Tóm tắt Luận án Improve management capacity supply chain in medical examination and treatment at military hospital on Hanoi - Hospital 108, 103, 354

+ The Military Medical Department continues to advise the Ministry of Defense and coordinate with agencies and units to step up the consolidation and consolidation of the military medical force throughout the army.

+ The branch maintains the rotation of military officials and employees to work in difficult areas, borders and islands.

+ Promote breakthroughs in training, training, building human resources of high quality, ensuring a balanced and synchronous medical, pharmaceutical and medical equipment;

+ Appropriate remuneration policies and policies for the contingent of military officials and physicians in accordance with the Party's policy, aimed at attracting, preserving and developing human resources, ensuring the industry's sustainable development, .

+ Deploying to build and upgrade preventive medicine system in the whole army along the direction of ensuring regional, synchronous, unified,

+ The branch continues to build and consolidate the comprehensive system of traditional medicine at all levels (the key point is the Military Traditional Medicine Institute) according to the motto "Universal in the first and intensive areas at the back".

+ The branch continues to promote the development of military medical technology in the direction of "leapfrog ".

 

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ry - Obsolete inventory - Inventory turnover - Classification of inventories. Indexes on revenue, expenses, profits. - Selling expenses - Sales - Sales profits - Return on revenue - Cash rotation (Source: Authors compiled by themselves) 1.3.2 Criteria to assess supply chain management capacity at hospitals 1.3.2.1 Capacity to make decision on logistics supply in medical examination and treatment at hospitals 1.3.2.2 The level of meeting the main professional requirements of the hospital First; Professional and technical quality Second; Functional quality 1.3.2.3 Satisfaction of the patient's medical examination and treatment needs 1.3.2.4 The level of meeting the requirements of performing tasks of each stage (medical examination and treatment) in the hospital supply chain 1.3.2.5 Activities supply , transportation , warehousing logistics in the hospital 1.3.2.6 Coordination for implementation of supply chain stages in hospitals  Table 1.2: Summary of measurement criteria for supply chain management capacity in hospitals TT Criteria Specific criteria Note 1 Capacity to make decisions on logistics supply in medical examination and treatment at hospitals Capacity to make decisions Only from the perspective of hospital staff The ability to organize making decisions Effective implementation of decisions Management capacity of logistics 2 The level of meeting the main professional work requirement at the hospital Ability to provide medical examination and treatment services From the perspective of patients and hospital staff Cure rate Quality, technical expertise Attitudes and professional operations of medical staff 3 Satisfaction of medical examination and treatment needs of patients System of signs and instructions at medical examination and treatment places From the perspective of patients and hospital staff Administrative procedures Hospital fee Facilities in clinics and disease rooms 4 The level of meeting the performance requirements of each stage At the stage of examination From the perspective of patients and hospital staff At the stage of storing medicines and medical examination and treatment equipment At the stage of patient transport Arranging sick rooms and clinics, administrative rooms Information system provided to patients 5 The coordination of implementation of the stages in the hospital Activities of coordination between logistics and medical examination and treatment Only from the perspective of hospital staff Coordinated activities between research and medical examination and treatment 6 Activities of supply, shipping, warehouse logistics Quality of transportation for patients From the perspective of patients and hospital staff Convenience of the signage system Quality of transportation vehicles and equipment The level of medicine supply (Source: Authors compiled by themselves) 1.4 Factors affecting supply chain management capacity in enterprises and organizations 1.4.1 Factors affecting supply chain management capacity 1.4.1.1 Organizational structure 1.4.1.2 Human factor 1.4.1.3 Technology factor 1.4.1.4 Effective measurement and evaluation system 1.4.1.5 Customer satisfaction 1.4.2 Factors affecting supply chain management capacity in hospitals 1.4.2.1 Organizational and operational management structure of the hospital 1. 4 . 2 .2 Hospital facilities 1.4.2.3 Staff working in the field of supply 1.4.2.4 Credibility of beneficiaries from the hospital's supply chain 1.4.2.5 Modern level of information systems and technology in hospitals Organizational structure Infrastructure Supply chain management capabilities Logistics staff Patient's credibility Technology Figure 1.9: Factors affecting supply chain management capacity in hospitals (Source: Authors compiled by themselves) 1.5. Experience of supply chain management in a number of domestic and foreign enterprises and organizations and lessons learned for military hospitals in Hanoi 1.5.1 Experience of supply chain management in a number of domestic and foreign enterprises and organizations [18] 1.5.1.1 Experience in supply chain management at IBM ( International Business Machines) - A multinational computer technology corporation. 