Suggestions on establishing a quality management department for nguyen trai hospital

I MINISTRY OF EDUCATION AND TRAINING HOCHIMINH CITY UNIVERSITY OF FOREIGN LANGUAGES-INFORMATION DEPARTMENT OF INTERNATIONAL TECHNOLOGY BUSINESS ADMINISTRATION GRADUATION PAPER SUGGESTIONS ON ESTABLISHING A QUALITY MANAGEMENT DEPARTMENT FOR NGUYEN TRAI HOSPITAL Student's name: TRUONG LE QUE ANH ) , Student's Code: llDH490103 Advisor: TRAN TUY NGA, MBA JUNE, 2015 I ACKNOWLEDGEMENT I am taking this opportunity to express my deep gratitude and regards to all people who gave me the possibility to finish this research paper on schedule First of all, I would like to give my special thanks to my beloved family I must proudly say I have the most wonderful parents in the entire world Not only they brought me to this beautiful world but also, they always their best to assure my healthy and happy life They are the major reason and motive for me to keep on working to complete the paper no matter how hard things could possibly be Without their unconditionally love and nonstop caring, understanding and supports, I not think I could make this far Next, allow me to express my deep appreciation to my advisor, Mrs Tran Tuy Nga, for her constant instruction, valuable advices, whole-hearted support and encouragement in this research paper Also, I must acknowledge all my lecturers in HUFLIT for general and in the Department of International Business Administration for particular, who have taught me such valuable knowledge that plays an important part in my research as the theoretical base Last but not least, I am also indebted to the members of Nguyen Trai Hospital for the information provided by them in their own field CONG HOP xA HOI CHU NGHIA VII;:T NAM [)~iHQc Ngo~i Ngfr - Tin hQc Doc L~p - T\T Do - H~nh Phuc Khoa Quan Tri Kinh Doanh ADVISOR'S COMMENTS Title SUGGESTIONS ON ESTABLISHING A QUALITY MANAGEMENT DEPARTMENT FOR NGUYEN TR.AI HOSPITAL Student Code: IlDH490103 Student: Tru'o'ng Le Qu~ Anh Class: KQII-0l Advisor : Trh Tuy Nga ,MBA PRACTICALITY: The population of Ho Chi minh City has been increasing rapidly since 1975 The problem of health care services is very necessary to society nowadays This research aimed at offering A quality management department for all hospitals in HCM city in general and especially Nguy~n Triii hospital to satisfy the need of numerous patients in HCM city CONTENT The graduation paper has six chapters Chapter One : Introduction It is composed of six parts: I Background of the research Review some previous research Aims of the research benefits of the research Limit of the research Structure of the research Chapter Two Literature Review It is composed of two parts I.Overview of quality Overview of quality management Chapter Three: An Introduction ofNguy~n Trai hospital It is composed Chapter four Chapter five Chapter six Conclution of three parts 1.Introduction 2.0rganizatinnal structure Human resources : Methods and materials : Resu[ts and Discussion : Suggestions PRESENT AnON The paper contains 02 tables ,03 figures ,0 photos, to tell us how hard and enthusiastic 01 appendices with relevant notes and References the writer is The paper is well-presented GENERAL ASSESSMENT [n term of applying Department of [nternational Relations knowledge learnt at the university, the writer with ambition and diligence is capable of studying individually and scientifically In the process of completing this graduation she always shows us her self-confidence The paper is really a success at the SA level The presentation is well-illustrated, and the content is arranged logically with rather feasible suggestions SUGGESTED • I appreciate GRADE: highly this graduation paper Excellent 1-10 Chi Minh City June 9th 20 I TRAN TUY NGA, MBA - - -"' I EXAMINERS' COMMENTS , ~ IV ABSTRACT Realizing the significant roles of quality for healthcare services, this paper 1S aimed at giving out some suggestions on how to establish a Quality Management Department for Nguyen Trai Hospital The research was structured with five chapters With chapter one, readers are taken on a quick tour to have an overview on the research Next is chapter two which provides a literature review or the theoretical base of the research Chapter three introduces some basic information of Nguyen Trai Hospital Then, chapter four presents the methods and materials used in the research In chapter five, there are discussions about the results achieved from the primary research (questionnaire) Finally, chapter six presents some suggestions on establishing a Quality Management Department for the hospital v TABLE