Phát triển dịch vụ y tế ở các bệnh viện công lập trên địa bàn tỉnh hải dương tt ta

1 INTRODUCTION Reasons for choosing the thesis topic Health services play a particularly important role in ensuring the health of the people, the quality of labor resources to meet the socio-economic development In the process of formation and development of the health sector in Vietnam after the renovation period, public hospitals have achieved many great achievements in protection, care and health promotion for the people However, the socialist-oriented market economy and the trend of international integration, public hospitals in Vietnam in general and Hai Duong province in particular have many opportunities while facing tremendous challenges in health service development under the strong impact of market laws As a province located in the Red River Delta, in the Northern Key Economic Region, Hai Duong Province has 24 public hospitals including general and specialty Public hospitals in Hai Duong province have achieved achievements such as: the increase in the number and expansion of the scope of medical services in medical examination and treatment, prevention, counseling and health care; Human resources, facilities and equipment have made significant changes, contributing significantly to improving the quality of health services, many newly deployed technologies, and applications in examination and The treatment and structure of medical services are being completed, meeting the health care needs of the people of Hai Duong and neighboring provinces, contributing to the socio-economic development of the province and the region and the whole country Along with the achieved results, health services in public hospitals in Hai Duong province still have many shortcomings, facing many difficulties in the context of growing and growing private health services Health care needs of people are increasing, disease patterns are changing However, health services in public hospitals in Hai Duong province have not met the requirements of protection and care of the people's health in the new situation, the deterioration in facilities and the limitations on professional qualifications in some hospitals, the network of specialized and hightech medical centers is incomplete and inconsistent, investment in health care is still limited, the overload in one number of hospitals; the quality of medical services have not met the requirements and the service structure is not reasonable In order to meet the increasing quality of health care needs, making an important contribution to the human resource development strategy, creating momentum for the socio-economic development of Hai Duong province, it is necessary to develop epidemics health service in public hospitals in the province Since then, the research and explanation of finding solutions that have a scientific and feasible basis for developing health services of public hospitals are topical issues with very high theoretical and practical significance especially for the development of health services of public hospitals in Hai Duong province in the direction of efficiency and sustainability in the coming time Therefore, the PhD student chooses "Development of health services in public hospitals in Hai Duong province" as a political economic thesis Research purposes and tasks * Research purposes Clarify theoretical and practical basis for developing health services in public hospitals in Hai Duong province, based on that, propose views and solutions to develop health services in public hospitals in Hai Duong province in the future * Research missions - Overview of research situation related to the thesis - Interpretation of the rationale of health education in public hospitals in Hai Duong province; clarify the experience of some provinces in the country on health service development, based on that, draw lessons for health education in public hospitals in Hai Duong province - Analyzing and assessing the current situation of health education and training in public hospitals in Hai Duong province in recent years, generalizing the issues that need to be focused on resolving health care in public hospitals in Hai Duong province in the future - Proposing viewpoints and solutions of health care in public hospitals in Hai Duong province in the coming time Subjects and scope of research * Research object: Health service development * Research scope Regarding the content: the thesis focuses on research and development on the scale, quantity, quality of health services,structure of health services (including medical examination, care, treatment, rehabilitation and traditional medicine) in public hospitals in of Hai Duong province About place of research: Public hospitals in Hai Duong province (including 24 hospitals) About research period: The dissertation examines the practical data on health education in public hospitals in Hai Duong province from 2014 to 2018 and recommends views and solutions of health care in public hospitals in the Hai Duong in the future Rationale, practice and research methods * Theoretical basis The thesis is studied based on the theoretical basis of Marxism - Leninism, Ho Chi Minh's thought and views, guidelines and guidelines of the Communist Party of Vietnam on PTDVYT, the theory of health services, Health education at public hospitals to interpret health care in public hospitals in Hai Duong province * Practical basis The thesis is completed on the basis of summarized reports and statistics of departments and agencies of Hai Duong province and the results of the actual investigation, survey and research of the author * Research Methods On the basis of the method of dialectical materialism and historical materialism, the approach of qualitative and quantitative research uses the following basic research methods: Methods of abstracting science and methods legal, historical, analytical, synthetical and comparative methods Specifically: The method of scientific abstraction is used in the whole process of dissertation implementation, especially the theoretical basis research on