1.5.1.2 Experience in supply chain management in a number of businesses, organizations in the field of medicine, medical equipment in the US               - Pfizer uses RFID (Radio Frequency Identification) technology: ensuring safe and efficient supply chain. - McKenson works closely with suppliers: ensuring a safe and efficient supply chain. - Roche Diagnostics: Product life cycle Management (PLM) product management 1.5.1.3 Experience from supply chain management at hospitals in Singapore 1.5.1.4 Experience from supply chain management in Vietnamese hospitals - Supply chain at Bach Mai hospital - Supply chain at K hospital - Supply chain at Le Loi Hospital - Vung Tau City 1.5.2. Lessons learned for military hospitals in Hanoi One is; General lessons for businesses and organizations               - Application of information technology is a key factor - Strategic planning in supply chain management               - Ensuring a safe and efficient supply chain               The two are; Lessons for military hospitals in Hanoi - Improve the quality of medical services at hospitals - Consider choosing more than 1 supplier. - Logistics activities can be outsourced. - Human element always needs to be improved. CONCLUSION OF CHAPTER 1 In Chapter 1 of the thesis, the author has systematized the theoretical basis of supply chain management capacity in businesses and organizations, including: Firstly, an overview of supply chains and supply chain management in enterprises and organizations . Secondly, analysis of supply chain management capacity in enterprises, organizations in general and supply chain management capacity in hospitals in particular . Thirdly, stating the criteria for measuring the capacity of supply chain management in enterprises and organizations. Fourth, analyze the factors affecting supply chain management capacity in organizational enterprises. Fifthly, stating experience in supply chain management in a number of domestic and foreign enterprises and organizations from which to draw lessons for military medical hospitals in Hanoi. The theoretical foundations in chapter 1 will be a solid foundation for the study of the current situation of supply chain management capacity in medical examination and treatment at military hospitals in Hanoi in chapter 2. CHAPTER 2 CURRENT SITUATION OF SUPPLY CHAIN ​​MANAGEMENT CAPACITY IN MEDICAL EXAMINATION AND TREATMENT AT MILITARY HOSPITALS IN HANOI 2.1. An overview of Military Hospital in Hanoi and supply chain management in Hospitals 2.1.1. An overview of Military Hospital in Hanoi 2.1.1.1. Functions and duties of the Military Medical branch               Along with well implementing the work of military medicine, health care for soldiers, the Military Medical branch continues to make great contributions to the cause of care, protection and improvement of the people's health.  2.1.1.2 History of establishment and development of Military Hospital in Hanoi               Central Military Hospital 108 Yen Trach Central Hospital - 108 Military Central Hospital was born on April 1, 1951 in Nong Village, Yen Trach Commune, Phu Luong District. Thai Nguyen province.               Hospital 103 Treatment team 3 (precursor of Hospital 103) was established on December 20, 1950 in Trung Giap village, Anh Dung commune (now Trung Giap commune), Phu Ninh district, Phu Tho province. On May 21, 1989, the General Staff Department issued Decision No. 183 / QD-TM recognizing Military Hospital 103 as the first-class hospital of the Army. In 1995, Military Hospital 103 was renamed Hospital 103.               Hospital 354                Hospital 354, formerly known as Tran Quoc Toan Medical Clinic (also known as Central Military Hospital), was established under Decree 82 / ND, dated 27/5/1949 of the Ministry of Defense General Commander. On November 30, 1974, the Ministry of Defense decided that 354 Military Hospital belonged to the Military Medical Department - the General Department of Logistics. 2. 1 .1 . 3 Major characteristics of Military Hospital in Hanoi - Hospitals were established very early, starting in the early years of the war against the French - Carry out the contents of special political duties: serving the object of senior officials in the army, military personnel and relatives in the army. - Serving special political missions; - Specific management mechanism: Under the management of the Ministry of Defense in terms of personnel as well as the executive mechanism under orders, subject to the strict control and management of the General Department of Logistics. - Expanding service subjects to be servicemen and people. 