OF CONTENTS Acknowledgement Advisor's Comments Examiners' Comments Abstract List of tables List of figures Cha pter 1: INTRO DUCTI 0N 01 1.1 Background of the research 01 1.2 Review some previous researches 02 1.3 Aims of the research 03 1.4 Benefits of the research 04 1.5 Limit of the research 04 1.6 Structure of the research 04 Chapter : LITERATURE REVIEW 05 2.1 Overview of quality 05 2.1.1 Definitions of quality and cost of quality 05 2.1.1.1 Definition of quality 05 2.1.1.2 Definition of cost of quality (COQ) 06 2.1.2 Relationship between quality and cost 06 2.1.3 Necessity of quality 08 2.2 , Overview of quality management 09 2.2.1 Definition of quality management 09 2.2.2 Principles of quality management 10 2.2.3 Basic functions of quality management 12 2.2.3.1 The planning function 12 Vi 2.2.4 2.2.3.2 The organizing function 13 2.2.3.3 The controlling function 13 2.2.3.4 The stimulating function 14 2.2.3.5 The adjusting and coordinatingfunction 14 Four basic methods of quality maoagement 14 2.2.4.1 Quality inspection 14 2.2.4.2 Quality control 15 2.2.4.3 Total quality control 16 2.2.4.4 Total quality management 16 Chapter 3: AN INTRODUCTION OF NGUYEN TRAI HOSPITAL 28 3.1 Introduction 28 3.2 Organizational structure 29 3.3 Human resources 31 3.3 Board of directors 31 3.3 Medical and non-medical staff 32 Chapter 4: METHODS AND MATERIALS 33 4.1 Methods 33 4.2 Materials 33 4.2.1 Primary research 33 4.2.1.1 The location of primary research 33 4.2.1.2 The subjects and content of survey questionnaire 34 4.2.1.3 The objectives of questionnaire 34 Secondary research 35 4.2.2.1 Quality evaluationfor hospitals in Vietnam 35 4.2.2.2 Criteriafor evaluating hospital quality 36 4.2.2 Chapter 5: RESULTS AND DISCUSSION Vll 39 5.1 Overloaded situation of Nguyen Trai Hospital 5.2 Healthcare service quality from patients and their relatives' perspective Cha pter 6: 39 42 SUGG ESTI NS • 46 6.1 Outline main missions of the department 47 6.2 Plan the personnel 48 6.2.1 Administrative structure 49 6.2.2 Employee recruitment and training 51 6.2.3 Personnel policies 55 6.3 Determine the physical facilities for the department 56 6.4 Constitute a system of continuous quality improvement 57 6.4.1 Basic perspectives of Kaizen 60 6.4.2 Improved objects of Kaizen 61 6.4.3 Benefits of Kaizen 61 6.4.4 Steps to implement Kaizen 61 CO N CL U S I ON 63 List of References Appendix viii LIST OF TABLES Table 1- Criteria for evaluating hospital quality 37 Table - Two approaches to improve productivity and quality 59 ix LIST OF FIGURES Figure - Organizational Structure of Nguyen Trai HospitaL 30 Figure - Example of Administrative Structure 50 Figure - The Circle of Plan- Do- Check-Act (PDCA) 62 x skills and knowledge Analyzing feedbacks would allow the human resource department to identify any weaknesses or deficiencies in the program to avoid them from happening in the next ones For short, time, efforts, humans and money are consumed to hold a training program A successful training program would help improve performance efficiency and increase productivity; as a result, it would reduce any unnecessary costs and increase profit for the hospital In contrast, besides being a waste of money, a fail program could discourage employees by making them feel that they are boringly wasting their time for nothing Therefore, in order to save resources, a training program requires careful designing and closely monitoring as well as fair evaluation 6.2.3 Personnel policies • While recruitment brings new employees to the department, the personnel policy is a mean to keep them from leaving Policy points out rules and procedures as well as benefits and rewards that employees should know Moreover, the policy such as those about health and security helps employees understand what employers need in them and what they should Besides, policies help shape the department culture A clear policy system would reduce many unwanted issues, such as disciplinary punishments or lawsuits Also, a fair system of policies could help increase productivity and moral as well as achieving employees' loyalty Moreover, establishing a detailed system of policies could build a positive image of the department in particular and the hospital in general in patients' eyes A good image could also attract more employees with better skills and greater experiences The personnel policy system of Quality Management Department could use the policies of the hospital as a base Of course the policies of the department cannot escape the general policies of the hospital However, based on the particularities 55 of the department, some