Determinants of medical equipment performance to improve management capacity within health system in Viet Nam

Lead Research Organisation: Hanoi School of Public Health
Department Name: Medical Equipment Management

Abstract

1 Background
Medical equipment is one of the major contributors to the rapid progress of healthcare and the improvement of public health services. The constant increase in the variety and complexity of available health technologies require good management capacity to allocate the resources efficiently. The review of the World Bank's global $1.5 billion investment in medical devices showed that there are cases where 30% of the more sophisticated equipment stock was unused and the rest had 25-35% downtime. A root cause turned out to be ineffective management including planning, acquisition and subsequent operations .
In the context of limited public health care funding, ensuring resources for medical equipment and infrastructure is challenging for Vietnam. There is no official data by Vietnam Ministry of Health (MOH) on total budget for medical equipment investment, maintenance and effectiveness throughout the health system. There are international guidelines and recommendations by WHO, especially for developing countries, on how to organize the management according to the equipment life-cycle . How well Vietnam equipment management practice follow the recommended guidelines and how WHO guidelines and recommendations can apply in Vietnam are basic questions to be investigated.
The research will thus address one important, but often neglected, building block of the Vietnamese health system; Technologies, with particular focus on finding determinants of medical equipment performance to improve management effectiveness via education and training intervention.
2 Rationale
In Viet Nam, as in many other countries of a similar income level, health technology management is not well-developed. There is no sound evidence on the effectiveness of the health technologies. According to a recent report, the percentage of medical equipment in good use condition ranges from 20% to 50% of total medical equipment in use in hospitals at all levels. In addition, the percentage of equipment being maintained drops to 30% in central and provincial level hospitals, and even to 10% in district level hospitals .
The education of e.g. public health experts and/or clinical engineers in Health Technology Management is not systematically taking place in Vietnam. However, Department of Medical Equipment Management at the Hanoi School of Public Health (HSPH), the only of its kind among all health related universities in Vietnam, is responding to the importance of this area and is eager to identify priority areas to be addressed in the curriculum of master of hospital management and continuous training for health professional training program.
Access to functioning and safe medical equipment at the point-of-care is key for providing health care services to the population. Typically technology "intensive" services profit more from an improved technology infrastructure. In this sense, everybody using health care services will eventually benefit from the system change.
3. Importance
There is no current data or studies of similar systematics or scope. In the area of health systems and policies, there is thus a great interest in obtaining such reference data. The research is proposed specifically in Vietnam because of its development level - the health care expenditure on health technology in relation to the presence of appropriate management practices and education is particularly poor, i.e. there is great potential for improvement.
4. Research Impact
At all stages of the research, relevant stakeholders and policy-makers will be involved closely. The results of the research will on one hand inform the MOH in the development of policies and actions on the other hand allow the HSPH in curriculum development and on design further research.

Technical Summary

The proposed research will be investigating 30 public hospitals in Viet Nam. That allows coverage of all hospital classes, according to Circular 43/2013/TT-BYT dated 11/12/2013 by Vietnam MOH , in different geographical regions within Vietnam.
The input variables will be chosen along the management cycle. For parameters in which specific equipment types are concerned, the study will focus on 4-5 key technologies (e.g. Incubator, autoclave, anaesthesia machine, x-ray machine, etc.) in order to obtain complete and comparable results. Variables are:
a) Human resources presence, education and skills
b) Degree of adoption of Health Technology Assessment
c) Equipment procurement costs as share of total expenditures
d) Equipment repair practices (mix of in-house and outsourced services)
e) Following of preventive maintenance practices
f) User training and documentation

The dependent variable will be the performance of the equipment. This is a combined indicator comprising of different qualitative and quantitative dimensions:
i. Presence of functional devices necessary to provide clinical services
ii. Average down-time of devices
iii. Number of incidences
iv. Safety status of devices
v. Satisfaction of staff, i.e. equipment users
vi. Total costs of unitized equipment
The data will be collected by visiting the study hospitals and making in-depth interviews, focus group discussions, self-administered questionnaires, analysis of the electronic inventory and accounting data, technical inspections and checks. The data will be analysed by multivariate regression in order to find determinants for good performance.
In addition, a desk study will be done to synthesize available reference materials. Interviews with key informants such as policy makers from MOH, provincial health department, educators, relevant professional associations, medical equipment manufacturers will be organized.