the development of health services in public hospitals; in analyzing and assessing the situation of development of health services in public hospitals in Hai Duong province Methods of analysis and synthesis are also used in all chapters of the thesis when studying documents, scientific works, reports, published data, to present central concepts of the thesis; regulatory issues in health service development; the current situation, advantages and limitations of health service development in public hospitals over time; issues that need to be focused on resolving, proposing views and solutions to develop health services in public hospitals in Hai Duong province in the near future The historical and logical methods used in chapter 1, chapter and chapter of the thesis to understand the process of cognitive formation of health service development in general, health service development in diseases public institutes in particular; as well as practical activities to develop health services in public hospitals in Hai Duong province in each specific historical period This method requires analysis and evaluation of health service development activities in public hospitals in Hai Duong province, which must be set in specific historical contexts, but always associated with real requirements that make up the concept of health service development in public hospitals Also used when analyzing and evaluating the experience of some countries in the world as well as some localities in the country Statistical and comparative methods are used in focus in chapter when statistics on assessing the status of health service development in public hospitals in Hai Duong province from 2014 to the present, From there, compare the targets of the years to assess the situation of health service development in public hospitals in Hai Duong province, the successes, limitations and issues that need to be focused on solving in the past health services development process next time New contributions of the thesis - Develop concepts and contents of health education at public hospitals in Hai Duong province under the perspective of political economy - Point out some issues that need to be addressed to solve problems of health care in public hospitals in Hai Duong province in the coming time - Proposing views and solutions of health education in public hospitals in Hai Duong province in the coming time The theoretical and practical significance of the thesis Theoretical meaning: The dissertation contributes to clarify the theoretical issues of health education in hospitals in general and public hospitals in Hai Duong province in particular Practical significance The thesis can be used as a reference for research and teaching political economy; The views and solutions proposed by the dissertation may be suggestive to the central and Hai Duong management agencies to offer appropriate solutions to health care providers in public hospitals in Hai Duong province today Structure of the thesis Structure of the thesis includes: Opening; chapters (10 periods); conclude; list of published works of the author related to the thesis topic; List of references and appendices Chapter RESEARCH OVERVIEWRELATED TO THE THEMES In Chapter I, the PhD student has reviewed 15 foreign projects and 24 domestic works related to the thesis Through the research of published scientific works, the author of the thesis has some general comments as follows: Firstly, the works have gained generalizations about common theoretical issues about services, health services, and development of health services from which the author of the thesis inherits the concepts for the research Second, scientific studies have analyzed the content and factors affecting the development of services and health services Some researches on experiences in development of health services in localities in the country These are very important issues for PhD student to refer to the analysis of influencing factors and draw lessons to develop health services in public hospitals in Hai Duong province Thirdly, the above scientific works have evaluated and analyzed the situation of service development, health services and health service development in recent years Some works mention views, strategies and solutions for health service development These are meaningful documents for PhD students to refer and apply to build views, orientations and solutions to develop health services in public hospitals in Hai Duong province It can be said that the research works of foreign and domestic authors have different approaches, more or less referring to medical services, medical service development, but not subjects The research of the works should lead to an in-depth study of the authors and systematic research on the development of health services in public hospitals, individual slices, or part of a medical service object Based on the overview of the published research results, the graduate student realized that there was no research on "Development of health services in public hospitals in Hai Duong province" from the perspective of political economy From the overview of the main results of scientific works related to the thesis topic, the issues that the thesis continues to solve are: Firstly, clarifying the concept of health services, developing health services, developing health services in public hospitals, basic characteristics of public health services, and classifying medical services, what is the content and criteria for evaluating the development of health services in public hospitals in Hai Duong province? Second, what factors affect the development of health services in public hospitals in Hai Duong province; In order to develop health services in public hospitals in Hai Duong province, how we need to learn the experience of the localities in the country? Thirdly, the situation of how health service development in public hospitals in Hai Duong province has achieved achievements and limitations in recent years; From this situation, what problems should be focused on to develop health services in public hospitals in