sections of the general policy could be adjusted to better fit the working condition of the department 6.3 Determine the physical facilities for the department The next task to in the establishment of Quality Management Department is to determine the physical facilities This work can be done by the supply and equipment department At first, there is one thing needed to be clear Although the Quality Management Department is established for a hospital, its working style is similar to any quality department of any business and non-business organization - that is, an office department For more details, just the same with any office, the Quality Management Department needs a location, or a room for specific The room can be anywhere as convenience in the hospital campus and, of course, has enough capacity for the working requirements The room should be equipped with some indispensable furniture such as desks, chairs, shelves, as well as other office equipment like computers, faxes, telephones, printers, photocopy machines and so on As mentioned above, the one reason why this task should come after finishing the personnel planning is because the determination of physical facilities for the department could be more accurate if we already had the estimated number of staffs who are working in it How large should the room be? How many tables and chairs that are needed? Those kinds of questions can be estimated without the number of staffs, but having the specific number gives you a good starting point to make further estimate for the physical facilities The superfluous or missing situations would not happen if this task is well planned 56 One more thing, it is necessary to keep in mind that, the number of documents and files, maybe the number of employees could increase in time Therefore, when choosing a place for the department, we should concern about this matter The location cannot be "just enough" at the starting point of the department It should have some extra spaces for any possibilities of enlargement in the future This matter should be carefully considered unless you want your staffs to work in a room so small that they could pump into each other when walking around, and files pile up all over the place because there are not enough shelves to store them Also, it is necessary to prepare a stable supply for office supplies such as papers, printing inks, pens, file covers or paper-clips These stuffs are consumed every day in the department so their supply should be well planned The surplus would cause unnecessary waste and the shortage could create inconvenience that makes works become slower This task could be the job of the supply and equipment department; still, it needs constantly reports from the Quality Management Department for in-time supply at the required quantity • 6.4 Constitute a system of continuous quality improvement The establishment of a quality management system consumes a lot of resources, such as time, efforts, humans, and money However, all of those resources could come to waste if the system is not constantly maintained and improved The quality management system is the same with any system - Soon, it would become out of date The world is changing every day, technology is continuously advancing and customer needs get more and more fastidious and diverse Therefore, in order to survive and succeed, every business has no choice but to adapt to the new situation as quickly as possible by continuously maintaining the available core competences while improving the deficiencies in the process of creating quality I would not discuss further about quality assurance in this section On the other hand, I focus only on quality improvement 57 Quality improvement is an important task of quality management Quality improvement refers to actions aiming at increasing effectiveness and efficiency of every process to achieve development that is profitable to the organization and its customers According to ISO 9000:2000, "quality improvement is a part of quality management which focuses on increasing the ability of requests fulfill." Due to the ever-fluctuation of business environment, the impact of demand factors, and customer tastes, the pressure of competition on the market as well as the fast development of new technologies, businesses are facing greater challenges to constantly improve quality Quality improvement has significant meanings as the followings • Quality improvement is a basis that gives the organization the possibility of perfecting the quality of products, services as well as other activities • Quality improvement helps