTS FROM 2010 TO 2015

Session 3

S.M.A.R.T. OBJECTIVES Specific Measurable

Outpatients
Inpatients

 Achievable

Surgical patients

 Timely

Session 4

Emergency patients

 Realistic

YOU ARE SMART BUT YOUR GOALS ARE NOT ALWAYS SMART

Session 5

Proper indication of antibiotics after surgery

By
when?

What
result?

 Compliance toantibiotics
indication insurgery increased

Session 6

Measured with what?

Who?

but no evidence
to indicate after
surgery

Session 7
Annex

APPLICATION OF PDCA CYCLEYOU CAN NOT IMPROVE SOMETHINGWITHOUT MEASURING IT !!!

CONTINUOUS IMPROVEMENT

12

97

Compliance rate increases by 5% ineach PDCA cycle/month. Compliance
rate reaches 80% after 6 months

COMPLIANCE RATES

records

Proper	  use	  of	
  an,bio,cs	
  a0er	  surgeries	
  Compliance to hospital guidelines
for antibiotic use

ECONOMIC EFFICIENCYDEVELOPMENT OF GUIDELINES, PROTOCOLS

2015

ProperImproper

Total

2016

Quantity

Percentage%

Quantity

Percentage
%

33

14.0

160

78

202

86.0

45

22

235

100.0

205

100.0

Reduction of 64% of patients improperly indicated antibiotics after
surgery (Not including 12% following other guidelines or those with unclear
evidence)

Reduction of 12,800 surgeries/year (40,000 surgeries every year)
Reduction of 12,800 x ( 3 to 5) = 38,400 to 64,000 days of antibiotic
use
14

ACTIONSPERCENTAGE OF EARLY SSI Organizing trainings
P > 0,05

 Developing software in smart phone Issuing guidelines
 Monitoring Reporting regularly Providing EBM evidence(Downloading guidelines)

LESSONS LEARNT- Strong direction from MOH+ Guidelines on antibiotics use+ Campaign for prevention of antibiotic resistance+ Supports from international organizations

20

98

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 4 | How to Ensure Quality and Safety in Clinical Work?

- Consensus anddetermination of the Directing

 Clear division of work

Board, especially the leader

 Measurable objectives- Role of QMD

Session 1

HOW TO ACHIEVE EFFECTIVENESSIN QI ACTIVITIESLESSONS LEARNT Collaboration, not opposing- Clinical pharmacists
 Supportive, not trying to find- Calculation of economic

others’ mistakes
 Overcome barriers- Create output products, findsponsors

 Know how to work in a team
21

Create friendly environment
What is your attitude to surrounding people? 	

Session 3

COMMITMENT AND SUPPORT OF
HOSPITAL LEADERS

25

Session 2

efficiency

Session 4

26

22

Session 5

LESSONS LEARNTINFORMATION SHARING- Encourage CQI.

 Sharing obtained results

Session 6- Provide scientific evidence.

(Contextual effects)

 Develop QI culture.

 Developing objectives step by step CÁC BẬC THANG CHẤT LƯỢNG BỆNH VIỆN VIỆT NAM
MỨC 5• KẾT QUẢ ĐẦU RA TỐT• CHẤT LƯỢNG “VÀNG”• TIỆM CẬN QUỐC TẾ

MỨC 4• THỰC HIỆN VƯỢT TRÊN QUY ĐỊNH• CÓ ĐÁNH GIÁ KẾT QUẢ ĐẦU RA• ĐẠT ĐƯỢC MỘT SỐ KẾT QUẢ TỐT

Mức
chấp
nhận
được!

MỨC 3

• THỰC HIỆN ĐẦY ĐỦ QUY CHẾ, QUY ĐỊNH• THIẾT LẬP VÀ HOÀN THIỆN CẤU TRÚC• TRIỂN KHAI HOẠT ĐỘNG CTCL
• CÓ MỘT SỐ KẾT QUẢ ĐẦU RA

MỨC 2

MỨC 1

BÁO ĐỘNG!
Cần tập trung mọinguồn lực cải tiếnchất lượng BV!
(xác định ưu tiên)

23

27

24

CPR

Annex

TAKE THE CHANCE

Session 7• THỰC HIỆN QUY CHẾ, QUY ĐỊNH• TRIỂN KHAI MỘT SỐ HOẠT ĐỘNG CTCL
• THIẾT LẬP MỘT SỐ YẾU TỐ ĐẦU VÀO• CHƯA THỰC HIỆN CẢI TIẾN CHẤT LƯỢNG (CTCL)• VI PHẠM QUY CHẾ, QUY ĐỊNH28

99

CONCLUSIONS PDCA is an effective tool for CQI
 Objectives should be short term, clear and SMART
 Conducting RCA or SWOT analysis to achieve

objectives.
 Clear results should be shown to prove work

effectiveness.

29

THANK YOU VERY MUCH
 If you want to go fast, go alone, If you want to go

far, go together.
 tonthanhtra@yahoo.com

QUALITY - CIVILIZED – MODERN - BENEVOLENT
30100

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 5 | How to Reduce Waiting Time?

Summary of Discussion
Standardization
1.

Ninh Thuan Provincial General Hospital first developed their regulation on timely turnaround of laboratory test

Session 2

1.

Session 1

Session 5 How to Reduce Waiting Time?

results in 2014. Previously there was no time requirement for turnaround of laboratory test results and doctors
may forget or be late in treating patients. This self-development of hospital standard is a good approach to
2.

Other hospitals who wish to develop their own standards on timely turnaround of laboratory test results can referto the standard in Ninh Thuan Provincial General Hospital.

How Was the Timing Standard Determined?
1.

The standard for timing of test turnaround in Ninh Thuan Provincial General Hospital was determined based on
their actual practice, improvement expectations, consultation with practitioners, and gradual adjustment overSession 4

2.

Session 3

standardize hospital activities when there is no common standard.

time.
Meetings were organized for practitioners to discuss if the proposed timing standard was proper and feasible.

3.

The hospital updated the standard continually and the current regulation is the 3rd version.

Session 5

3.

2.

Timing Measurement
1.

Time span of test turnaround in Ninh Thuan Provincial General Hospital is calculated in minutes between theof time span is collected from the time recorded in the IT system. The IT system records the time when (i) the
doctor indicates tests, (ii) the laboratory receives the samples, and (iii) the laboratory returns the results.

2.

Session 6

time of the doctor’s indication of tests and the time of the patient receiving test results. The data for calculation

The time spans that are not measurable yet are (i) the span between the time of the doctor’s indication of tests
and the time of the nurse taking samples, and (ii) how long it takes a nurse to bring samples to the laboratory.
This timing standard applies for all inpatients within 24 hours of inpatient admission. This means it excludes any
previous tests indicated before the patient is admitted as an inpatient (e.g., when the patient is in emergency
department).

Issues for Further Considerations
1.

How do we know if our self-developed standards are proper? What are possible outcomes for compliance tothis timing regulation? E.g., less incidents, less complaints from patients, less complications?

2.

Annex

4.

Session 7

3.

The process from when the doctor indicates tests to when s/he receives test results consists of different small
stages, for example, patient’s waiting time until a nurse takes samples, time for samples transfer, etc. If we
can measure more specific these stages we may know what standard we should set and where in the current
process we should improve, for e.g., reducing waiting time or reducing time for transferring samples to thelaboratory.

101Session 5
Acceleration of Specimen Collection and Sending
Test Results to Doctor within the First 24 Hours ofEmergency Response
Pham Viet Thai, Phung Nhat Minh, Vo Vinh Chau, Dao Thi Ly, Ngo Thi Thuy Phuong
Ninh Thuan Provincial General Hospital

1.

Reasons for choosing the topic
The Vietnam Law of Medical Examination andTreatment (Article 55) states clearly that healthcare
workers have the responsibility to examine, diagnose, andindicate treatment in a timely manner.
Besides, according to the criterion A1.4 of the Hospital
Quality Standards, if the hospital’s untimely response toto emergency response timing within the first 24 hours
in the hospital from April to September 2015. The results
show that 70% did not follow specimen collection timing;and 8.8% did not follow timing for sending test results todoctors.

4.

Objective

emergency patients causes serious consequences (suchSpecimen collection and sending test results toas death, limb amputation due to necrosis, unrecoverable

doctors for additional interventions in internal medicine

injuries...), this criterion is ranked grade 1.

departments are accelerated in September 2016,

In 2014, the hospital issued regulation on emergency
response timing, including time for specimen collection
and sending test results to doctors… during emergency
response process in the hospital.
Although the hospital had sent the regulation toeach healthcare worker, nurses of internal medicine
departments did not meet the required time for specimen
collection and sending test results to doctors for additional
interventions.
In September 2016, we implemented the project“Acceleration of specimen collection and sending testcompared with the first week of July 2016.  

5.

Methods

1. Subjects of the study− Inpatients in 4 internal medicine departments (ICU, 02
internal medicine departments and Infectious Diseases
Department) of Ninh Thuan Provincial General Hospitalfrom July to September 2016.
− Exclusion: patients discharged within 24 hours after
admission and those who have been admitted in less than
24 hours.

results to doctors within the first 24 hours of emergency

2. Establishment of measures

response” in internal medicine departments, contributing- Sample size: 20 medical records per week from the four

to improve hospital quality.  

2.

Implemented plan
Healthcare workers were instructed to follow standard

timing of specimen collection and sending test results todoctors for additional interventions.
Compliance was checked, monitored, and studiedmonthly and unannounced.

3.

102

A survey of 600 medical records on the compliance

Actual state

departments (12 weeks from July to September 2016).
- Sampling: single random sampling by drawing lots, firstchoosing one day from Monday to Friday, then choosing
patients in the four departments (for example, there are
15 patients in the department, make 15 lots and thenrandomly choose 5).
- Statistical process control:•

Calculating average time spans for specimen
collection and sending test results to doctors at 4

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 5 | How to Reduce Waiting Time?

different emergency levels.
Statistics: Using Excel to calculate data and draw
charts.

6. Causes of prolonged specimen collection
and sending test results to doctors

performance assessment;- Weekly reviewing the compliance to the regulation on
timing for specimen collection and sending test results todoctors, as well as conducting RCA of incompliance.

8.

on emergency response timing;- Average time for specimen collection and sending test

- Nurses working in the internal medicine departments did
not know how to arrange work, which causes untimely

Results

results to doctors in all emergency levels of weeks 1, 2, 3
and 4 did not meet the regulation requirements.
- After identifying some causes and conducting someforgot to send specimen or to send results to doctors

interventions, average time for specimen collection

when they received new emergency patients);

was improved and stayed stable in weeks 6, 7 and 8.

- Test results were available at midnight, therefore sending
results to doctors was delayed until morning;

However, time of sending test results to doctors for
additional interventions at emergency level 4 is not stable.