2.1.1.4 Organizational model of Military Hospital BOARD OF MANAGER Blocks 1. Internal block 2. Foreign sector 3. Subclinical block 4. Other faculties Institute, Center 1. The Orthopedic Hospital 2.Vascular card 3. Clinical Institute of infectious diseases 4. Radiation surgery center 5. Stroke center 6. Center accelerator 7. Endoscopic surgery center Administrative units 1. General Planning Division 2. Department of Science-Military 3. Nursing room 4. The Military Department 5. The department directing the line 6. Office of General Staf 8. Postgraduate Department 9. Finance Department 10. Political Division 7. Technical logistics department Figure 2. 1 . General organizational model at three Hospitals (Source: Author synthesis) 2.1.1.5. Organizational model of the Logistics - Technical Department at Military Medical Hospitals in Hanoi  Logistics - Technical Department Department of Nutrition Housing Management Board (Barracks Board) Military paramedic Military supplies Advisory Committee Boards of motor vehicles and petrol (including car fleets) 2.1.2 Supply chain management at Military Hospital in Hanoi 2.1.2.1 Supply chain management in Hospitals               Supply of pharmaceutical products for medical examination and treatment:               The hospital is a distributor and supplier of pharmaceutical products and medical equipment to end customers who are different patients, so the hospital plays an extremely important role in this assurance. Supplier:               For medical examination and treatment, the main source of pharmaceuticals and medical equipment of the hospitals is through domestic and foreign pharmaceutical companies. Producer: Although the Hospital has a medicine production department and only produces simple drugs, mainly infusion and basic medicines only meet 10% of the patients' needs in the Hospital. Therefore, the hospital must import drugs from domestic and foreign pharmaceutical manufacturing companies. 2.1.2.2. Management of operations and coordination of supply chain elements in Hospitals Supplier Foreign Domestic Agency channel Live channel Producer Figure 2. 3 . Relationship between supplier and manufacturer Transport Place Logistics information Examination and treatment Storage and treasure Figure 2. 4 . Supply chain management within the Hospital               Firstly, generalizing medical examination and treatment activities at hospitals              At 3 Military Hospital , object examination and treatment of mainly military and insurance of active military troops occupy about 14% . The next subjects are Military Insurance and Personal Insurance accounting for 22% , Health Insurance reaches about 24%. Object services contributed to almost 4 0 % , the object of social policies, you and the children only about less than 1 %. Thus, it can be seen that the main medical examination subjects are soldiers. The hospital still focuses on the service patients segment to diversify the objects of medical examination and treatment to supplement non-state budget revenues and constantly innovate to improve the quality of the hospital's health service. 14% 22% 24% 40% Military service insurance and military insuarance Pension insurance and relative insurance Health Insurance Service object Figure 2. 5. Percentage of patients with hospital patients on the island of Hanoi in 2012-2017 (Source: [7])               Secondly, storage and storage activities at Hospitals               This content analyzes the storage and storage of medical equipment, supplies and medicines at hospitals.               Thirdly, patient transportation and medicine supply activities in hospitals               At Hospital 103, the fleet annually receives nearly 70,000 liters of petrol and oil; vehicles are regularly stored and maintained at regular intervals, exploited and used with proper features, efficiency, kept well and used sustainably; meeting requirements of transporting war invalids, officials on business trips and supplies and equipment to ensure prompt and absolute safety.               Fourthly, the situation of location, departments, departments in the hospitals For the smooth running of the supply chain, the most important thing is to arrange space for the departments of Technical Logistics, Department of Equipment, Department of Pharmacy and Department of Examination. Fifth, about supply chain information               At Central Military Hospital 108, the management of the supply chain is decentralized, from the General Planning Department, the Financial Department, the Logistics - Technical Department, the Equipment Department, the Pharmacy Department without being concentrated in one room. which boards are specific. 2.2. Analysis of the current situation of supply chain management capacity in medical examination and treatment at Military Hospital in Hanoi 2.2.1 Actual situation of supply chain management in medical examination and treatment at Military Hospital in Hanoi area according to the evaluation criteria 2.2.1.1 Actual situation of logistics supply decision in hospitals                            From May 30, 2016, when the Quality Management Board - Central Military Hospital 108 was officially established, a specialized agency was set up to consult and advise the hospital's Board of Directors.               For Hospital 354 Military Hospital, according to Central Resolution 4 (Session XI), the Party Committee of the hospital has issued a specialized resolution on medical ethics.               