the organization save expenses by shortening times, procedures and activities or reducing spoiled products in the production • By proposing appropriate ideas, quality improvement allows the organization to increase productivity and efficiency of works as well as to enhance the organization's prestige in the market • Quality management is a basis that gIves the organization the ability to renovate products, performances and create new products with better usage functions that could meet customer needs There are two approaches to improve productivity and quality for an organization, which are (1) the step-by-step approach - Improvement, and (2) the innovative approach - Breakthrough 58 Table - Two approaches to improve productivity and quality Improvement refers to small, simple, gradually accumulated and step-bystep improvements in a long time Breakthrough refers to innovations in technology or application of new production techniques Breakthrough usually is an instant event Consume little investment Consume a lot of invested capital costs Mobilize participations employees than new of managers, Most participations is from managers Have small changes and solve daily Issues Have few changes, most of them are breakthrough changes Application rate: 80% Application rate: approximately 25% The step-by-step approach (Improvement) does not cost much so it could be used on a daily basis However, the changes this approach brings are usually small, simple and could not last for a long time As a result, it requires constantly implementation to achieve the best results On the other hand, the innovative approach (Breakthrough) may consume a large amount of investment but the changes it brings to the organization are definitely satisfYing A breakthrough could help the organization take a step forward and become more competitive Also, a breakthrough could be reuse many times in a very long time and as a result, bring a lot of profits These two approaches have their good and bad so which one should we choose? The best answer is not anyone of them but both of them If we could figure out a way to balance between the two approaches, the best success could be ours There are many methods of quality improvement that are used widely all over the world However, in this research paper, I would only choose one method - 59 Kaizen Kaizen refers to activities of continuous improvement with participations of everyone to constantly improve working conditions and environment In Japanese, Kaizen is joined by "Kai" - change or make it right and "Zen" ", good or continuously improve Kaizen means accumulation of small improvements into big result It focuses on determining the matter, solving the matter and changing standards to ensure the matter is solve to the every roots Whereby, every member of the organization, from leader to worker, is encouraged to put forward even a small idea of improvement which comes from daily works Kaizen is an approach to the processes, and when the processes are improved then the results would be improved If the results are not achieved, the processes are at fault Talking about Kaizen, the following sections would cover four aspects (1) Basic perspective ofKaizen (2) Improved objects ofKaizen (3) Benefits ofKaizen (4) Steps to implement Kaizen 6.4.1 Basic perspectives of Kaizen In order to conduct the system of continuous quality improvement as Kaizen, it is necessary to keep in mind the following perspectives • The present activities always have many opportunities to improve • The means and methods at present can always be improved by some effort • Accumulation of small improvements will create a big change • It is needed to attract the entire employees Note that, we should avoid the negative perspectives about Kaizen such as: • There is no motive to propose new ideas 60 • We not have any more idea • We are no longer in a Kaizen process • We have tried so much to innovate ll?d nothing has been done 6.4.2 Improved objects of Kaizen The system of Kaizen helps improve the objects as below • Goods and services • Quantity of false, scrap and waste • Processes and performances • Working methods and working styles • Working environment and working conditions • Productivity and efficiency of using human resources • Work relationships 6.4.3 Benefits of Kaizen Kaizen brings many tangible as well as intangible benefits (1) Tangible benefits • Accumulate small improvements into big result • Reduce waste and increase productivity (2) Intangible benefits • Create motives that encourage individuals to propose ideas of improvement • Create collective and united