Session 3

collection of specimen (for example, sometimes nurses

Session 2- There were some inappropriate points in the regulation

Session 1•

if any delays are detected they would be reflected in- Shift handover did not include sending test results todoctors, therefore some were delayed.
set in the computer system;- Many patients were admitted from 18h to 23h every day,Session 4- Specimen collection time increases due to incorrect time

therefore only 2 nurses on duty were not able to collectspecimen on time;such as: emergency, urgent, semi-urgent, or non-urgent;- Head nurses of the internal medicine departments didn’t

Session 5- Doctors forgot to check emergency classification boxes

remind staff regularly about compliance to emergency
response timing;
emergency response timing;- New nurses were not trained about the regulation, their

Session 6- Some nurses didn’t know well the regulation on

slowness slowed down the process.

- Adjusting the regulation on emergency response timing
and re-training nurses in internal medicine departments,

Session 7

7. Action plan

especially new nurses;- Training and implementing 5S for internal medicine- Reviewing manpower, adding 10 nurses for 2 internal
medicine departments, increasing the number of nurses

Annex

departments;

on night duty (03 nurses/night/80 beds);- Head nurses regularly checking and reminding staff tocomply to the regulation on timing for specimen collection
and sending tests results to doctors in the daily morning
meeting;- Checking and monitoring regularly and unannounced,

103

Level1

Name

Functional Examination (FE)Diagnostic imaging (DI)Time for
Testing time
Ultrasound, endoscopy,
X-ray, CT, MRI
doctor to
ECG
examineand initiallyTime for nurse
Time for
Time for
Time forrespond,to report results
nurse to readnurse tonurse toTime forsince
to doctor andtest results
Time fortransfertransfer
nurse topatient’s
doctor to give
Time for FE patient to DI Time for DI
additional
patient toTime for test and reportcollect andadmission
additional
FE orturnaround, to doctor to interventions
turnaround, department turnaround,transport
to hospital/
since
update the by doctor, arrange for since request or arrange since request interventions,specimen,
department
since FE and DI
specimen
results thatsince test
bedsidefor bedsideor patientor patient
since doctor
or patient’s
results received
receivedinfluence
results
ultrasound,
X-ray, sincereceived
receivedfinishescondition
diagnosis
received since doctor
doctorexamination
becomesin medical
finishesfinishes
severerecord (4)examination
examination

Emergency Immediate

Within10 ≤ 40 minutes
minutes (1)(3)

Within10
minutes≤ 15≤ 10 minutes
minutes≤ 20 minutes≤ 20 minutes
Within15   ≤ 20   ≤ 20 minutes
Within 15
if there wasif there wasminutes (1)minutes if minutes (1)if there was
no DI (6)no FE (6)there wasoperation (5)operation (5)Maximumtime for DI
turnaround is
20 minutes

50 minutes is the maximum time fornurses to send test results to doctor(since laboratory receives specimen)
For example,
emergency
patient is admitted
at 9.00 o’clock2

UrgentFor example,
urgent patient isadmitted at 9.00
o’clock

3

Semiurgent

For example,
semi-urgent
patient is admitted
at 9.00 o’clock4

9h

Within 05
minutes

9h05

Within 15
minutes (2)9h15

Within 20
Non-urgent
minutes (2)

9h10

9h50

10h00

10h15
Maximum
80 minutes
if there wasoperation

9h15

104

9h20

9h15

9h35

≤ 15
minutesWithin≤ 40 minutes≤ 40 minutes
WithinWithin 20≤ 30
20 minutes if there was 20 minutes if there was≤ 60 minutes ≤ 25 minutes
minutes if
minutes (1)(1)(1)
no DI (6)no FE (6)there wasoperation (5)Maximum
Maximum
85 minutes is the maximum time fortime for DI
time for FE
nurses to send test results to doctor
turnaround isturnaround is(since laboratory receives specimen)
40 minutes
40 minutes

9h25

10h25

10h50

11h05
Maximum
140 minutes
if there wasoperation

9h25

10h05

9h25

10h05

9h45
Maximum 55
minutes if there
was operation≤ 15 minutes≤ 30 minutes
if there wasoperation (5)10h20
Maximum 95
minutes if there
was operation≤ 30≤ 30 minutes
minutes≤ 60 minutes≤ 60 minutes
WithinWithin 40≤ 120
Within≤ 60≤ 60 minutes≤ 35 minutes
if there wasif there wasif there wasminutesminutes if 50 minutes
minutes
50 minutes
no DI (6)no FE (6)there wasoperation (5)operation (5)Maximum
Maximum
155 minutes is the maximum time fortime for DI
time for FE
nurses to send test results to doctor
turnaround isturnaround is(since laboratory receives specimen)
60 minutes
60 minutes
13h00
11h35
Maximum
Maximum 185
9h55
11h55
12h30
270 minutes
10h05
11h05
10h05
11h05
minutes if there
if there waswas operation
operation

Within 60
minutes≤ 180
minutes≤ 30
minutes≤ 90 minutes≤ 90 minutes≤ 90
WithinWithin≤ 40 minutes
if there wasif there was
60 minutes
minutes if 60 minutes
no DI (6)no FE (6)there wasoperation (5)

10h20

13h20

14h

14h30
Maximum
390 minutes
if there wasoperation

10h20

11h50

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2≤ 30 minutes≤ 90 minutes
if there wasoperation (5)Maximumtime for FE
turnaround is
90 minutes

Maximumtime for DI
turnaround is
90 minutes

220 minutes is the maximum time fornurses to send test results to doctor(since laboratory receives specimen)
For example, nonurgent patient isadmitted at 9.00
o’clock

9h35

Maximumtime for FE
turnaround is
20 minutes

10h20

11h50

12h20
Maximum 260
minutes if there
was operation

Session 5 | How to Reduce Waiting Time?

Notes:- Tests included in the emergency response procedure
are: biochemistry, immunology, hematology; those listed
in remark (7) below are not included.

- Patients at emergency level 4 still need to be indicatedlaboratory tests, FE and DI, except those that require
empty stomach or non-emergency gastro endoscopy.

- In clinical departments, if new patients come when
the doctor is taking care of patients who are in stable
or non-emergency condition, the doctor must arrange
his/her time to visit and examine patients according toemergency level (identified by Emergency Department or
OPD) following the timing regulation.

Annex- Pediatric Emergency and ICU, Cardiovascular Internal
Medicine, Gastroenterology Internal Medicine, and ICU –Toxicology Departments that have more than 01 urgent
emergency case at the same time, time for testing, FE
and DI will be extended by 10 minutes.

(6) When both FE and DI are indicated to the patient,time is extended by 20 minutes. When 02 or more
FE or DI techniques are indicated, time for eachtechnique performance is extended by 10 minutes (ifX-ray of several bones is indicated, time for techniqueperformance on each kind of bone is extended by
05 minutes only). Time for head CT scan without
contrasts is extended by 15 minutes. MRI, abdominal
CT scan with contrast, head CT scan with contrast,
vascular ultrasound, heart ultrasound, emergency
endoscopy is extended by 40 minutes.

Session 7- During patient’s stay in the hospital, if laboratory tests,
FE and DI are necessary, time for specimen collection,
test turnaround and intervention is calculated as specified
above.

(5) If the surgery is not conducted following the timing
regulation, there must be a confirmatory signaturefrom the operation theater (OT) in the medical record
about surgery delay due to lacking of OT or otherproblems.

Session 6- DI included in the emergency response procedure are:normal X-ray, including contrast X-ray such as stomach
and intestinal X-ray using barite, KUB, pelvis X-ray, head
CT scan with/without contrast, sinus CT scan, MRI, chest
and abdominal CT scan with/without contrast.

Session 5- FE included in the emergency response procedure
are: ultrasound, stomach endoscopy, electromyography,
electroencephalogram, …; colonoscopy is not included.  

(4) Based on the regulation on test results turnaround,nurses should actively check the results via intranet
and report to the doctor for him/her to write abnormal
results in the treatment sheet. However, the result
paper must be attached to the medical record within
12 hours after results are available. When results
are not available on the intranet, the laboratory must
inform nurses to come to get the result paper following
the timing regulation. If everyone is working on an
emergency case, these works can be done later.

Session 4- The priority for para-clinical examinations is as follows:
first blood tests, second FE and finally DI.  

(3) Maximum time for taking blood gas and result
turnaround is 05 minutes, for blood type test 15
minutes, for bedside X-ray 10 minutes, for some othertests can be longer.

Session 3- The regulation on timing for examination, specimen
collection, test turnaround and response applies to bothnormal working hours and outside of normal working
hours, including Saturdays, Sundays and holidays.

(2) Nurses must receive patients immediately when
they arrive at the hospital or department, explain indetails and comfort patients while waiting for doctor’svisit.

Session 2- The doctor (or the authorized nurse) marks theappropriate box of emergency level for Laboratory,
FE Department and DI Department to do their work
accordingly. Staff of FE Department and DI Department
must write the time of receiving patient in the indication
form (with signature and full name of people who
handovers and who receives).

Session 1- After the patient comes to the department, the nurse
must immediately receive him/her, arrange bed, measurevital signs, and invite doctor – if the doctor is away, there
must be somebody else to help with inviting him/her. Timefor doctor’s examination and initial response is calculated
since the patient is admitted.

( 1 ) D u r i n g e m e r g e n c y p ro c e s s t h a t re q u i re s
mobilization of more manpower, the doctor examinesand give verbal indication for test, FE and DI. Rightafter that, the nurse must take specimen, if different
tests are indicated 5-10ml of blood can be taken.
If ultrasound and/or X-ray is indicated, the nurse
must contact FE Department and/or DI Department
for bedside services or transfer the patient to thesedepartments if the patient’s condition allows. In caseof difficulty in taking specimen, time can be extendedby 5-10 minutes, depending on each case.

(7) Some tests not included in emergency timing are:peripheral blood smear, SLE, Pap smear, pathology,
blood culture, hepatitis virus quantification.  

Director:

Dr. Thai Phuong Phien, MD, 2nd Degree Specialis

105

Acceleration of specimen collection and sending test results
to doctors within the first 24 hours of emergency response 	
  Presenter: Dr. Pham Viet Thai

Regula-on	
  on	
  emergency	  -ming	
  Maintaining	
  the	  regula-on	
  1.No patient misidentifications
2.Teamwork
3.High risk drugs
4.Communication during
surgery
5.Handwashing
6.Reduction of patient falls	
  Regula-on	
  on	
  emergency	
  -ming	  	  Modified by Pham Viet Thai 2016

THE STATE OF THE HOSPITAL IN 2015, THE HOSPITALIMPLEMENTS 17 QI PROJECTS IN 2016 SUCH AS:

Các Đề án cải tiến đã triển khai tại BV năm 2016

SCIENTIFIC BASIS FOR IMPLEMENTATIONOF QUALITY IMPROVEMENT PROJECTSIN NINH THUAN PROVINCIAL GENERALHOSPITAL IN 2016

Reasons for choosing the topic
Examination, diagnosis, indication oftreatment methods in a timely manner.
Standard A1.4, if the patient is not given
emergency treatment timely, this standard
will be ranked grade 1.