Hai Duong province in the near future? Fourthly, in order to develop health services in public hospitals in Hai Duong province in the future, what views and solutions should be implemented? To answer those questions, the thesis needs to focus on explaining the following issues: Firstly, build up the concept, identify the content and factors affecting the development of health services in public hospitals in Hai Duong province This is a very important issue, because it is a theoretical framework to ensure the implementation of the thesis goals and tasks To this, firstly, postgraduate students need to inherit the concepts of services, health services, health services in public hospitals, develop health services in public hospitals by a number of published scientific authors in order to build up the concept of developing health services in public hospitals in Hai Duong province from a political economic perspective In particular, the thesis needs to clarify the content and factors affecting the development of health services; as a theoretical basis to investigate the current situation and propose solutions Those factors must include objective and subjective factors; in which, the objective factors are: natural conditions, socio-economic conditions (economic, social, population), guidelines of the Party and State on the development of health services, trends integration, market factors Subjective factors are: perceptions of management staff, capacity of hospitals, reputation and brand of hospitals etc Secondly, to research experiences on health service development in some localities and lessons for public hospitals in Hai Duong province Based on the scope of the study, the dissertation focused on the experience of health service development in the neighboring provinces of Hai Duong province such as QuangNinh, HaiPhong and BacNinh On that basis, the thesis draws lessons learned as a basis for proposing views and solutions to develop health services in public hospitals in Hai Duong province Thirdly, the survey assesses the situation of health service development in public hospitals in Hai Duong province, specifying the issues that need to be focused on solving to develop health services in public hospitals established in Hai Duong province in the coming time PhD student bases on the content and factors affecting the development of health services identified in the theoretical chapter to investigate and assess the status of health service development in public hospitals in the province Hai Duong; specify achievements, limitations, causes of these achievements and outline the issues that need to be focused on solving from the current situation of health service development in public hospitals Fourthly, from the theoretical and practical basis, the thesis proposes views and solutions to develop health services in public hospitals in the near future The system of views and solutions proposed in the thesis ensures public hospitals to simultaneously implement health care goals for the people in the new period, thereby improving the status of diseases public institutes in the province in particular and the whole country in general The proposed solutions in the thesis will be the key solutions, meeting the requirements of realizing the identified views; at the same time solve the problems posed from the current situation of health service development Conclusion of chapter Concerning the thesis, many authors at home and abroad are interested in researching on many different angles It can be affirmed that the system of research works on domestic and foreign health services is relatively high, the achievements that the works achieved in terms of theory and practice have great significance and determination directions for the development of health services in Vietnam However, there is no in-country or in-depth research work on the theoretical and practical issues of developing health services in public hospitals in HaiDuong province under the corner political economy Therefore, the author has reviewed 15 works by foreign authors; 24 works of domestic authors in various types, such as monographs, doctoral dissertations and scientific articles On that basis, the author has generalized the successes and limitations of the works, thereby posing problems that the thesis needs to focus on Chapter RATIONALE FOR DEVELOPING HEALTH SERVICES IN PUBLIC HOSPITALS IN HAI DUONG PROVINCE AND PRACTICAL EXPERIENCE 2.1 General issues about health services and health services at public hospitals 2.1.1 The concept of medical services and services 2.1.1.1 The concept of service Today, services are increasingly becoming an economic sector that plays an important role in the national economy From a scientific and economic perspective, the service is an economic sector, an area of operation of the national economy The more the society develops, the more new service industries are born to meet the needs of people towards civilization and convenience From the commentaries on the author's conception: Services are social labor activities that create goods that exist in the form of invisible morphology to meet a certain need of people to contribute to promoting the socio-economic development of the country 2.1.1.2 The concept of medical services On the basis of the notions of services and health services, approach from the perspective of political economy, PhD student said: Health service is the result of the interaction between service providers and customers to meet health needs such as medical examination, treatment, prevention, health education, health counseling provided by state health facilities and private health facilities 9 2.1.1.3 Classification of health services Currently, the classification of health services is often categorized by types of service providers, by technical routes and technical lists, especially in the trend of international integration of health services WHO Specifically: Firstly, classify according to the service object Secondly, classify according to the technical hierarchy and technical list in medical examination and