working spirit • Create awareness orienting to reduce waste • Build organization's culture 6.4.4 Steps to implement Kaizen Steps to implement Kaizen in workplace must comply with the circle of Plan- DoCheck-Act (PDCA) As this is called a circle, when you go from Plan to Do to 61 Check then finally to Act, you start it all over again with Plan The circle must keep on rotating to create a system of continuous quality improvement The figure below would illustrate the PDCA circle of Kaizen in a more specific and easier way to understand Figure - The Circle of Plan- Do- Check-Act (PDCA) Implementinf! Collect data • Record, validate and store data • Review and revise • Analyze Data • Analyze data • Prepare report • Present report • Review and revise Evolve process • Evaluate Measurement Improvinf! , CHECK ACT 62 CONCLUSION Quality has been a remarkable concern of every company in all around the world Also, it is considered as an indispensable factor of success for any product No matter if your product is tangible (a good) or intangible (a service), it must include quality in any of its features as a required benefit towards customers Furthermore, in the present context, known as the age of globalization, the world is now "flatter" than it used to be Cusoomers are given greater power in making purchasing decisions One reason is due to the considerable advancement of the Internet, customers could make purchases from the other side of the world with just a single click on their computer or smartphones Moreover, since Vietnam joined the World Trade Organization (WTO), the tax barrier is now lowered; as a result, many foreign brands have been and are penetrating into Vietnam, which makes the competition become much tougher than ever The research paper is mainly focused on the service sector of Vietnam's economy, and the healthcare industry in particular It seems that the service sector is one step behind in compared with the manufacturing sector, especially the healthcare industry Many domestic hospitals'spend few concerns to quality since quality of services is harder to control than that of tangible products To be honest, a service requires much complex techniques to control its quality Also, good inputs not guarantee good outputs However, there is a cruel fact that the health care industry is no longer the playground for only public hospitals With a more professional style of services and more modem facilities, international hospitals are continuously increasing in number In such new challenging situation, public hospitals seems losing their market shares to the hand of these new players Honestly, the golden age of price competition is fading away, and now on the way is the age of quality competition Unless public hospitals realize the important roles of quality, they would lose on their homeland 63 This leads to the urgent need for establishing a system of quality management in every public hospital An effective quality management system could' help improve quality of health care services, create more profit by satisfying customer needs better Also, a comprehensive quality management system allows hospitals to save unwanted costs by renovating all of the processes to reduce as much waste as possible All of the members in the hospital must take part in the tasks of establishing a quality management system In addition, these tasks need helps and directions from a department in charge of quality management - that is the Quality Management Department It serves as an adviser that gives directors guidance and suggestions related to the field of quality and quality management Nguyen Trai Hospital is a senior hospital in the country and was ranked as firstclass In Nguyen Trai Hospital, there are no bed sharing and no patient must stay in the corridor Those are remarkable sides in compared with some other public hospitals However, there are still some deficiencies that need to be fixed, especially the wordy procedures and the attitudes of staffs towards patients This is another reason why Nguyen Management Department Trai Hospital - to propose should establish solutions a Quality to fulfill what are still uncompleted Throughout chapter six of this research paper, I gave out four suggestions on establishment of the department for Nguyen Trai Hospital They are not specific steps but more like a manual to help managers take a closer look on the field of quality management Based on that, they could make their own decisions on how, when, and what are the processes of setting up a Quality Management Department for the hospital , 64 PREFERENCES Bi) tieu chi