2016
2015, not good implementation
2014, the hospital issued the regulation on
emergency response time

DIAGNOSIS AND TREATMENT PROCEDURE

Specimen	  collec-on	  106

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Sending	  results	
  to	
  doctors	
  Session 5 | How to Reduce Waiting Time?

Emergency response procedure in
Ninh Thuan Provincial General Hospital

Methods

Time for nurses sending test
results to doctors• Clinical examination• First diagnosis• Diagnostic
classification• Identifying
emergency level• Indication ofpara-clinical tests• Initial response• Collecting specimen• Sending patient toultra sound, X-ray…

• Checking test results• Reporting to doctor• Doctor update
abnormal results into
medical record• Diagnostic
consultation
if necessary• Final diagnosis

Para-clinicaldepartments• Tests,• Functional
exploration• Diagnostic
Imaging- Weekly survey of 20 medical records of the 4 departments (12Additional
interventions• Appropriate• Timelyrounds of survey in 3 months – from July to September 2016).
• Follow-up patient

Final diagnosis

SURVEY FORM
Doctors,
Nurses- Single random sampling- Statistical process control:+ Calculating average time spans for specimen collection andTime for specimen collection andtransportation is different, depending on
the emergency level.

Providing guidance for staff tofollow the regulation on timing
standard+ Using Excel to calculate data and draw charts.

Causes of prolonged specimen collection and sending test
results to doctors:- There were some inappropriate points in the regulation on
emergency response timing;- Test results were available at midnight, therefore sending todoctors was delayed until morning;- Shift handover did not include sending test results to doctors,
therefore some were delayed.

Session 4-Nurses working in the internal medicine departments did notknow how to arrange work;
Checking and monitoring thecompliance to the regulation

Session 3

Implemented planssending test results to doctors at 4 different emergency levels.

Session 2

Doctors, Nurses
First diagnosis,
diagnostic
classification

Time for specimen collection
and transportation

Session 1

Subject of the study:
Inpatients in 4 internal medicine departments from July to
September 2016
Establishment of measures:

Session 5

Current state- Many patients were admitted from 18h to 23h everyday, therefore
only 2 nurses on duty were not able to collect specimen in time;+ Delayed specimen collection and transportation (46-68%);+ Delayed sending results and updating abnormal values (13-20%)- Doctors forgot to check emergency classification boxes such as:
most severe emergency, emergency, partly emergency, etc.

- Study by Christopher L. Roy:- Head nurses of the internal medicine departments didn’t remind
staff regularly about compliance to emergency response timing.

Session 6- Study by Robert Hawkins,

Causes of prolonged specimen collection and sending test
results to doctors:

41% patients received test results at discharge time,
9.4% of which were affected due to delayed para-clinical results- Some nurses didn’t know well the regulation on emergency
response timing;- New nurses were not trained about regulations, their slowness
slowed down the process.

Not following specimen collection timing (70%)
Not following timing for sending test results to doctors (8.8%)  Objective
Specimen collection and sending test results to doctors for
additional interventions in internal medicine departments areaccelerated in September 2016, compared with the first week ofJuly 2016.

IMPROVEMENT ACTIONS- Adjusting the regulation on emergency response
timing and re-training for nurses in the internal
medicine departments, especially new nurses;

Annex

Current state
In 2015: A survey of 600 medical records on the compliance toemergency response timing within the first 24 hours in thehospital from April to September 2015

Session 7

and may sue the doctors.

- Training and implementing 5S for the internal
medicine departments;- Reviewing manpower, adding 10 nurses for 2 internal
medicine departments, increasing the number ofnurses on night duty (03 nurses/night/80 beds);

107

IMPROVEMENT ACTIONS- Head nurses regularly checking and reminding staff to comply
to the timing regulation on specimen collection and sending
tests results to doctors in the daily morning meeting;- Checking and monitoring periodically and unannounced, if
any delays are detected they would be reflected inperformance assessment;

CONCLUSIONS- Weekly reviewing the compliance to the timing regulation on
specimen collection and sending test results to doctors, as wellas conducting RCA of incompliance.

06 BASIC ISSUES MAKING PATIENTS SATISFIED
Prof. Dr. HANDA Yujiro, Japan	

Healthier and happier patients6	
  Staff satisfaction

RESULTS

Productivity, quality, price, distribution, safety and ethics

5

Resources, equipment, consumable materials, methods4	
  Continuous improvement to reduce waste and overload3	
  Standardization and output control	

RESULTSAFTER 8 WEEKS OF SURVEY ON SPECIMEN COLLECTION TIME
Emergency level 1

Emergency level 2

Teamwork 	

2	
  Improved working environment 	

1
22

Iden'fying  issues  related  to  standardiza'on  and  compliance  to  standards
In  the  organiza'on

No

Are  there  standards?

ErrorsMake  standards

Yes

Emergency level 3

E.g.: 01 case of
total peritonitis
due toappendicitis diedbecause ofdelayedemergency
treatment

Emergency level 4No

Staﬀs  must  follow  standards

Yes

Review  standard  procedures

Yes

Staﬀs  must  follow  standards

Are  staﬀs  aware  of  the  standards?
Yes
Do  staﬀs  follow  the  standards?
No
Are  standards  easy  to  follow?
No

Review  standards© Shinsuke Murai

RESULTSAFTER 8 WEEKS OF SURVEY ON TIME OF SENDINGTEST RESULTS TO DOCTORSEmergency
level 1

Emergency
level 2CONTINUOUS IMPROVEMENT
An example of improvement activity in
Ninh Thuan Provincial General Hospitalin 2016

Handwashing complianceof healthcare workers in
2016

Emergency
level 3PDC

6/2016Emergency
level 4
11/201502	
  PDCA	
  cycles	  108

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

P

D

A

C

P

D

A

C

12/2016

Handwashing performance

55%

A

85%

75%

Session 5 | How to Reduce Waiting Time?

CONCLUSIONSBESTMEDICALSERVICES

TRAINING

TIME

ARRANGEMENTMANPOWERCOLLABORATIONFINANCE

PRIORITY

Session 2

KNOWLEDGE

Session 1

STANDARDS,
PROCEDURES	
  Session 3
Session 4

THANK YOU FOR YOUR ATTENTION

08/8/2014

26

Session 5
Session 6
Session 7
Annex
109

Session 6 The Role of Quality Management
Department in Hospital
Summary Discussion
1.

QMD’s Supporting Role to the Hospital Director
1.

QM/PS is a relatively new area for both the hospital director and QMD staff. In some hospitals, the director
may lead QMD in their QM/PS work while not in some others, QMD may need to start on their own and try toconvince their director to acknowledge their work and position.

2.

If a QMD can propose plans/initiatives that convince the director, they are taking the role of an advisor to thedirector. If they cannot propose ideas or propose those that do not convince the director, they must then follow
the director’s ideas and in such cases they are taking the role of a helper.

3.

In some hospitals, such as in Da Nang Hospital for Women and Children, the director may prefer to discuss not
only with QMD but also with other departments (e.g., General Planning Department, Personnel Department) todevelop strategies and plans for QM/PS in their hospital.

4.

In some hospitals where QM/PS is considered very important, determining the survival of the hospital in a more
and more competitive context, a competent QMD head can be expected to be promoted to a hospital top
management position (vice director or director).

2.

QMD’s Relationship with Other Departments
1.

QMDs in many hospitals were established under the requirement of MOH. At the beginning, many people,
including the hospital leaders, did not know QMD’s roles and functions. Some hospital staff even think that QMD
staff have no work to do. However, QMD’s work usually need collaboration from other departments. So asking
for such collaboration can be a real challenge for QMD staff.   

2.

Nursing department may be the one who will work most closely with QMD in QM/PS activities. In Da Nang
Hospital for Women and Children, where QM/PS just started recently (QMD was established in May 2016),
the Nursing Department was among the first ones that worked with QMD. The head of Nursing Department
acknowledged that by working together they created some visible small changes in the hospital.

3.

Support from heads of other departments in hospital is important for implementation of QM/PS activities. For
example, in Can Tho Central General Hospital, because the heads of four departments supported QMD to apply
5S in their departments, 5S has been implemented and maintained in these departments. Meanwhile, it is very
difficult for QMD to apply 5S in other departments because the department heads there are not very supportive.

110

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 6 | The Role of Quality Management Department in Hospital

Cao Duc Phuong

Session 2

Procedure for Handling Healthcare Complaints and
Denunciations in Division of Technical Medicine
and Pharmacy, Medical Services Administration

Session 1

Session 6-1

Medical Services Administration, Ministry of Health

Session 3

Chapter I
GENERAL PROVISIONSThis procedure regulates all steps of the process forhandling citizens’ complaints and denunciations about
medical services in the hospitals under the Ministry of
Health (MOH) or in other healthcare institutions when

Chapter II
PROCEDURE FOR HANDLING COMPLAINTS AND
DENUNCIATIONSArticle 5. Information receiving process

responsible agency.

- MSA Office receives complaint letters from citizens orArticle 2. Applied subjects

direction of task division.

This procedure applies to staff of Division of Technicaldenunciations by individuals or organizations following
current laws.
Article 3. Principles for handling complaints anddenunciations

Accuracy, objectivity, transparency, democracy andtimely manner are assured;

2.

Proper authority, procedure and timing;

3.

Legal rights and benefits of collectives, organizations,
agencies and individuals are respected andprotected.

- Chapter VII, Law on Medical Examination and Treatment
in 2009,

handle.
Article 6. Process for verification and handlingcomplaints/denunciations
1.

Verification and clarification of complaint anddenunciation letters

1.1. For cases in which a citizen sends acomplaint/denunciation letter about medical

services in a hospital under MOH, a sectoral one,or a private one- MSA sends an official document to the complained/
denunciated hospital to request a report of the event.
The document must state clearly that:•

establish one to review the event and respond to

regulating functions, tasks, authority and organizational

the patient, as well as report to MSA. (1)structure of the MOH
by the Minister of Health regulating functions, tasks,

If the hospital does not have a technicalcommittee to review the event, it is required to- Decree number 63/2012/ND-CP dated 31/12/2012- Decision number 458/QD-BYT dated 08/02/2014

Annex

Article 4. Documents of reference

information in the system and assigns responsible staff to

Session 7

1.

- DTMP: after receiving order from MSA leaders, enters

Session 6

Medicine and Pharmacy (DTMP) and complaints andother MOH units and submits them to MSA leaders for

Session 5

citizens do not agree with previous decisions by aAdministration (MSA).

Session 4

Article 1. Scope of regulation

authority and organizational structure of Medical Services•

If the hospital has a technical committee andhas already responded to the patient but he/she

111

continued to complain, the hospital is required
to send to MSA a stamped copy of the technicalcommittee’s meeting minutes and of the patient’s
medical record for MSA to review. (2)* Remark: The document must be copy sent to thepatient so that he/she knows the process.