Recently, Hospital 354 has effectively implemented the consultation of people and patients through the suggestion box system, conducted irregular medical surveys to each patient.               The fact that management capacity is weak or weak leads to a complicated and unscientific organization. This will make administrative procedures cumbersome.                             The majority of workers surveyed chose the level of dissatisfaction or anxiety about the effectiveness of decisions (mean = 2.6667). 2.2.1.2 Actual situation of meeting the main professional requirements of Hospitals               Through the statistical report of the Ministry of Health, the average cure time was shortened compared to the plan: 108 Central Military Hospital was shortened by 3 days, Military Hospital 103 shortened 2, In 5 days, 354 Military Hospital has shortened 2.6 days. The percentage of patients cured at Military Hospital are high from 80% - 91%.               However, regarding the ability to meet medical examination and treatment needs, the staff still think that they are not satisfied (mean = 2.6078). The number of patients seeking medical services every year is increasing (Military Central Hospital 108 in 2017 increased by 133% compared to 2016; Military Hospital 103 in 2017 increased the number of patients. 120% compared to 2016; Military Hospital 354 in 2017 increased the number of patients by nearly 130% compared to 2016). 2.2.1.3 Situation of satisfying patients' need for medical examination and treatment               The rate of regular bed use is over 100% and ranges from 120% to 150%, even 200% at times of high epidemic disease from February to July. Overactive patients appear in the area. examination area and inpatient treatment area: 2-3 inpatients / 1 bed, 1 clinic doctor must examine 60-100 patients / day is common.               The statistical results of the author's survey show that both employees and patients are quite satisfied but the level of satisfaction is not high (mean in the range of 3.0 - 4.0). 2.2.1.4 . Situation meets the requirements of each hospital (medical examination and treatment) in the supply chain of hospitals               Survey results of staff of CNV staff said that they were not satisfied with the level of meeting the requirements of implementing tasks of each stage in the supply chain of hospitals, especially at the stage of patient transport (mean = 2,9608) and Sewing arrangement of rooms and clinics, administrative offices (mean = 2.9098). For information storage systems, and information provided to patients has not been applied information technology, so CNV staff also only gave a level of satisfaction at 3,0275 (still confused).               For patients, the survey results also show that patients are only temporarily satisfied with the medical examination and treatment, however, patients also think that the arrangement of rooms and clinics have not met the needs of the medical examinations and treatments, so the statistical result of the patient satisfaction level is 2.6667. 2.2.1.5 Actual situation of supply and transportation of logistics warehouse in medical examination and treatment at hospitals               Survey results show that employees are also quite satisfied with the convenience and quality of the vehicles to transport patients as well as the means to transport drugs and medical equipment (mean in approx. 4)               However, the survey results for patients assessing the level of satisfaction with the quality and transportation of patients, medicines and medical equipment shows that the transportation and supply of drugs has not been timely (mean = 2.7412 to 3.2627) 2.2.1.6 Actual situation of coordinating the implementation of supply chain stages in hospitals                Military Medical Hospital is not only responsible for providing medical examination and treatment for patients who need medical examination and treatment at the hospital, but the Military Medical Hospital has an important task of taking care of the health of the army. According to the report of the Ministry of Defense, in 2017, the military medical sector has successfully completed the task of protecting and taking care of health for the army, the army's health force has always maintained firmly above 98%.               Through the results of the survey, the result is that the employees are quite satisfied about the coordination between medical examination and treatment and logistics with the percentage of satisfaction rating is mainly with mean = 3.9275.               In this stage, the survey results show that employees are satisfied with the collaboration between research and medical examination (mean = 3.9124). 2.2.2. Analysis of factors affecting supply chain management capacity in medical examination and treatment at Military Hospital in Hanoi 2 .2. 2 .1. Organizational and operational management structure of the hospital               Through the survey results from subjects employees, percentage shares agreed with the influence of the factor "Structure management and operation at the hospital" to energy management supply chain in diseases The hospital is very high (with mean of 4.3529 - 4.8186). Especially in which the qualifications of managers have a great influence on the capacity of supply chain management in hospitals (mean = 4.8186).               