Planned Impact

Impact
1 Short term impact (during the grant)
- The research objectives are in line with the priorities of the Ministry of Health (MoH) and the development plans of the Hanoi School of Public Health (HSPH). The project is aiming at having practical involvement of the partners from an early stage. This will be assured by regular board meetings and joint activities. As a result, the research grant as has, and will further put health technology management on the agenda of both the HSPH and the MoH, raise the importance and create the necessary awareness for a system change.
- There is little or information and evidence on the determinants of medical equipment performance in the Vietnamese health care system. The data collection in both the qualitative and the quantitative study will inform decision-makers and key stakeholders throughout the process of the research. Reports on sub-topics and preliminary data analysis will be shared and discussed as early as possible in order to generate targeted data and evidence needed to improve the health system.
2 Mid-term impact (by the end of the grant)
- The Department of Medical Equipment Management at the HSPH is committed during and after the research to use the newly generated evidence to identify priority areas for the curriculum of the master of hospital management and continuous training for health professional training program. Health workers are expected to benefit from the advancements in academic and non-academic education.
- The health technology industry is complex and growing at a fast pace. In many countries, actual structures in place are dating back from times when devices and instruments were rather simple and basic. International experience together with the survey in the country will generate improved capacities and alongside suggest and promote structures (positions, job-profiles, responsibilities) to meet the needs of today's health technology infrastructure in Vietnam.
- The research outcomes will also identify and compare successful and less successful ways of managing medical devices in hospitals through number of indicators. A clear, concise and targeted dissemination of the research findings and an active dialogue of the HSPH with the hospital management are envisaged to assure effective management practices will be adopted.
- Medical devices are part of the public health policy. The HSPH with her advisory role and specific experts will during and after the research promote and advocate a policy change together with the MoH that is reflecting the importance of medical devices for health care services provision and make use of the evidence generated in this work.
3 Indirect and long-term impact (beyond the grant)
- The research outcome will allow the health care providers and decision-makers to measure the impact of medical devices on the Quality of Care (e.g. if the equipment used is effective, efficient, accessible, patient centred, equitable and safe). The work eventually proposes an approach for decision-making at country level, to make informed strategic interventions for predictable improvement in quality of care.
- Financial resources for medical devices and subsequent operations are limited in the Vietnamese heat care system. Even more important the scare resources are used in an economic way. Currently, cost-effectiveness is often compromised by new or donated equipment which is idle, used incorrectly or non-functional. The study will deliver answers to the question of cost-effectiveness of specific medical device groups and concrete recommendations for improvements.
- The research project is also creating further heath systems research capacity at the HSPH. In a future full-scale project, the researchers would aim for building a regional team, and apply a similar methodology in neighboring countries. The work will contribute to the advancement of scientific knowledge nationally and internationally and constitute a basis for further research.

Publications

10 25 50
 
Description National Academy of Medical equipment regulatory affair
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
 
Description National Medical Equipment Policy Review
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact National policy review report done. Results has been advocated to Ministry of Health Recommendations from policy review report were taken into consideration for the new government decree of medical equipment management drafting process Report results was used to finish, supplement to qualitative tools. One publication in Vietnamese has been started writing as one more channel of policy advocacy.
URL https://drive.google.com/file/d/0B3i2o0udLZIMZzVTU2N3LTVhN3c/view?usp=sharing
 
Description National policy review used as training material
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Policy review document is used for as training material for master of hospital management, public health specialist level 2, short course for working professional. We are currently translating the policy review report (around 120 pages) into English. We make the list of policy and their summaries available first.
 
Description Rapid advice/feedback to managers/policy makers
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact Preliminary results from quantitative data, results of national policy reviews has been advocated to Director of Department of Medical Equipment of Health Construction, Vice Director of Health Services Administration, Vice Director of Department of Planning and Finance, Ministry of Health, directors and vice directors of university and colleges teaching medical equipment management and technical, hospitals director board. Recommendations have been taken into consideration for changes within hospitals, and in regulatory framework of Ministry of Health
 
Description Set fundamental basis for managerial studies in medical equipment in Vietnam
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Title 26 equipment checklist 
Description Checklist to see how well 26 selected equipment is managed in hospital in Vietnam 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact In Vietnam, there is yet any tool develop to analyse how well an equipment is managed in a hospital. It is novel in the field in Vietnam 
URL https://drive.google.com/folderview?id=0B3i2o0udLZIMUEFZVDg2MWV3Zkk&usp=sharing
 
Title Hospital structured questionnaire 
Description Structured questionnaire to collect information about finance, human resource, information system, etc related to medical equipment management in hospital. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact This is not novel 
URL https://drive.google.com/file/d/0B3i2o0udLZIMQ1Y2MHB0bExTNEk/view?usp=sharing
 
Title List of equipment selected 
Description 4 most equipment-crowded and technology-intensive departments in a hospital are selected: Intensive care unit, operational theatre, Laboratory, and Imaging to study. In those department, 4-5 equipments were selected for the study. Criteria to select: both most popular and important equipment and rarely used but must have equipment in each department, to prevent bias in result of management practice. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact A reference list for other research interested in describing equipment management practice in hospitals and in those departments 
URL https://drive.google.com/file/d/0B3i2o0udLZIMWXZrMGFzQkZEVFE/view?usp=sharing
 
Title Medical equipment management knowledge and practice questionnaire, evaluation of determinants 
Description Health staffs in hospital is tested for their knowledge and practice of medical equipment management. They are asked for their evaluation about influence of proposed determinants to medical equipment management in their hospitals 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact It is the first time in the literature, knowledge, practice and determinants to medical equipment management is studied, not only in Vietnam but also internationally. 
URL https://drive.google.com/folderview?id=0B3i2o0udLZIMRkZUSDBWbWZpNnc&usp=sharing
 