2.

Establishment of MOH Technical Committee tohandle complaints and denunciations- Study carefully medical records, meeting minutesof technical committees at all levels and relevant
documents to:•Committee (Committee Chairman): who is usually- For cases (1), if after the hospital responds to theprestige professor or associate professor of thepatient, he/she does not accept and files a complaint

specialty covering the disease being complained.

to MOH, then follow process (2).
1.2. For cases in which a citizen sends a•

Invite people to be members of the Technicalcomplaint/denunciation letter about medical

Committee from specialties related to the patient’s

Healthlaboratory test and diagnostic imaging.

complaint, including functional examination,

services in a hospital under local Department of- MSA sends an official document to the complained/* Remark:

denunciated hospital to request a report of the event.

- Leader of MSA is a permanent Vice Chairman of the

The document must state clearly that:•

If Department of Health (DOH) does not havea technical committee to review the event, it isrequired to establish one to review the event andrespond to the patient, as well as report to MSA. (1)•

If DOH has a technical committee and has
already responded to the patient but he/she
continued to complain, DOH is required toTechnical Committee.
- C o m m i t t e e m e m b e r s i n c l u d e p e o p l e f ro m
Departments of Legislation and relevant functional
departments.
- A lawyer is a mandatory member of the Committee- Secretary of the Committee is an expert from DTMP
whose specialty covers the disease being complained.

send to MSA a stamped copy of the technical- After that, submit draft Submission Form andcommittee’s meeting minutes and of the patient’s

Decision to establish the technical committee to MSA

medical record for MSA to review. (2)and MOH leaders for approval.

* Remark: The document must be copy sent to thepatient so that he/she knows the process.

3.

Technical Committee’s Meeting- After the technical committee is approved by- For cases (1), if after the DOH responds to theMOH, DTMP reports to MSA leaders to schedulepatient, he/she does not accept and files a complaint

the committee’s meeting, with approval from theto MOH, then follow process (2).

committee chairman.

1.3. For cases in which a citizen sends a- Send invitations, medical records and relevant

services to a People’s Court at any level and- Send invitation the patient’s family who files thecomplaint/denunciation letter about medical

the Court sends an official document to MOH

to request its conclusions of the event forconsideration- If necessary documents are attached with the Court’s
document, MSA proceeds as in the next section.
- If necessary documents are not attached with the
Court’s document, MSA sends an official document to
the Court to request relevant medical record, technicalcommittee’s meeting minutes of responsible agencies
for consideration.
* Remark: The document must be copy sent to thepatient so that he/she knows the process.

112

Invite one person to be the leader of the Technicaldocuments to committee members for study.
complaint to attend the committee meeting.
- Organize the committee meeting.
- Depending on the complexity of the event and thecommittee’s consensus, one or more meetings will beheld.
- After the meeting(s), the secretariat finalizes themeeting minute(s) and collect comments fromthe committee members before submitting to thecommittee chairman for signature* Remark:- Before the meeting day, call to confirm with thePractices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 6 | The Role of Quality Management Department in Hospital

about whether there were technical errors in reception,

least two thirds of committee members are able toemergency response, examination and treatment

attend, including committee chairman, member offor the patient and specify the errors (if any). The

Department of Legislation, lawyer.

Committee also makes recommendations and lessons- The person who files the complaint and patient family
members can attend only some sessions, which aredecided by the committee.
that he/she receives the invitation to avoid later
complaint about not receiving the invitation.
4.

Announcement of conclusions for the complaint

sends to the person who files the complaint an official
document which includes these conclusions as abasis for handling the complaint according to the Law
of Complaint and Denunciation. MSA also reports to
MOH leaders, inspectors and Office.  

Session 3- MOH Technical Committee makes conclusions- After having the committee’s conclusions, MSA

Session 2- Call the person who files the complaint to confirm

learnt to fix the error(s).

Session 1

committee members. The meeting will be held if at

Session 4
Session 5
Session 6
Session 7
Annex
113

Session 6-2
The Role of Quality Management Department
Duong Huy Luong, MD, PhD
Quality Management Department, Medical Services Administration, Ministry of Health

Main contents:
1.

The role of the QMD and its relationship with thedirecting board, QM network, other departments,- How to balance activities of the QMD?
3. The QMD’s advantages and disadvantages- Advantages: Ministry of Health’s orientations,patients, and healthcare workers
2.

The QMD’s functions, tasks, and actual activities

3.

The QMD’s advantages and disadvantages

4.

What the QMD needs to do and should do

5.

Development orientations and future trends of thedirective documents, policies; and others…
- Difficulties: old viewpoints, shortage of manpower,
resistance from colleagues, huge workload, limited
budget...
4. What the QMD needs to do and should do- Building trust and passion for QI among QM staff

QMD

Detailed contents:
1.

- Approaching new viewpoints on quality andimproving QM knowledge

The role of the QMD and its relationship with the- Changing viewpoints of the directing board anddirecting board, QM network, other departments,

healthcare workers

patients, and healthcare workers- Clarifying the scope of work and management- What is the role of the QMD? Making QI plans,
implementing, monitoring?  

- Making QI plans- Important or not important role?  

- Mobilizing financial resources for QI- Relationship with the directing board (advisor,- Instructing other departments to implement activities

implementer, monitor…)  

and monitoring- Relationship with QM network (coordinator, leader…)  

- Making products with QMD “brand”- Relationship with other departments, healthcare- Measuring important indicators to evaluate theworkers (supporter, working condition facilitator…)  

impacts of QI activities- Relationship with patients (listener, receiver, feedback
giver…)
2. The QMD’s functions, tasks, and actual activities- Functions, tasks (according to Circular 19/2013/TTBYT)- Actual activities: either assigned too much work or
nothing to do114- Other work…
5.

Development orientations and future trends of

the QMD- Envisioning for the QMD- Developing the QMD’s orientations for the next 5, 10
years- QM trends in hospitals: The QMD expands andPractices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 6 | The Role of Quality Management Department in Hospitalincreases its role

Session 1- Modern private hospitals have the director (or one
vice director) in charge of all hospital quality issues.  

Conclusions:
Identifying clearly the QMD’s roles, position, strengths,
weaknesses, activities, products, and results will help

Session 2

the department work more effectively, contributing
to improved quality and satisfaction of patients andhealthcare workers.

Session 3

What is the role of the QMD?
THE ROLE OFQUALITY MANAGEMENT DEPARTMENT

Important or not important role?
Relationship with the directing board (advisor,
implementer, monitor…)n Relationship with QM network (coordinator,
leader…)n Relationship with other departments,
healthcare workers (supporter, working
condition facilitator…)n Relationship with patients (listener, receiver,4
feedback giver…)nn

Dr. Duong Huy Luong, MD, PhD
Dr.Luong.kcb@gmail.com; Cellphone: 0915363369

Session 4

Forum on Quality Management and Patient Safety
NCGM – Da Nang Hospital for Women and Children
27-29/9/2016

Session 5

What is the role of the QMD?

Main contents:

Session 6

Important or not important?

The role of the QMD and its relationship with the directing
board, QM network, other departments, patients, andhealthcare workersn The QMD’s functions, tasks, and actual activitiesn The QMD’s advantages and disadvantagesn What the QMD needs to do and should don Development orientations and future trends of the QMDn

5

Session 7

2

Annex

What is the role of the QMD?
1. The role of the QMD and its
relationship with the directing board,
QM network, other departments,
patients, and healthcare workers

3

6

115

“My voice echoes in themountain, why no one answer”?

What is the role of the QMD?
Is part-time working good?
Playing football and blowing whistle all inone?
n Self-monitoring?
nn

Nobody listen?

n

7

11

“The voice” of the QMD?
Everyone wants instruction from the QMD?
n Everyone wants to work with the QMD?
n

8As an “umbrella” covering all hospital
activities, including monitoring thedirecting board’s activities?

“The voice” of the QMD?
n
n

12

Everyone must follow?
Everyone wants to listen to the QMD?

9

13

Blowing hot air to activities?
Emotionally terrorizing colleagues if they
don’t complete work?

10

116

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 214

Session 6 | The Role of Quality Management Department in Hospital

Session 1

Actively handling andovercoming difficult situations…

Fire fighting at hot spots?

19

Session 3

Ready to protect others(healthcare workers, patients…)

A referee for disputes?

Session 2

15

Session 4

16

20

Session 5

Monitoring, inspection, fault
finding, hair splitting?

Identifying the role of the QMD?
n

18

Annex

Active, creative to create its own
work, maximizing existing resources

21

Session 7

17

Session 6

Bonding, socializing, closely collaborating withother colleagues…
(understanding each other better in hardship)

The QMD has to implement and monitor all
activities by itself?

22

117

The QMD does not know what to doè play game

The QMD’s functions, tasks, andactivities
Functions, tasks (according to Circular
19/2013/TT-BYT)n Actual activities: either assigned too muchwork or nothing to don How to balance activities of the QMD?
n

23

27

3. The QMD’s advantages anddisadvantages

The QMD’s tasksn

Making plans and development orientation forthe hospital’s QInAdvantages: MOH’s orientations, directive
documents, policies; and others…

24

28

3. The QMD’s advantages anddisadvantages

The QMD’s tasksn“50 different aspects”

n

Difficulties: old viewpoints, shortage ofmanpower, resistance from colleagues, huge
workload, limited budget...

25

The QMD is assigned too many tasks, fromplanning for QI, implementation,
monitoring other departments, toevaluation

29

4. What the QMD need to do andshould do
What does the QMD need to do according to
the MOH’s guidance?
n What should the QMD do to improve hospitalquality?
n

26

118

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 230

Session 6 | The Role of Quality Management Department in Hospital

5. Development orientations and future
trends of the QMD
Envisioning for the QMDDeveloping the QMD’s orientations for the next 5,
10 yearsn QM trends in hospitals: The QMD expands andincreases its rolen Modern private hospitals has the director (or one
vice director) in charge of all hospital quality issues
n

n

n

31

35

Session 3

4. What the QMD need to do andshould doConclusions:nn

Identifying clearly the QMD’s roles, position,
strengths, weaknesses, activities, products, andresults will help the department work more
effectively, contributing to improved quality andsatisfaction of patients and healthcare workers.

32

Session 4

Building trust and passion for QI among QM staff
Approaching new viewpoints on quality andimproving QM knowledgen Changing viewpoints of the directing board,
healthcare workers: without quality èpatients don’t come è excellent staff quitn Clarifying the scope of work and managementn Making QI plansn

Session 2

Need to collaborate with other departments?
What will the QMD do??
n How does the QMD affect the directing board
to increase its role?
n How does the QMD affect colleagues toincrease its role?
n How does the QMD affect patients toincrease its role?
n

Session 1

4. What the QMD need to do andshould do

36

Session 5

4. What the QMD need to do andshould do

Session 6

Be work, be stronger!