According to the survey results from patients in hospitals in Table 2.12 below, the factor "Structure of hospital operation management" also has a great influence on the capacity of supply chain management (votes ratio Survey results mean> 4.0). In particular, according to patients, the organization of the hospital management system has the greatest impact on the capacity of supply chain management (mean = 4.2902). 2 .2. 2 .2. Facilities for medical examination and treatment of hospitals               According to the results of the survey of hospital officials and employees shown in Table 2.13, most of the hospital staff said that "Facilities for medical examination and treatment of the hospital" have a great influence on supply chain management capabilities at hospitals (mean 4.2 to 4.5).               According to the survey results from the patient subjects shown in Table 2.14, the same results were obtained. Most patients also assessed “Hospital facilities for treatment: affecting the ability of the hospital's supply chain management (with a mean of 4.2 to 4.4). 2.2.2.3. Staff working at the hospital               The factor "Staff working in hospitals" affects the ability of supply chain management in hospitals to be quite high to very high (mean range from 3.1 to 4.7). In particular, according to hospital officials and employees, the working attitude and qualification of administrative staff in the hospital affects supply chain management capacity (mean = 3.1 and 3.7). , but does not affect the high level as professional as well as professional ethics of the medical staff (mean = 4.6 and 4.7). Clearly, in the hospital, the professional and ethical element of the team of physicians directly treating people is extremely important.               N pleased elements of "The staff of the hospital" has the capacity to influence the supply chain management from a high to very high (mean of 3.8 to 4.6). The patient also said that the professional qualifications and ethics of physicians have a major influence on supply chain management capacity (mean 4.5 and 4.6). In addition, the organization of the medical staff and administrative staff has less impact on the supply chain management capacity in hospitals (mean = 3.8). 2.2.2.4. The level of trust of the audience benefit from the supply chain of Diseases Hospital              At the end, the survey results from subjects workers and hospital officials, a majority of respondents said that the level of trust of audiences benefit from the supply chain have high impact to capacity management supply chain . In which, the level of patient satisfaction with medical examination and treatment services at the hospital is the most influential with mean = 4.4235 and the satisfaction level of patients on administrative procedures is less influential but still quite good. high with mean = 3.3765.               The satisfaction of patients with hospital services was the most influential (mean = 4.1035), the patients' satisfaction with hospital fees was lower (mean = 3.4431). . 2.2.2.5. Analysis of modern information systems and technologies in hospital               In the case of hospital officials and employees, the modernity of the information system at the hospital and the modernity of the information transmission system among departments have a great influence on management capacity of supply chain management (mean = 3.6). The modernity of the device system that updates and stores patient information has less impact on supply chain management capacity but is still quite high (mean = 3.3882).               In the surveyed patients, the factor "Modernity of information systems and technology in hospitals" also has a significant influence on supply chain management capacity. In particular, the level of modernization of the hospital information system is the most influential with mean = 3.8, while the modernity of the information transmission system between departments has a lower influence on management capacity and supply chain with mean = 3.3. This assessment is a little different from that of hospital officials. 2.3. General assessment of the current situation of supply chain management capacity in medical examination and treatment at Military Hospital in Hanoi 2.3.1 Main points - The logistics management of Hospitals has a clear division of work and close links between departments, from the General Planning Department to the Logistics - Technical Department. - Supply chain management is also effective when Hospitals select reputable suppliers. - Hospitals are interested in supporting all aspects and timely from the Ministry of Defense. - According to the assessment of patients and staff of hospitals, the supply chain management capacity in hospitals is reflected through the evaluation criteria at a quite satisfied level. 2.3.2. Limited and causes 2.3.2.1 Limitations - The supply chain management is still in its infancy and has not followed the standards of a modern supply chai

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