treatment Thirdly, the WTO classification has the following forms: Each hospital, depending on its ability, can provide customers with different health care services In the dissertation, the author focuses on the research according to the second classification: classification by technical lines and technical lists in medical examination and treatment 2.1.2 Public hospitals and medical services in public hospitals 2.1.2.1 Public hospital concept Public hospital is a state-owned hospital and receives grants from the state This type of hospital provides medical services and its costs are offset by the funds it receives Inheriting the above points of view, the author proposed the concept: “Public hospital is a medical and social organization owned by the state with functions and tasks of medical examination and treatment and health care for patients, scientific research and training of health workers” 2.1.2.2 Medical services in public hospitals Health services in public hospitals are the result of interactive activities between service providers and customers to meet health needs such as medical examination and treatment, disease prevention and health education and health counseling provided by state health facilities (commune health stations, district/city health centers, provincial and central health facilities) According to the author of the thesis, "public health services are all activities and results brought about by the interaction between health workers in state health facilities and patients, family members and patients society in medical examination, treatment, health care counseling and health education to meet people's health needs ” 2.1.3 Characteristics of health services in public hospitals Firstly, public health services are a service with "public goods" characteristics and "foreign" nature Secondly, providing services in the market generally people are free to participate as well as free to withdraw from the market 10 Thirdly, for the provision of some health services in public hospitals, the State still plays a decisive and long-term role in the quality of health services 2.2 Concepts, content and factors affecting the development of health services in public hospitals in Hai Duong province 2.2.1 The concept of developing medical services in public hospitals in Hai Duong province From the conception of service, health service and health education, the PhD student introduced the concept: Health education in public hospitals in Hai Duong province is an increase in quantity, expansion in scale and quality enhancement the quality and improvement of the structure of health services contribute to the protection, care and improvement of people's health, ensuring the sustainable development of the Province The above concept has clearly pointed out the subject, content, purpose, method of health insurance in public hospitals in Hai Duong province 2.2.2 Content of developing medical services in public hospitals in Hai Duong province 2.2.2.1 Increase in quantity, expand the scale of health services in public hospitals in Hai Duong province The content of increasing and expanding the scale of medical services is considered in the following criteria: Firstly, the increase in the number and size of medical services (1) Criteria for the number of examination services (2) Criteria for scale of medical examination service Secondly, criteria for evaluating the quantity and scale of medical services This is one of the important criteria to evaluate the development of a hospital (1) Number and size of hospital beds (2) Quantity and scale of disease prevention (3) New treatment techniques 2.2.2.2 Improving the quality of health services in public hospitals in Hai Duong province Quality of health services is the most important criterion for patients to choose services In particular, the quality of each type of health service provided to the people must be raised, people can access quickly, conveniently and safely Therefore, the quality of medical services is assessed by the following criteria: Firstly, the quality of examination, diagnosis ability and referral rate of examination Secondly, treatment results 11 Thirdly, the level of people's satisfaction when using the service Fourthly, criteria for health advice 2.2.2.3 Completing the structure of health services in public hospitals in Hai Duong province The development of new health services is the development of new medical services, or the development of health services that were not previously available in public hospitals in Hai Duong province Firstly, the criteria for structure of health services Secondly, the change in the proportion of people using health insurance cards for medical examination and treatment 2.2.3 Factors affecting the development of health services in public hospitals in Hai Duong province 2.2.3.1 Objective factors: natural conditions, socio-economic conditions, the development of medicine, the trend of international integration, advocacy of the Party and the State on the development of health services, impacts market, legal environment 2.2.3.2 Subjective factor group: awareness of subjects in health service development in public hospitals; capacity of public hospitals in Hai Duong province such as facilities, equipment and science and technology, health and financial human resources; needs of health care of people 2.3 Experience in developing health services in public hospitals of some local localities and lessons learned for Hai Duong province 2.3.1 Experience of QuangNinh province To develop health services in public hospitals in QuangNinh province, it has improved the quality of medical services to meet the medical needs of people on the basis of applying new technologies in examination and treatment and developing epidemics health service at public hospitals on the basis of developing new services and techniques in medical examination and treatment, developing health services in public hospitals on the basis of innovation, streamlined and efficient apparatus Results and health services in public hospitals are aimed at the