Mobilizing financial resources for QI
Instructing other departments to implement
activities and monitoringn Making products with QMD “brand”
n Measuring important indicators to evaluate
the impacts of QI activitiesn Other work…
n
n

Annex

Important: Identifying specific products
made by the QMD with measurable
outputs!

37

Be think, be smarter…

34

Session 7

33

38

119

Be others, be together, be one
team, get more success!

Dr. Duong Huy Luong, Deputy Head of Quality
Management Department, Medical Services
Administration
Dr.Luong.kcb@gmail.com; Cellphone 0915363369

39

DISCUSSION (the most interesting
part is in your hand)
n
n
n
n
n

What is the role of QMD?
Would you please share experience in:
How to increase the role of QMD?
How to mobilize people for QI?
How to inspire people to be active in QI?

40

120

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 7 | What Can the Hospital Director Do to Promote QM/PS?

Summary of Discussion
The Roles of the Hospital Director in QM/PS
1.

In Vietnam, compared with other areas in hospital management, QM/PS is relatively new. Therefore, it may takeSession 2

1.

Session 1

Session 7 What Can the Hospital Director Do
to Promote QM/PS?

some time for hospital directors to understand its concepts and scope of work. In many hospitals, QMD wasestablished under the requirement of MOH. At the beginning, hospital leaders were not clear about QMD’s roles
2.

Once the hospital director has some basic understandings of QM/PS, he/she can employ a PDCA approach to
QM/PS, according to experience of the director of An Giang Hospital of Obstetrics, Gynecology and Pediatrics:b.

Direct implementation (= Do): It is very important that the hospital director not only orients but also directs
QM/PS activities by himself/herself. Some directors actually only orient (in words) but refuse to involve
directly in QM/PS management due to business with other activities.

c.

Check: Once the hospital director directs QM/PS activities, he/she should regularly check if his/her staff
really implement them. If they do not, the director needs to push. In such way it can help QM/PS gradually
become routine in the hospital.

d.

Improve (= Act): After checking implementation, the hospital director may want to orient his/her staff toimprove their QM/PS activities.

Session 5

Orient (= Plan): The hospital director should take lead in QM/PS development in a hospital, creating a pathfor hospital staff to follow. If this task is led by a vice director, it may be less convince to staff. In the future,
one vice director can take charge of QM/PS.

Session 4

3.

a.

Session 3

and what it should do. In these hospitals, the director might not know where to start their QM/PS work.

QM/PS is not a separate area in hospital management, but it crosses many other areas, such as clinical work,
infrastructure, equipment management, etc. A director with good understanding of QM/PS can direct his/her
In An Giang Hospital of Obstetrics, Gynecology and Pediatrics, to enhance clinical quality, the director
oriented his staff to prioritize some tasks to avoid some common mistakes and increase safety, such as(i) Update treatment protocols; (ii) Develop procedures for patient identification, newborn identification; (iii)
Control safe and rational use of drugs.

b.

The director of Da Nang Hospital for Women and Children asked all of his staff to manage some time toattend this Third Forum on Hospital Quality Management and Patient Safety to start learning basic concepts
and issues in QM/PS so that they can join in the hospital’s QM/PS activities in the future.  

If a hospital director recognizes the roles of QM/PS in hospital development, he/she can support QMD

Session 7

4.

a.

Session 6

staff to integrate safety practices in their daily work. For example:

development, such as choosing a competent and committed person to lead the QMD, sending QM staff to QM/
PS trainings and workshops, etc.
The hospital director should specify their own quality expectations based on their unique context. For example,
a hospital in Northwestern Vietnam may receive a lot of H’mong patients who cannot speak Vietnamese. For
this hospital, the director may want to prioritize enhancement of communication between H’mong patients and

Annex

5.

Vietnamese doctors over other common quality improvement activities.
6.

Is the hospital director the most important factor in developing QM/PS in a hospital?
a.

The hospital director’s role in QM/PS development in a hospital is significant, because if the hospital leader
doesn’t know where the hospital is going, how can his/her staff have a way to go?

b.

However, the director alone cannot improve hospital quality and patient safety. He/she needs help from
QMD as well as other departments to do the job.

121

Session 7-1
Fulfilling the Role of the Hospital Director to
Improve Quality Management and Patient Safety
Pham Huu Thuong1, Nguyen Trong Khoa2
1 Ha Noi Lung Hospital, 2 Medical Services Administration, Ministry of HealthGeneral contents:
1.
2.
3.

The role of the hospital director in QM/PS
Advantages and difficulties in fulfilling the role ofSome QM/PS achievements and next plans in Ha

management system in hospital.

The role of the hospital director in QM/PS

1. Concepts of leadership and leader, management
and leadership, model leader

The leader’s products are “right and valid decisions,
feasible and effective plans”.

Qualifications a leader (hospital director)

must include: vision, inspiration, influence and 03

essential skills (understanding, social relationshipand executive ability)

To create the director’s dignity, which is:•

Ability to adapt to environment, sensibility,

flexibility and creativity to create a vision forthe hospital/department

•
3.

4.

Implementation of Circular No. 19/2013/TT-BYT

on “Guidance to quality management of examinationand treatment services in hospital”. Pay special

Detailed contents:

2.

5.

Consistency and trust

What the leader should avoid:•

The top 10 mistakes of the leader•

7 common mistakes of the leader

attention to Article 10: Organization of quality

Part II.

General idea: Deming (1984) stated that there is

1. Five advantages•

Consistent leadership and implementation•

QM staff have knowledge, skills, enthusiasm andare responsible•

cannot come do not send anyone else”.  

122

Considerable international cooperation scientificresearch•

High prestige and trust•

Supports from Ha Noi Department of Health

2. Seven difficulties•

Infrastructure•

Financial mechanisms•

Staff’s satisfaction with current hospital quality•

S t a f f ’s “ b a d ” h a b i t s i n p e r f o r m i n g d a i l yprofessional tasks•

Punishment and reward mechanism is oldfashioned.

•

Safety for healthcare workers when unsafe
incidents happen to patients.

no quality in the organization without the highest
manager’s commitment. His words were “if you

Advantages and difficulties in fulfilling therole of Ha Noi Lung Hospital Director in QM/PSThe hospital director’s commitment with QI•

10 commitments of the hospital director in QI

Ha Noi Lung Hospital Director in QM/PS
Noi Lung HospitalPart I.

••

Subsidy remains because of the hospital’s current

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 7 | What Can the Hospital Director Do to Promote QM/PS?

disease pattern: TB is a social disease, which
TB patients (donors’ supports have decreased

Next activities•

I n M i c ro b i o l o g y D e p a r t m e n t : C o n t i n u i n g
improvement and quality enhancement to reachsignificantly or no longer exist).  

ISO 15189 standards•

Part III.

Some QM/PS achievements and next plans

1.

Priorities and rationale
10 priorities for implementation to ensure hospital

Implementing 5S in Pharmacy Storage, drug
cabinets and medical materials storage in clinicaldepartments…

*Objective: Services quality and patient safety in Ha
Noi Lung Hospital reach higher levels.

Session 2

in Ha Noi Lung Hospital

Session 1

needs state budget to ensure high services for•

quality
2.

Achievements and next plans

Session 3•

Initial results of 5S implementation in Microbiology
Department: Achieved 3* under laboratory quality
evaluation according to U.S. CDC’s criteria

Session 4
Session 5

FULFILLING THE ROLE OF THE HOSPITAL DIRECTORTO IMPROVE QUALITY MANAGEMENT
AND PATIENT SAFETY

Director, Ha Noi Lung Hospital
Supporter and informant:
Dr. Nguyen Trong Khoa, MD, MSc
Vice Director, Medical Services
Administration, Ministry of HealthI. CONTENTS:

DETAILED CONTENTSPART I. THE ROLE OF THE HOSPITALDIRECTOR IN QM/PS

1. Concepts of leadership and leader:+Leadership:• Jones and Jeoge: “Leadership is a process inwhich a person creates impacts on others,
promotes, encourages, and directs activities sothat the group or organization achieves its
objectives”.
• According to former Vice Prime Minister Vu
Khoan: “A leader is a person who set objectives andlead people to reach such objectives. To lead people,
you have to make them follow you voluntarily. If
you use power to force them to follow you, they will
only pretend to do so. If you want them to follow
you voluntarily, people must be attracted by yourintelligence and dignity”.

Fulfilling the role of the hospital director to improve QM/PS

Concepts of Management and LeadershipManagement

Annex

Fulfilling the role of the hospital director to improve QM/PS• The real leader is a person who uses his/her talent and virtue
to influence others, attract them to follow his/her way. This
leader has sustainable value. His/her power comes from
himself/herself without any impacts from outside.

Session 7

1. The role of the hospital director in QM/PS
2. Advantages and difficulties in fulfilling therole of Ha Noi Lung Hospital Director in
QM/PS
3. Some QM/PS achievements and next plansin Ha Noi Lung Hospital+Leader• The position leader (Chief) has authority owing to position,
etiquette, tradition and organizational structure. This leader
uses his/her position to influence others, which he/she can nolonger do once he/she loses that position.

Session 6

Presenter:
Dr. Pham Huu Thuong, MD, MPH

Fulfilling the role of the hospital director to improve QM/PS

Leadership

Is about authority

Is about influence (charisma)

A manager can be a leader

A leader is not always amanager

Copes with complication

Copes with changes

Complies to laws andregulations
Concentrates on products

Does things right
Concentrates on human123Fulfilling the role of the hospital director to improve QM/PS

Fulfilling the role of the hospital director to improve QM/PS

A model leader
•
•
•
•
•
•
•
•
•
•

ListenEmpathy
AttitudeDream-Decisive
Effective
Resilient
Sense of purpose
Humility
Integrity
People skills

Three essential skills of the leader:+ Understanding+ Social relationship+ Executive ability

Create the Director’s dignity• Ability to adapt to environment, sensibility, flexibility andcreativity to create a vision for the hospital/department• Consistency and trust

The leader’s products: right and valid decisions, feasible and effective plans.

Fulfilling the role of the hospital director to improve QM/PS

Three qualifications the (hospital) leader must have
1. Vision:

Fulfilling the role of the hospital director to improve QM/PS

What the leader should avoid (Hospital director)
The top 10 mistakes
1. The top-down attitude
2. Putting paperwork before people work
3. The absence of affirmation
4. No room for mavericks
5. Dictatorship in decision making
6. Dirty delegation
7. Communication chaos
8. Missing the clues of organizational culture
9. Success without successors
10.Failure to focus on the future

Is a positive image of the organization’s future which every member
believes in and wants to make it become true.
Creating vision is the main job of the leader. The leader must know whereto lead the organization to, must imagine a future for the organization.
Four levels of vision (John C. Maxwell)
1. Some people never see it (they are wanderers)
2. Some people see it but don’t pursue it (they are followers)
3. Some people see it and pursue it (they are successors)
4. Some people see it, pursue it and help other people see it (they are leaders).