Title Qualitative guidelines 
Description Qualitative in-depth interviews and focus group discussion are used to complement data collected in quantitative research, aiming at explanation of facts in quantitative data, exploration of reasons and possible solutions 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact Nothing novel, just based on conceptual framework 
URL https://drive.google.com/file/d/0B3i2o0udLZIMZXNFT0N3Z0I5VUk/view?usp=sharing
 
Title Research conceptual framework and methodology 
Description Based on the conceptual framework proposed, cross sectional description research design was used, combined desk study, quantitative and qualitative research. Detailed description can be found in files in attached link. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact This is the first time WHO conceptual framework of medical equipment life cycle management and health system building blocks is combined in the area of medical equipment management in Vietnam in particular and international in general. This approach can be considered for other further research in this field. 
URL https://drive.google.com/folderview?id=0B3i2o0udLZIMMXlKeG5aeW5qRW8&usp=sharing
 
Title Data analysis software 
Description Data were entered using Epidata 3.1 software. There are 26 REC files for 26 checklist of medical equipment, 3 REC files for technician, management and user entering and 1 form for general information of hospital. Every questionnaire/checklist had been check and has its own code before entering. Data entering team included 6 people who had experiment on Epidata and data entering. One training was conducted before entering data aim to make sure all the member have good understanding of questionnaires, checklist. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact Data entering team included 6 people who had experiment on Epidata and data entering. One training was conducted before entering data aim to make sure all the member have good understanding of questionnaires, checklist. 
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation Dak Lak Provincial Health Department
Country Viet Nam 
Sector Public 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation Dien Bien Provincial Health Department
Country Viet Nam 
Sector Public 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation Government of Vietnam
Department Department of Health in Hai Duong
Country Viet Nam 
Sector Public 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation Hue Central Hospital
Country Viet Nam 
Sector Hospitals 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation Khanh Hoa Provincial Health Department
Country Viet Nam 
Sector Public 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation NINH THUAN PORTAL
Country Viet Nam 
Sector Public 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation Swiss Tropical & Public Health Institute
Country Switzerland 
Sector Academic/University 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Research data collection, result buy-in for management and policy improvement 
Organisation Vietnam Ministry of Health
Country Viet Nam 
Sector Public 
PI Contribution Our research team actively set up those collaboration relationships and network. We made our partners involve in the research implementation since the beginning to ensure their buy-in of research results and recommendations upon finish. During different phases of the research, working with us helps them to further enhance their capacity in information collection, synthesis and usage of evidence in decision making. Our research team is responsible for coordination, management, and quality assurance of the research (design, tools, etc) in general and of data collection in particular.
Collaborator Contribution All partners participated in supporting research implementation, including contacting hospitals under their management to participate in the research, support data collection in hospitals, providing information or participated in qualitative research upon requested, and committed to buy in research results and recommendations in their real management practice upon finishing.
Impact With support from all listed partners, the research team has started data collection in 30 hospitals in 10 provinces. Director and staff of Department of Medical Equipment and and Health Construction, Vietnam Ministry of Health participated as research member. Ministry of Health has issued letter to all provincial health departments and hospitals to demand collaboration to implement research project and committed to consider research results and recommendations for management and policy formulation. Ministry of Health actively supplied secondary and primary information for the national policy review report. Ministry of Health, provincial health departments and hospitals participated in building, commenting research tools.
Start Year 2015
 
Description Hospital visit 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact We has visited 30 hospitals in 10 provinces in Vietnam to introduce the research, do quantitative data collection at their hospitals. We raised their interest in medical equipment management according to life cycle as recommended by WHO. They shows intention to further participation in the research and policy advocacy process for medical equipment management in Vietnam.
Year(s) Of Engagement Activity 2015,2016
 
Description Working group of Vietnamese and international experts in medical equipment management 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact We have form an expert group consist of both Vietnamese and international experts to build the research:
- Director, Department of Medical Equipment and Health Construction, Ministry of Health
- 2 staffs of Department of Medical Equipment and Health Construction, Ministry of Health
- Staffs of Department of Medical Equipment and Infrastructure management, Ha Noi School of Public Health
- Vice Dean, Ha Noi School of Public Health
- 3 experts from Health Technology Specialist group, Swiss Tropical and Public Health Institute, Switzerland
Year(s) Of Engagement Activity 2015
 
Description Workshop on research tools development 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact Ministry of Health delegates from Department of Medical Equipment Management, delegates from various different level hospital (central, provincial and district hospitals, general and specialised hospital), experts from academia attended our workshop to discuss on the research methodology, design, scope of conceptual framework, selection of equipment to study, comment on research tools. The final research tools and research design have been agreed among all. The workshop has raised further awareness for hospital staffs about medical equipment management practice according to life cycle.
Year(s) Of Engagement Activity 2015