satisfaction of the people 2.3.2 Experience of BacNinh province Experience of health education in BacNinh is: public hospitals in BacNinh province have made changes in expressing the expansion in scale, increasing the number of health services, the development of sources force to meet the needs of health care for people 2.3.3 Experience of HaiPhong city Research on practical development of health services in HaiPhong city shows that public hospitals in HaiPhong city have focused on developing high-tech services and developing health services towards the satisfaction of patients 12 2.3.4 Lesson learned for public hospitals in Hai Duong province Firstly, development of health services in public hospitals in Hai Duong province towards the satisfaction of patients Innovating the style and service attitude of medical staff towards the satisfaction of patients must first change the attitude of doctors and medical staff Instead of the attitude of gratitude as a small part of the past, the physician saw the patient as the center, the special customer and the medical facility as the service provider In other words, towards the satisfaction of the patient requires the physician and medical staff to go from the heart to action from there to attract patients to their facilities, especially when applying financial autonomy is approaching Secondly, the development of health services in public hospitals in Hai Duong province should promote the application of advanced and modern scientific and technological achievements This is an important lesson for public hospitals in Hai Duong province As private health services are growing, quality improvement in public hospitals is now an urgent job, especially under the impact of the 4.0 industrial revolution Thirdly, public hospitals in Hai Duong province need to have focused and key investments in health services Lessons learned from hospitals in QuangNinh, HaiPhong and BacNinh provinces show that investment in hospitals needs special guidelines in the context of implementing financial autonomy Conclusion of chapter In chapter 2, the author has developed a theoretical framework, focusing on clarifying concepts and contents of educational development, factors: objective and subjective; in which, the subjective factors affect the development of health care in public hospitals in Hai Duong province In order to meet the requirements of developing health services in public hospitals in Hai Duong province in the context of international integration, public hospitals in Hai Duong province should consult the experience in developing health services in some localities in the country such as QuangNinh, BacNinh, HaiPhong; thereby drawing useful lessons for the development of health services in public hospitals in Hai Duong province Chapter 13 CURRENT SITUATION OF DEVELOPING HEALTH SERVICES AT PUBLIC HOSPITALS IN HAI DUONG PROVINCE 3.1 Achievements and limitations in the development of health services in public hospitals in Hai Duong province 3.1.1 Achievements in health service development in public hospitals in Hai Duong province 3.1.1.1 Health services in public hospitals in Hai Duong province have expanded in size, increased in number 3.1.1.2 The quality of health services in public hospitals in Hai Duong province is still low compared to central hospitals 3.1.1.3 The structure of health services in public hospitals in Hai Duong province lacks high quality services 3.1.2 Limitations in development of health services in public hospitals in Hai Duong province 3.1.2.1 The increase in number and expansion of scale of health services in public hospitals in Hai Duong province is slow and uneven 3.1.2.2 The quality of health services in public hospitals in Hai Duong province is still low compared to central hospitals 3.1.2.3 The structure of health services in public hospitals in Hai Duong province lacks high quality services 3.2 Reasons for achievements, limitations and issues need to focus on solving from the situation of developing health services in public hospitals in Hai Duong province 3.2.1 The cause of achievements in health service development in public hospitals in Hai Duong province 3.2.1.1 Objective reasons Firstly, public hospitals in Hai Duong province are located in the northern key economic region with a high population density, a high educational level, many industrial parks Secondly, public hospitals in Hai Duong province near central hospitals should have favorable conditions in support and cooperation to develop health services Thirdly, the Party and State policies on the care and improvement of people's health have contributed to improving the quality of health services in public hospitals in Hai Duong province 3.2.1.2 Subjective reasons 14 Firstly, public hospitals in Hai Duong province always receive the guidance of relevant levels and branches in improving the quality of health services Secondly, public hospitals in Hai Duong province have developed regulations and criteria for behavioral attitude and professional capacity of staff in hospitals Thirdly, public hospitals in Hai Duong province have applied IT in curative care to contribute to improving the quality and effectiveness of health services 3.2.2 Reasons for limitations in the development of health services in public hospitals in Hai Duong province 3.2.2.1 Objective reasons Firstly, the mechanism of financial autonomy has been affecting the development of health services in public hospitals in Hai Duong province Secondly, degraded facilities, remuneration policies for officials, employees and workers in hospitals are still inadequate, thus affecting the development of medical services in hospitals public in Hai Duong province Thirdly, the development of health services in public hospitals in Hai Duong province is affected by the competitive environment 3.2.2.2 Subjective reasons Firstly, the perception of the subjects is still limited, failing to meet the fast, effective and sustainable development requirements of public hospitals in Hai Duong province The management of all levels is still limited, the committees and