Fulfilling the role of the hospital director to improve QM/PS

2. Inspiration:
When developing a vision, the leader has to inspireothers to follow and implement it. If the vision is
not communicated to others and not implemented,
it will be meaningless. Therefore, the second job of
the leader is to inspire others.

Fulfilling the role of the hospital director to improve QM/PS

3. Influence• John C. Maxwell: “leadership is to influence (theability to win people’s hearts).” One cannot be aleader if he/she has no influence, and influencecomes from the leader’s power.
• “Best investments for the future is to create good
impacts from today”• To influence is a skill that can be developed.

124

Fulfilling the role of the hospital director to improve QM/PS

What the leader should avoid (Hospital director)
07 common mistakes
1. Not listening, inquiring, scrutinizing and assigning tasks
2. Taking the job passively
3. No proper guidance to the team
4. No consideration of motivation
5. Playing an important role as an implementer – not as aleader
6. No attention to emotion
7. No appreciation

Fulfilling the role of the hospital director to improve QM/PSThe Hospital Director’s commitment in QI
A. General idea:
Deming (1984) stated that there is no quality in theorganization without the highest manager’s commitment.
His words were “if you cannot come do not send anyoneelse”.
B. Ten commitments:
1. Declaring quality visions, policies and objectives consistent withhospital goals.
2. Leading the hospital as a role model with people’s trust (attending andgiving supportive speech at quality seminars)
3. Communicating the hospital’s orientations and values in providing
quality medical services.

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 7 | What Can the Hospital Director Do to Promote QM/PS?

Fulfilling the role of the hospital director to improve QM/PS

Implementation of Circular No. 19/2013/TT-BYT
on “Guidance to quality management of
examination and treatment services in hospital”.
Article 10: Organization of quality management
system in hospitalServices quality and patient safety in Ha Noi Lung Hospital reachhigher levels.

*Specific objectives:+ 5S implemented in departments+ Medical safety ensured in departments+ Hospital quality managed

Fulfilling the role of the hospital director to improve QM/PS

10 priorities:
1. Sufficient high quality staff
2. Good infrastructure
3. Modern medical
equipment
4. Sufficient supply of drugs
and consumable materials
5. Staff’s average income isincreased

6. Good communication andbehaviors
7. Ensured medical safety
8. 5S implementation
9. Good hospital management
10. Good security

Session 4

1. QM system in hospital includes: QM council chaired by the hospital
director and vice-chaired by the vice director in charge of professional
activities; QM department/unit; full-time QM staff; QM network
suitable with hospital size.
2. Hospitals at special and 1st levels establish QMD; other hospitals
establish QM department or unit depending on their own sizes,
conditions and needs. QM department/unit collaborates closely withfunctional departments to fulfill QM tasks.
3. QM network: is established from the hospital to department levels, with
QM department/unit as the coordinator.

*General objective:

Session 3

Fulfilling the role of the hospital director to improve QM/PS

PART III. SOME QM/PS ACHIEVEMENTS AND NEXT PLANS IN HA NOILUNG HOSPITAL

Session 2

Participating in quality projects, looking for new methods andsolutions, actively working to improve hospital quality.
5. Actively receiving feedback on the effectiveness and efficiency of QI
activities.
6. Identifying activities and medical services that increase hospital’s
prestige.
7. Identifying supporting processes that influence medical services’effectiveness and efficiency.
8. Creating an environment that encourages everyone’s participationand development. For example, acknowledging staff’s efforts andachievements in hospital QI.
9. Providing necessary structure and resources to support strategicplans of the hospital/departments.
10. Discovering and appointing a capable, reliable, and skillful person totake charge of QM.

Session 1

B. Ten commitments (cont’d):4.

Fulfilling the role of the hospital director to improve QM/PS

Session 5

Fulfilling the role of the hospital director to improve QM/PS

4. QM council’s activities :a) The chairman assigns tasks to members and develops the council’s
working regulations;b) The chairman establishes QM system, develops and issues documents
on QM in the hospital;c) The council organizes regular and ad-hoc meetings to support, monitor
and give recommendations for QM.

PART II. SHARING DIFFICULTIES AND ADVANTAGES OF HA NOI LUNG
HOSPITAL
1. Five advantages:+ Consistent leadership and implementation+ QM staff have knowledge, skills, enthusiasm and are responsible+ Considerable international cooperation scientific research+ High prestige and trust+ Supports from Ha Noi DOH

2. Seven difficulties:+ Infrastructure+ Financial mechanisms+ Staff’s satisfaction with current hospital quality+ Staff’s “bad” habits in performing daily professional tasks+ Punishment and reward mechanism is old-fashioned.
+ Safety for healthcare workers when unsafe incidents happen to patients.
+ Subsidy remains because of the hospital’s current disease pattern: TB is a social disease,which needs state budget to ensure high services for TB patients (donors’ supports havedecreased significantly or no longer exist).

Fulfilling the role of the hospital director to improve QM/PS

Selection of 5S and reasons (cont‘d):Annex

Fulfilling the role of the hospital director to improve QM/PS- Hospital quality assurance activities are implemented
according to the “Hospital Quality Standards” issued by
the MOH in 2013. In 2015, the hospital scored 3.75/5.00(raking good because there were no items scored 01 or 02)- Departments are actually badly organized- Incidents happen to patients (statistics is however notavailable)- Damage and discard of medical materials, drugs andmedical equipment still happen- Traffic jam and narrow working environment indepartments are common.

Session 7

5. Organization and tasks of the council and QM department/unit; tasks
and authority of QM department/unit’s chief and staff, members of
QM network follow the guidance under Article 11, Article 12, Article
13, Article 14, Article 15 in this Circular.

Selection of 5S and reasons:Session 6

Article 10: Organization of quality
management system in the hospital.

Fulfilling the role of the hospital director to improve QM/PS+ 5S is valuable in ensuring medical safety, especially PS,
and is the core of hospital quality+ 5S implementation doesn’t depend much on basic factors
such as technical/professional qualification, medical
equipment, infrastructure, income, etc.
+ High feasibility and high chance of success.

125

Fulfilling the role of the hospital director to improve QM/PS*Initial results of 5S implementation in Microbiology
Department:+ Why Microbiology Department: because the department
has been implementing the project “Improvement oflaboratories towards standard” under EXPAND-TB
Project, supported by FIND–CDC.
+ Results: Achieved 3* under laboratory quality evaluationaccording to U.S. CDC’s criteria.

*Next activities:+ In Microbiology Department: Continuing improvement
and quality enhancement to reach ISO 15189 standards+ Implementing 5S in Pharmacy Storage, drug cabinets
and medical materials storage in clinical departments…

Fulfilling the role of the hospital director to improve QM/PS

The plans having been implementing:Contents
1. Administrative management+ Establishing Steering Committee+ Establishing an implementation team and recruiting staff+ Establishing a network and recruiting staff
2. Making and approving a plan
3. Training
4. Implementation
5. Evaluation, application and maintenance (standardization)
6. Procurement of necessary materials

Fulfilling the role of the hospital director to improve QM/PS

Tentative results
1.From October 1 to December 31, 2016, 5S is implemented in
Biochemistry Department, Hematology and Blood
Transfusion Department, Pharmacy Department, Medical
Equipment Department and Outpatient department.
2.From January 1 to June 30, 2017, 5S is implemented for
drug cabinets and medical materials storage in clinicaldepartments
3.From July 1 to December 31, 2017, 5S is implemented inother departments and units
Implementation at the same time
Medical Safety Assurance from October 1, 2016

Fulfilling the role of the hospital director to improve QM/PS

Thank you very much!

126

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 7 | What Can the Hospital Director Do to Promote QM/PS?

Tran Quang Hien

Session 2

The Role of the Hospital Director in Quality
Management and Patient Safety

Session 1

Session 7-2

An Giang Hospital of Obstetrics, Gynecology and Pediatrics

Session 3

2. Working areas
1. Effective leadership and management
2. Quality human resource
3. Appropriate medical equipment andfacilities
4. Ensured professional quality
5. QM/PS system• Give directions for QM/PS activities• Preside the implementation• Check and monitor QM/PS activities• Give orientation for improvement of
QM/PS

2.2. Quality human resource

Annex

1. The role of the hospital director• Compliance to legal regulations; application of the
Hospital Quality Standards by the MOH• Implementing QM models such as ISO 9001, ISO
15189…
• Developing hospital’s mission, quality policy, plans,
projects, and management procedures in atransparent manner as a basis for hospital quality
culture.
• Developing PS procedures• Monitoring compliance to procedures

Session 7• Provincial, 2nd level hospital. 300 beds
• Mostly financially independent• Opened in 10/4/2016• 12,000 outpatient turns/month (35% withhealth insurance)• Bed occupancy rate: 110%
• 25 surgeries/day• 20 normal deliveries/day

2.1. Leadership and management

Session 6

Overview of An Giang Hospital of
Obstetrics, Gynecology, and Pediatrics

Session 5

Dr. Tran Quang Hien, MD, PhD
Director of An Giang Hospital of Obstetrics,
Gynecology, and Pediatrics

Session 4

THE ROLE OF
THE HOSPITAL DIRECTOR INQUALITY MANAGEMENT AND
PATIENT SAFETY• Verifying diplomas and practising certificatesof doctors and healthcare workers;
monitoring and evaluate staff’s professional
skills• There must be job descriptions, individual
CVs and working orientation for staff• Providing trainings for healthcare workers• Health protection and safety program for
staff

127

2.3. Medical equipment and facilities• Ensured safe and effective buildings• Safe electricity system, with good reserve
power system; Sufficient, effective and safe
water supply system;• Proper disposal of solid and liquid medical
waste;• Infection control program

2.4. Ensured professional quality• Issuing treatment protocols with regular
updates; Patients are guided to participate in
the treatment process (clinical pathways);
Assessing doctors’ and nurses’ professional
capacity• Accurate patient identification procedures• Accurate laboratory test services (ISO15189); accurate diagnostic imaging;• Safe and proper drug use; proper use ofanesthesia and analgesics;• Surgery services appropriate to patient’s
needs

2.5. Quality and patient safety
improvement system• Establishing QMD and Customer Service Department• Establishing incident reporting system with incident
analysis; establishing a system to receive andhandle customer complaints• Establishing monitoring procedures for high-riskpatients• Customer Service Department monitor patient andstaff satisfaction with analysis for improvement• Quality and PS communication system for staff

3.1. Leadership and management• Operating license issued for the hospital• Examination procedures for patients withhealth insurance following regulations• Implementation of Circular 19/2013/TT-BYT
on quality management• Implementation of ISO 9001, 15189 forlaboratories• Master plan for hospital development by
2020, with orientation to 2030 developed• Procedures are developed, their compliancechecked and monitored

3.2. Quality human resource• Doctors, nurses, technicians… withpostgraduate degrees and years-longexperience• Healthcare workers have proper
practising certificates; nursing
contests organized• Continuous trainings for skill
improvement• Health protection and safety program
implemented for staff

3.3. Medical equipment and facilities• Buildings were renovated to beappropriate with specialty activities• Electricity, water and oxygen supply
systems work effectively• Proper treatment of solid and liquid
medical waste, as well as trash

3.4. Professional capacity

3. Implementation in An Giang Hospitalof Obstetrics, Gynecology, & Pediatrics

128• Treatment protocols are updated timely• Procedures for patient identification,
prevention of wrong surgeries;
prevention of incorrect newborn
identification• Safe, proper, and effective drug use(ABC/VEN)• Surgical services with reasonable costs

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Session 7 | What Can the Hospital Director Do to Promote QM/PS?