danh gia ch~t IUQIlgb~nh vi~n va hu6ng dfut ki€m tra b~nh vi~n nam 2013 Retrieved on May 2015, from http://www.kcb.vnlbo-tieu-chi kiem-tra-benh-vien-nam-20 -danh -gia-chat-Iuong- benh- vien- va- huong-dan- 13/ Ca nuac thlJc hi~n dl.lttY I~ 22,3% giuOng b~nh tren Vl.llldan Retrieved on May 2015, from http://baothainguyen.org vn/tin- tuc/trong -nuoc/ ca-nuoc-thuc-hien-dat -ty-Ie-223 -giuong-benh-tren-l-van-dan-215173-206.html ChUc nang, nhi~m V\lphong Quan Iy ch~t IUQIlg.Retrieved on April 2015, from http://www.tudu.com.vn/vn/nhan- vien- y-tel guan-Iy-chat -Iuong -benh- vien/he- thong -guan -Iy-chat-Iuong/ chuc-nang -nhiem -vu-phong -guan-Iy-chat -Iuong/ Danh sach xSp hl.lng cac cO'sa y tS cong I~p tren dia ban phB He, Chi Minh Retrieved on March 2015, from http://www.medinet.hochiminhcity.gov.vn/Tin Tuc/ chuyennganhlLists/Posts/Post aspx?CategoryId=47 &ItemID=318&PublishedDate=20 14-09-14 T 19:55 :OOZ Khai ni~m chi phi ch~t IUQIlg.Retrieved on March 2015, from https://www.scribd.com/doc/80 108452/ 16/Khai -ni%E 1%BB %87m-chi-phi- ch%El %BA %A5t-I%C6%A3%El %BB%A3ng-COQ-%E2%80%93-Cost-ofQuality Lu~n van tBt nghi~p: Hoan thi~n M thBng quan Iy ch~t IUQIlgtl.li Cong ty C6 ph~n Cong trinh DuOng s~t theo tieu chuful ISO 9001:2000 Retrieved on February 2015, from http://tailieu vn/ doc/luan- van- hoan- thien -he-thong -guan-I y-chat -Iuong -tai -congty-co-phan-cong-trinh-duong-sat-theo-tieu-c-1453 " 861.html Lu~n van: Qw'm ly chit lm;mg - th\fc tqmg va m{>ts5 gild phap nhAm ap d\mg m{>tcach hQP ly va hi~u qua h~ th5ng qua tri chit lugng cac DNCN Vi~t Nam Retrieved on February 2015, from http://tailieu vn/ doc/luan- van -quan-Iy-chat -1uong-thuc-trang- va- mot -so- giaiphap-nham-ap-dung-mot-cach-hop-Iy-va-hieu-qu-185695 html Lu~n van: Th\fc tqmg m{>ts5 giai phap hoan thi~n h~ th5ng qulin ly chit lugng theo ISO 9000 dich V\l hanh chinh Retrieved on February 2015, from http://tailieu vn/ doc/luan -van-thuc-trang -va-mot -so-giai -phap- hoan- thien-hethong-quan-Iy-chat-Iuong-theo-iso-9000-trong 121 1921.html M{>ts5 phuong phap qulin ly chit lugng Retrieved on May 2015, from http://www.tcvn.gov.vn/default.asp?action=article&ID= 1429 nd Nguyen, P & Dang, S (2012) Giao trinh Quan trj Chat lut;rng(2 edition) Hanoi, Vietnam: National Economic University (NEU) publisher Official web sites of Nguyen Trai Hospital Retrieved on March 2015, from http://bvnguyentraicdt.com/ Crosby, Philip B (1979) Quality isfree New York: McGraw-Hill publisher BQ GIAO DVC vA DAo T4-0 TRUONG D4-I HQC NG04-I NGU- TIN HQC THANH PHO HO CHi MINH • KHOA QuAN TRI KINH DOANH QUOC TIt BANG KHAo SAT VE CHAT LUONG DICH VU KHAM CHUA BENH • •• • CVA BENH VIEN NGUYEN TRAI • • Xin chilO quy vi! • Toi la sinh vien nam tu clla truang HUFLIT, khoa Quan tri kinh doanh qu6c tS, chuyen nganh Kinh doanh qu6c tS Hi~n toi dang th\fc hi~n lu~ an t61 nghi~p v&i cM d€ "MQt s6 gqi y v€ vi~c l~p phong Quan tri ch~t luQTIgcho b~nh vi~n Nguy€n Trai" D~ thu th~p du li~u th\fc tS cho bai lu~, toi tiSn hanh khao sat th\fc tS v€ ch~t luQTIgdich V\l kham chua b~nh & b~nh vi~n Nguy€n Trai qua m~t CllanhUng nguai dang tf\IC tiSp su d\lng dich V\lnay Toi xin dam bao thOng tin quy vi cung dp bang khao sat se duQ'c bao m~t phl;lm vi bai lu~ an t6t nghi~p R~t mong nh~n duQ'c S\f hQ'Ptac Clla quy vi Quy vi vui long danh dAu X vao trang trU'lYCcau tnilOi minh muan chQn pHAN I: THONG TIN CHUNG Gi&i tinh clla quy vi? o o Nam Nu DQ tu6i clla quyvi? o Du&i 18 tu6i o 18 - 40 tu6i o Tren 40 tu6i I \ Trang 1/3 Quyvila: o o o o • B~nh nhan di@utri ngo~i trti B~nh nhan di@utri ni}i trti Than nhan b~nh nhan Nguoinuoib~nh N~u guy vi KHONG chQn hai m\lc "B~ob ohao" thi vui long hi) qua dIU 4, va lam tiip tit diu trO'ili Quy b~nh nhan hi~n dang kham chua b~nh t~i b~nh vi~n Nguy€n Trili theo hinh thUc: o Bao hi~m y t~ o Dich V\l Quy b~nh nhan dil kham chua b~nh t~i b~nh vi~n Nguy€n Trili duqc bao lau r6i? • pHAN II: DANH GIA TONG QUAN Quy vi vui long danh gia cac tieu chi cau Va duai day theo thang di~m tir d~n 5, vai di~m 11a tbip obit va di~m la cao nbit N~u guy vi la b~nh nhan (ho~c than nhan cua b~nh nhan) dang di@utri NGO~I TRU, vui long danh gia cac tieu chi duai day Tieu cbi daob l?:iacbuol?: Bi} rang va C\l the cua cac chi d~n, huang d~n v@quy trinh kham chUa benh Quy trinh lam tM t\lCkham chua b~nh Quy trinh kham chUa b~nh Toc di}cua cac quy trinh Khu V\fC cho lam tM t\lC va kham chua b~nh Thai di}cua nhan vi en lam tM t\lC Thai dQ cua dQi ngu y hac si v~ sinh khu V\fC kham chua b~nh nm" chung ,, Trang 2/3 N€u quy V! la b~nh nhan (ho~c' than nhan cua b~nh nhan) dang dieu tr! 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