authorities in some localities are not properly aware and inadequate of health development strategy in the new period Secondly, the training, retraining and development of human resources are sometimes not focused Every year, public hospitals have also focused on training professional qualifications for health workers at hospitals However, the training is sometimes heavy in theory while the medical profession should be tied between theory and practice The lack of human resource structure, especially the postgraduate level and the team of excellent experts, affects the implementation of high quality medical services 15 Thirdly, the working environment is not attractive, so it is difficult to attract high quality human resources at public hospitals in Hai Duong province 3.2.3 The issuesraised from the current situation in the development of health services in public hospitals in Hai Duong province Firstly, overcoming the limitations of subjects in the development of health services in public hospitals Secondly, it is necessary to focus on developing resources in public hospitals in Hai Duong province to ensure the health care, rehabilitation and counseling of health education in the community Thirdly, the reform of administrative procedures associated with the development of information technology, application of scientific and technological advances in the areas of medical examination and treatment Conclusion of chapter Analysis of the status of health service development in public hospitals shows that in recent years health services in public hospitals in Hai Duong province have developed a step to meet the examination needs not only for the people in the province but also for the neighboring provinces In particular, in 2018, under the impact of the industrial revolution 4.0 many new techniques have been implemented in hospitals, the quality of human resources has changed However, in addition to the achievements, public hospitals are also facing challenges Chapter VIEWPOINTS AND SOLUTIONS FOR DEVELOPING HEALTH SERVICES IN HAI DUONG PROVINCE 4.1 Perspectives on health service development in public hospitals in Hai Duong province in the coming time 4.1.1 Development of health services in public hospitals in Hai Duong province must take patients as a center Health is the most precious capital of every citizen and society Protection, care and improvement of health are the obligations and responsibilities of every citizen, both political system and the whole society, requiring active participation of the committees, authorities, Fatherland Front national and mass organizations, of which Hai Duong Health sector is the core Therefore, investment in the protection, care and improvement of people's health is investment in development 16 Currently, public hospitals in Hai Duong province are facing challenges in reforming financial mechanisms and renovating hospital quality, especially when the policy of online health insurance is available at the level In the district, patients have the right to choose a better hospital for medical examination and treatment Therefore, hospitals need to identify patients as centers Following this point of view, it is necessary to some of the following requirements well: Firstly, reforming administrative procedures, creating conditions for people to have quick and timely access to health services This is the most important requirement to improve the quality of health services in public hospitals in Hai Duong province Focus on perfecting the health-oriented system of fairness - efficiency and development, in order to create favorable opportunities for all people to be protected, cared for and improve their health with higher and higher quality, in accordance with economic development of the country Secondly, innovating styles and attitudes of health workers towards the satisfaction of patients The style and attitude of serving the patients plays an important role in practical activities at the medical examination and treatment facilities, bringing closeness, trust, cooperation, compliance and sharing from patients contributed to improving the effectiveness of examination and treatment, and it may even be more convenient to repair, remedy or handle unexpected medical problems Thirdly, to diversify health services to meet people's health care needs With the motto of taking patients to the center, health care services meet the satisfaction of patients In recent years, public hospitals in Hai Duong province have constantly renewed the style and attitude of serving patients Along with that is the development of various types of services, in which state health still plays a key role 4.1.2 Development of health services in public hospitals in Hai Duong province must effectively use internal resources and combine external forces Firstly, mobilize and effectively use existing resources of public hospitals for the development of health services Secondly, strengthening joint venture between organizations and individuals outside the hospital with the public hospitals to develop health services 4.1.3 Development of health services in public hospitals in Hai Duong province is the responsibility of the whole political 17 system, in which the core is the leadership of hospitals and all staff, employees in the hospital Firstly, promote the role and responsibility of leaders of the Department of Health and the Director board of hospitals Secondly, promoting the role of officials and employees in hospitals in health service development Thirdly, implementing socialization in the development of health services in public hospitals in Hai Duong province 4.2 Solutions to develop health services in public hospitals in Hai Duong province in the coming time 4.2.1 Raising awareness and responsibilities of subjects on health service development in public hospitals in Hai Duong province This is one of the important solutions to create unity of awareness and determination of action of the system and each people in protecting, caring and improving health for themselves and their families and the community Implementing