3.5. QM/PS System

Session 2
Session 3

4. Conclusions

Session 1• QM Unit and Customer Service Unit were
established• IRS was established• Customer complaints system wasestablished• Analysis, evaluation of patient satisfaction• Website, fanpage, and email are used forcommunication on QM/PS.

Implementation of QM/PS is the mosteffective when the director can identify
his roles and responsibilities.

Session 4
Session 5
Session 6

THANK YOU

Session 7
Annex
129

Forum Outline
2nd Vietnam Forum on Quality Management and Patient Safety
Da Nang, Vietnam, 2016

Introduction:
The Vietnam Forum on Quality Management and Patient Safety is one of the threemain activities of the project Strengthening Management Capability for Quality and Safety
in Healthcare, under the Program for International Promotion of Japan’s Healthcare
Technologies and Services, funded by Japan’s Ministry of Health, Labor and Welfare.
The project is implemented by National Center for Global Health and Medicine (NCGM)
with assistance from NCGM – Bach Mai Hospital Medical Collaboration Center (MCC).
The co-host of the second Forum (September 2016) is Da Nang Hospital for Women andChildren.

Objectives:
1.

To share experience of achievements and challenges in hospitals;

2.

To discuss practical solutions to tackle challenges; and3.

To enhance communication among graduates and their colleagues who areinterested in quality and safety in healthcare.

Venue:Da Nang Hospital for Women and Children, Da Nang City, Vietnam

Program:130

27/09/2016 (Tuesday) 		

Hospital tour 			

28/09/2016 (Wednesday)

Presentations and discussion (Day 1)		29/09/2016 (Thursday) 		

Presentations and discussion (Day 2)

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Annex

Session 1

Program
Program 28/09/2016
Reception and registration

08:30 - 08:35

Welcome speech by the Director of Da Nang Hospital for Women and Children

08:45 - 09:00

Forum objectives - Dr. Shinsuke Murai (NCGM)

Session 1

How to implement 5S effectively?
learntDr. Le Viet Nho, Quang Nam Central General Hospital

Session 3

5S implementation in clinical and paraclinical departments: Results and lessons
09:00 - 09:15

Session 2

08:00 - 08:30

Evaluation of 5S implementation in National Hospital for Obstetrics andGynecology
Dr. Vu Van Du, National Hospital for Obstetrics & Gynecology
09:35 - 10:15

Evaluation report on 5S implementation in Thai Nguyen Central General Hospital
Dr. Dang Hoang Nga, Thai Nguyen Central General Hospital

09:45 - 10:00

Coffee breakand difficulties
Dr. Tran Thi Quynh Anh, Thai Binh Provincial General Hospital

10:15 - 10:30

Session 5

Results of 5S implementation in Thai Binh Provincial General Hospital: Advantages
10:00 - 10:15

Session 4

09:15 - 09:30

Challenges in 5S implementation in Ha Dong General Hospital
Dr. Nguyen Thi Huong Lien, Ha Dong General Hospital
Discussion

11:30 - 13:00

Lunch

Session 2

How to make incident reporting system work?

Session 6

10:30 - 11:30

Initial results of implementing incident reporting system in Quy Hoa National
Leprosy & Dermatology Hospital
Dr. Nguyen The Toan, Quy Hoa National Leprosy & Dermatology Hospital
13:15 - 13:30

Dr. Phan Anh Phong, Ha Nam Provincial General Hospitall
The incident management journey in Tu Du Hospital
Dr. Tran Nguyen Nhu Anh, Tu Du Hospital

13:45 - 14:45

Discussion

14:45 - 15:00

Coffee break

Session 3

Guidelines in hospital

15:00 - 15:15
15:15 - 16:00

Annex

13:00 - 13:15

Failures in operating incident reporting and management system

Session 7

13:00 - 13:15

Experience in improving hospital guideboard system
Ms. Huynh My Thu, Thu Duc District Hospital
Discussion

131Program 29/09/2016
Session 4
08:30 - 08:45

How to ensure quality and safety in clinical work?
Surgical safety in Bach Mai Hospital
Dr. Nguyen Thi Huong Giang, Bach Mai HospitalSome experience in implementing surgical safety checklist in Ha Tinh Provincial

08:45 - 09:00

General Hospital
Dr. Hoang Song Hao, Ha Tinh Provincial General Hospital

09:00 - 09:15

Actual state of applying surgical safety checklist in Hue Central Hospital
Dr. Phan Hai Thanh, Hue Central Hospital
Applying PDCA to continuous quality improvement: An example in microbial

09:15 - 09:30

stewardship in Cho Ray Hospital
Dr. Ton Thanh Tra, Cho Ray Hospital

09:30 - 10:30

Discussion

10:30 - 10:45

Coffee break

Session 5

How to reduce waiting time?
Acceleration of specimen collection and sending test results to doctors within the

10:45 - 11:00

first 24 hours of emergency response
Dr. Pham Viet Thai, Ninh Thuan Provincial General Hospital

11:00 - 11:45

Discussion

11:45 - 13:00

Lunch

Session 6

The role of quality management department in hospital
Procedure for handling healthcare complaints and denunciations in Department of

13:00 - 13:15

Medical and Pharmaceutical Professional Qualification Management (MOH)
Dr. Cao Duc Phuong, Medical Services Administration, Ministry of Health

13:15 - 13:30

The role of quality management department
Dr. Duong Huy Luong, Medical Services Administration, Ministry of Health

13:30 - 14:15

Discussion

14:15 - 14:30

Coffee break

Session 7

What can the hospital director do to promote QM/PS?
Fulfilling the role of the hospital leader to improve quality management and patient

14:30 - 14:45

safetyDr. Pham Huu Thuong, Hanoi Lung Hospital

14:45 - 15:00

The role of the hospital director in quality management and patient safety
Dr. Tran Quang Hien, An Giang Hospital of Obstetrics, Gynecology and Pediatrics

15:00 - 15:45
15:45 - 16:00

132

Discussion
Closing - Dr. Duong Huy Luong

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Annex

Session 1

Organization
Da Nang Hospital for Women and Children:
Dr. Thai Thi Thanh Thuy, MD, 2nd Degree Specialist, Deputy Head of Quality Management
Department
Dr. Huynh Thi Bich Ngoc, MD, 2nd Degree Specialist, Head of Department of Direction of
Healthcare Activities - Training and International Cooperation
Chairs:Dr. Nguyen Thi Huong Giang, MD, MSc, Head of Quality Management Department, BachMai Hospital

Session 3

Session 1: How to implement 5S effectively?

Session 2

Dr. Tran Dinh Vinh, MD, PhD, Director

Dr. Tran Nguyen Nhu Anh, MD, MSc, Deputy Head of Quality Management Department,
Tu Du Hospital
Dr. Le Viet Nho, MD, PhD, Vice Director, Quang Nam Central General Hospital
Dr. Vu Van Du, MD, PhD, Head of Quality Management Department, Head of Treatment
Services Department, National Hospital of Obstetrics and Gynecology

Dr. Tran Thi Quynh Anh, MD, 1st Degree Specialist, Deputy Head of Quality Management
Department, Thai Binh Provincial General Hospital

Session 5

Dr. Dang Hoang Nga, MD, MSc, 2nd Degree Specialist, Head of Quality Management
Department, Vice Director of Center for Training – Direction of Healthcare Activities, Thai
Nguyen Central General Hospital

Session 4

Presenters:

Dr. Nguyen Thi Huong Lien, MD, MSc, 2nd Degree Specialist, Head of Quality
Management Department, Ha Dong General Hospital
Chairs:Dr. Le Viet Nho, MD, PhD, Vice Director, Quang Nam Central General Hospital

Session 6

Session 2: How to make incident reporting system work?

Ms. Huynh My Thu, MSc, Head of Quality Management Department, Thu Duc District
HospitalDr. Nguyen The Toan, MD, PhD, Head of General Planning Department, Quy Hoa Central
Leprosy – Dermatology Hospital

Session 7

Presenters:

Dr. Tran Nguyen Nhu Anh, MD, MSc, Deputy Head of Quality Management Department,
Tu Du Hospital
Chairs:Dr. Vu Van Du, MD, PhD, Head of Quality Management Department, Head of Treatment
Services Department, National Hospital of Obstetrics and Gynecology

Annex

Session 3: Guidelines in hospital

Dr. Tran Thi Quynh Anh, MD, 1st Degree Specialist, Deputy Head of Quality Management
Department, Thai Binh Provincial General HospitalPresenter:
Ms. Huynh My Thu, MSc, Head of Quality Management Department, Thu Duc District
Hospital

133

Session 4: How to ensure quality and safety in clinical work?
Chairs:Dr. Tran Quang Hien, MD, PhD, Director, An Giang Hospital of Obstetrics, Gynecology
and Pediatrics
Dr. Phan Hai Thanh, MD, PhD, Head of Quality Management Department, Deputy Headof Abdominal Surgery Department, Hue Central HospitalPresenters:
Dr. Nguyen Thi Huong Giang, MD, MSc, Head of Quality Management Department, BachMai Hospital
Dr. Hoang Song Hao, MD, 1st Degree Specialist, Head of Quality Management
Department, Ha Tinh Provincial General Hospital
Dr. Phan Hai Thanh, MD, PhD, Head of Quality Management Department, Deputy Headof Abdominal Surgery Department, Hue Central Hospital
Dr. Ton Thanh Tra, MD, MSc, Head of Quality Management Department, Cho Ray
Hospital
Session 5: How to reduce waiting time?
Chairs:Dr. Ton Thanh Tra, MD, MSc, Head of Quality Management Department, Cho Ray
HospitalDr. Dang Hoang Nga, MD, MSc, 2nd Degree Specialist, Head of Quality Management
Department, Vice Director of Center for Training – Direction of Healthcare Activities, Thai
Nguyen Central General HospitalPresenters:
Dr. Pham Viet Thai, MD, 1st Degree Specialist, Head of Quality Management Department,
Ninh Thuan Provincial General Hospital
Session 6: The role of quality management department in hospital
Chairs and Presenter:
Dr. Duong Huy Luong, MD, PhD, Deputy Head of Quality Management Department,
Medical Services Administration, Ministry of Health
Session 7: What can hospital director do to promote QM/PS?
Chairs:Dr. Duong Huy Luong, MD, PhD, Deputy Head of Quality Management Department,
Medical Services Administration, Ministry of HealthDr. Tran Dinh Vinh, MD, PhD, Director, Da Nang Hospital for Women and Children
Dr. Le Hong Trung, MD, MSc, Director, Vinh Phuc Provincial General HospitalPresenters:
Dr. Pham Huu Thuong, MD, MPH, Director, Hanoi Lung Hospital
Dr. Tran Quang Hien, MD, PhD, Director, An Giang Hospital of Obstetrics, Gynecology
and Pediatrics
Coordinator:
Dr. Shinsuke Murai, DDS, PhD, NCGM
Mr. Jun Moriyama, RN, MSN, NCGM
Secretariat:
Ms. Nguyen Hong Anh, MSc, MCC
Ms. Le Thi Thu Phong, MCC
Dr. Nguyen Thi Le Hang, MD, PhD, MCC
Ms. Pham Thi Phuong Thuy, MPH, MCC