this solution needs to well the following measures: 4.2.1.1 Improving the capacity, effectiveness and efficiency of hospital leaders in hospital management Here are the suggested solutions: Firstly, commit and implement the commitment to improving hospital quality Secondly, allocate funds for quality management activities Thirdly, ensure human resources and support training in quality management Fourthly, ensuring conditions for quality improvement 4.2.1.2 To bring into play the role of officials, employees and laborers in hospitals and the whole community in the protection, care and improvement of people’s health Health care for patients not only plays the role of managers but also needs the contribution of all health workers and the community As society grows, the more civilized the need for health care is raised How to make each person, community and society have to take care of their health, Therefore, it is necessary to promote the role of health workers, workers in hospitals, implementing systematic solutions is not only about ensuring the health of a particular individual, but also protecting the health of everyone 4.2.1.3 Renovating and improving the effectiveness of health propaganda and education for the people Campaigns have the content and criteria related to the protection, care and improvement of health Promoting the supervision role of the people, creating favorable conditions to 18 mobilize social and religious organizations to protect, care and improve people's health in accordance with the law Hospitals strengthen propaganda, political and ideological education for hospital staff to raise awareness, change attitudes and behaviors at work; improve the sense of responsibility, sense of organization of labor discipline, the spirit of serving the patients; constantly training and cultivating professional ethics, bringing true effectiveness for the operation of the hospital Health education communication is the most effective way to help patients and communities get information, have health knowledge, carry out their health protection and improvement behaviors In addition to the main task of treating and caring for patients, the hospital found that health counseling, education and communication helped patients understand their disease, be assured of treatment and prevent one The number of complications may occur When patients get the knowledge of medicine they will become communicators at home and community Need to innovate the content and methods of health education communication such as verbal, written communication, visual communication, audio-visual means by indirect or direct methods such as presentations and discussions group, performance, role play, brainstorming, health education communication via video, storytelling Giving advice, direct communication with projectors with illustrated images with leaflets Regularly communicating through video tapes and discs at places where the patients are concentrated, such as medical examination and clinical areas In addition to improving the professional capacity to well the health care for the people, hospitals need to make efforts in propagating and guiding people to have a sense of self-health care 4.2.2 Completing the organizational structure, management and administration of health service development in public hospitals in Hai Duong province Firstly, review the organization and staffing compared to requirements, new tasks of hospitals to consolidate and re-arrange for more reasonable This is one of the important measures for public hospitals Continue to innovate, arrange and streamline medical staff to operate effectively, effectively and in accordance with the characteristics of each hospital and the trend of the era 19 Secondly, doing well in advising and proposing to the management agencies at all levels in completing and organizing the payrolls of hospitals for cases outside the hospital's competence In order to organize, manage and administer health care in public hospitals in Hai Duong province in a scientific way, to become a regional medical examination and treatment center, requiring leaders of hospitals to have innovations in thinking, dynamic, creative in operating, creative application of guidelines and guidelines of the Party, policies and laws of the State in medical examination, treatment, counseling and health education for People, especially the work of advising the authorities at all levels in health service development First of all, public hospitals in Hai Duong province need to research, expand and develop new services along with human resources and other resources Thirdly, concretizing the management system into a basic task for organizations and individuals in performing the tasks of medical examination, treatment, counseling and health care for people Strengthening the management role of leaders of hospitals, professional councils, scientific councils, promoting the creative spirit of staff in hospitals.At the same time, plan to inspect and supervise the implementation of the responsibilities and duties of units and individuals in accordance with the provisions of law In order to well manage, hospitals need to study and concretize the management system into a specific task with organizations and individuals to perform their responsibilities and tasks Constructing and perfecting the system of responsibilities for each specific position and expertise, closely linking the rights and obligations and responsibilities expressed in the level of accomplishing tasks, quality and performance work results Maintain the coordination of information between external influencing factors and internal impact factors of hospitals, creating relationships between departments and rooms in hospitals as well as between hospitals in the province , as well as with relevant agencies in health development 4.2.3 Building a group of health workers and staff in public hospitals "both knowledgeable and specialized" to meet the people's health care needs 20 In the field of health care, it can be said that the quality of health care services of a