134

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Annex

Session 1

Hospital Tour Program
Program 27/09/2016

Welcome speech by the Director of Da Nang Hospital for Women and Children

08:40 - 08:50

Introduction by Department of Quality Management

08:50 - 08:55

Speech by Dr Shinsuke Murai (NCGM)

08:55 - 09:00

Speech by representative of the visiting delegation

09:00 - 10:30

Hospital tour - Group 1

Session 4

08:30 - 08:40

Session 3

Welcome and Introduction

Session 2

08:30 - 09:00

Visiting Reception
Visiting Outpatient Department (OPD)
Visiting Laboratory

08:55 - 09:00
Visiting Postnatal & Child Care Department

09:00 - 10:30

Hospital tour - Group 2
Session 7

Visiting Neonatal Deparment
09:00 - 09:45

Session 6

Visiting Neonatal Deparment

Session 5

09:00 - 09:45

Visiting Postnatal & Child Care Department
Visiting Reception

Annex

Visiting Outpatient Department (OPD)
08:55 - 09:00
Visiting Laboratory

10:30 - 11:00
11:00

Feedback, Discussion and Closing
Lunch

135

List of Participants

136

No.

Name

Affiliation

1

Duong Huy Luong2

Do Hong Phuong

UNICEF

3

Kyoko Takashima

JICA

4

Pham Van Man

Dien Bien Provincial General Hospital

5

Dang Thi Tu Loan

Dien Bien Provincial General Hospital

6

Pham Quang Phuoc

Son La Department of Health

7

Bui Thi Hoa

Son La Department of Health8

Do Huu Minh

Son La Provincial Health Education and Communication Center

9

Nguyen Van Long

Mai Son District Hospital, Son La Province

10

Cam Thi Huong

Son La Provincial General Hospital

11

Lo Thi Bich Ngoc

Son La Provincial General Hospital

12

Bui Ngoc Minh

Son La Provincial General Hospital

13

Dao Viet Hung

Lai Chau Provincial General Hospital

14

Bui Duc Vuong

Lai Chau Provincial General Hospital

15

Nguyen Khanh Thuan

Lao Cai Provincial General Hospital

16

Nguyen Ngoc Minh

Lao Cai Provincial General Hospital

17

Tran Lan Anh

18

Nguyen Trung Hieu

Yen Bai Provincial General Hospital

19

Do Dinh Van

Hoa Binh Provincial General Hospital

20

Le Tien Thanh

Hoa Binh Provincial General Hospital

21

Dang Hoang Nga

Thai Nguyen Central General Hospital

22

Nguyen Thi Huong Giang

Bach Mai Hospital

23

Nguyen Thi Thu Ha

Bach Mai Hospital

24

Nguyen Thi Huong Lien

Ha Dong General Hospital

25

Nguyen Xuan Thiem

Ha Dong General Hospital

26

Nguyen Thi Xuan

Me Linh General Hospital

27

Pham Huu Thuong

Hanoi Lung Hospital

28

Vu Van Du

National Hospital for Obstetrics and Gynecology

29

Nong Minh Hoang

National Hospital for Obstetrics and Gynecology

30

Uong Thanh Tung

Saint Paul Hospital

31

Tran Thi Quynh AnhThai Binh Provincial General Hospital

32

Pham Thi Phuong Hanh

Ninh Binh Provincial General Hospital

Quality Management Department, Medical Services Administration, Ministry of
HealthYen Bai Department of Health
Yen Bai Provincial General Hospital

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

AnnexNo.

Name

Affiliation

Ha Tinh Provincial General Hospital

36

Hoang Quoc Anh

Ha Tinh Provincial General Hospital

37

Nguyen Trong Tam

Vinh International Hospital

38

Phan Hai Thanh

Hue Central Hospital

39

Dang Duy Quang

Hue Central Hospital

40

Pham Nguyen Da Thao

Hue Central Hospital

41

Tran Le Bao Tram

Hue Central Hospital

42

Tran Thi Thuy Phuong

Hue Central Hospital

43

Ngo Viet Loc

Hue Medical and Pharmaceutical University Hospital

44

Le Viet Nho

Quang Nam Central General Hospital

45

Tran Quang Dat

Quang Nam Central General Hospital

46

Tran Hoai Bao

Quang Nam Central General Hospital

47

Phan Thi Thu Thuy

Quang Nam Central General Hospital

48

Nguyen Thi Thao

Quang Nam Central General Hospital

49

Nguyen Huu Xuan Truong

Da Nang Department of Health50

Tran Dinh Vinh

Da Nang Hospital for Women and Children

51

Nguyen Son

Da Nang Hospital for Women and Children

52

Le Thi Hoa

Da Nang Hospital for Women and Children

53

Nguyen Thanh Van

Da Nang Hospital for Women and Children

54

Huynh Thi Bich Ngoc

Da Nang Hospital for Women and Children

55

Thai Thi Thanh Thuy

Da Nang Hospital for Women and Children

56

Nguyen Tran Anh Thu

Da Nang Hospital for Women and Children

57

Le Thi Nhu Quynh

Da Nang Hospital for Women and Children

58

Nguyen Thi Thanh Hong

Da Nang Hospital for Women and Children

59

Tran Dinh Trung

Da Nang Hospital for Women and Children

60

Hua Thi Le Chi

Da Nang Hospital for Women and Children

61

Nguyen Bang Dinh

Da Nang Hospital62

Le Gia Loc

Da Nang Hospital

63

Duong Thi Vy Yen

Da Nang Eye Hospital

64

Phan Huu Hao

Da Nang Hospital for Mental Health65

Doan Van Hung

Da Nang Dermato-Venereology Hospital

66

Nguyen Duy Khanh

Da Nang Traditional Medicine Hospital67

Ho Quy Phuong

Da Nang Traditional Medicine Hospital68

Le Dinh Cu

Da Nang Rehabilitation Hospital

69

Dang Thi Phuong Dung

Da Nang Hospital for Tuberculosis and Lung Diseases

70

Tran Thi Anh Nguyet

Lien Chieu District Hospital, Da Nang

Annex

Hoang Song Hao

Session 7

35

Session 6

Vinh Phuc Provincial General Hospital

Session 5

To Quang Hung

Session 4

34

Session 3

Vinh Phuc Provincial General Hospital

Session 2

Le Hong Trung

Session 1

33

137

138

No.

Name

Affiliation

71

Ngo Thi Cam Vien

Lien Chieu District Hospital, Da Nang

72

Le Thi Thuan

Thanh Khe District Hospital, Da Nang

73

Tran Hung Minh

Thanh Khe District Hospital, Da Nang

74

Pham Thi Thu Hoa

Hai Chau District Hospital, Da Nang

75

Kim Thi Thuan

Hai Chau District Hospital, Da Nang

76

Tran Thi Phi Nga

Son Tra District Hospital, Da Nang

77

Phan Xuan Thanh

Ngu Hanh Son District Hospital, Da Nang

78

Nguyen T. Don

Cam Le District Hospital, Da Nang

79

Dang Thi Cong

Hoa Vang District Hospital, Da Nang

80

Ha Vi Khanh

Hoa Vang District Hospital, Da Nang

81

Tran Thi Hang

Family Hospital Da Nang

82

Su Thi Ngan

Hoan My Hospital Da Nang

83

Pham Thi Hong Nhi

Binh Dan Hospital, Da Nang

84

Le Thi Hoang Van

Da Nang Oncology Hospital

85

Nguyen Thi Ha

Da Nang Oncology Hospital

86

Nguyen The Toan

Quy Hoa National Leprosy - Dermatology Hospital

87

Pham Viet Thai

Ninh Thuan Provincial General Hospital88

Ton Thanh Tra

Cho Ray Hospital

89

Dang Hoang Vu

Cho Ray Hospital

90

Tran Quang Hien

An Giang Hospital of Obstetrics, Gynecology and Pediatrics

91

Huynh My Thu

Thu Duc District Hospital, Ho Chi Minh City

92

Luong Hoang Liem

Thu Duc District Hospital, Ho Chi Minh City

93

Luong Ngoc Minh Thanh

Thu Duc District Hospital, Ho Chi Minh City

94

Tran Nguyen Nhu Anh

Tu Du Hospital

95

Phan Thi Hang

Hung Vuong Hospital

96

Tran Thi Thanh Thuy

Hung Vuong Hospital97

Le Thi Kim Dai

Can Tho Central General Hospital

98

Shinsuke Murai

NCGM, Japan99

Jun Moriyama

NCGM, Japan

100

Koji Wada

NCGM, Japan

101

Yuni Otsuka

NCGM, Japan

102

Nguyen Hong Anh

MCC Hanoi

103

Le Thi Thu Phong

MCC Hanoi

104

Luong Xuan Truong

Photographer

Practices in Hospital Quality Management and Patient Safety in Vietnam: Challenges and Achievements Volume 2

Annex

Session 1

Session 2

Session 3

Session 4

Session 5

Session 6

Session 7

Annex

139

Practices in Hospital Quality Management and Patient Safety
in Vietnam: Challenges and Achievements
Volume 2

Based on Proceedings and Discussions in the 2nd Vietnam Forumon Quality Management and Patient Safety, Da Nang, Vietnam in September 27-29, 2016
Edited by Ms. Hong-Anh Nguyen1 and Dr. Shinsuke Murai2		

1. NCGM - Bach Mai Hospital Medical Collaboration Center, Hanoi, Vietnam

		

2. National Center for Global Health and Medicine, Tokyo, Japan

National Center for Global Health and Medicine (NCGM)
1-21-1, Toyama, Shinjuku-ku
Tokyo, Japan
www.ncgm.go.jp

The document was printed in February in 2018.
The document was made in the research on "Visualization of progress of efforts on quality and safety in healthcare in developing countries(T.Nakasa and S.Murai)" funded by The Grant for National Center for Global Health and Medicine (27 Shitei 2).