medical examination and treatment facility depends on the factors, that is: the level of medical staff and medical staff ; facilities, equipment and service attitude In particular, medical ethics is the most important factor in the assessment of patients, the satisfaction of patients is said to be an important component and criteria for assessing quality of medical care Therefore, the renovation of style and service attitude of health workers towards the satisfaction of patients is one of the important contents to improve the ethics of those who see drugs Implementing this solution needs to well the following measures: Firstly, it is necessary to organize political propaganda and education to improve medical ethics for health workers The process of providing medical services is a long-term, direct interaction between clients - patients and health service providers - a team of doctors and physicians Therefore, attentive, warm and caring attitude towards the sick will bring the patients peace of mind to believe and desire to use the service more times The service attitude of health workers assessed through the patient's perception is an important criterion to assess the quality of medical services of hospitals Secondly, improve professional qualifications for health workers in public hospitals in Hai Duong province Health human resources is one of the most important factors in the system of providing medical examination and treatment services at a medical facility, including professional skills, occupational skills, moral qualities, service attitudes, etc Health human resources include all employees working in the health sector They are the direct decision makers of the quality of services besides other factors such as technology, medical supplies, etc 4.2.4 Increasing investment in facilities and application of modern science and technology in developing health services in public hospitals in Hai Duong province Firstly, strengthen investment in facilities to ensure the development of health services in public hospitals in Hai Duong province In order to meet the demand of care and protection of people's health, not only the human resources are sufficient in quantity and high in quality but also a synchronous system of facilities and equipment 21 Planning to develop hospitals in population clusters, not according to administrative boundaries, developing specialized hospitals, creating conditions for hospitals to develop according to their capabilities and capabilities to increase their capacity to serve patients Hospitals invest, upgrade and supplement the function of checking medical equipment for units in the industry Investing in technical equipment, vehicles, communication equipment of the units according to the standards of the Ministry of Health Secondly, promote the application of modern science and technology to develop health services in public hospitals in Hai Duong province In modern society, the role of science - technology (science and technology) is becoming increasingly important The dramatic progress of science and technology in the past two decades, especially in the fields of information technology, biotechnology, Nano technology, automation has changed fundamentally about thinking and strategy of many countries No one can be skeptical about the role of science and technology in global economic development and of each nation In that trend, any country or locality, when developing a strategic development plan, must pay attention to the special role of science and technology and their close relationship with economic growth and development Conclusion of chapter From the practical development of health services in public hospitals in Hai Duong province in the past period, to promote the achievements and overcome limitations in health care for people In the coming time, Hai Duong Department of Health needs to thoroughly grasp the orientations of orientation, direct as a basis for effective implementation of solutions to develop health services in public hospitals in the province Hai Duong First of all, public hospitals in Hai Duong province must closely follow the leadership, direction and management of the Ministry of Health, Department of Health and state management agencies; improve the quality of health services; develop new services to meet the demand of health care for people in the new situation towards equity - efficiency development Based on the directions of direction, orientation, the process of developing health services in public hospitals needs to be implemented synchronously with many practical solutions In particular, improving the leadership and management capacity of the Party Committee, the Board of Directors of the Department of Health and hospitals is the solution to determine the development of health services in public hospitals; attracting, training, fostering and effectively using the labor force is an important solution; improve the 22 quality of health services; develop a network of medical services, develop new health services CONCLUSION Health is the most precious of every person and the whole society Investment in the protection, care and improvement of people's health is the investment for development Therefore, the development of health services in public hospitals in the socialistoriented market economy is urgent in the current trend Therefore, there have been many authors interested in studying on many different angles Based on an overview of 15 works by foreign authors; 25 works of domestic authors in various types, such as monographs, doctoral dissertations and scientific articles The PhD student found that there are no works of domestic and foreign authors who have studied fully and directly about the development of health services in public hospitals, but mainly focused on health services and health care services Therefore, the study "Developing health services in public hospitals in Hai Duong province" is an urgent issue both in theory and practice Development of health services in public hospitals in Hai Duong province is the overall measures of the subjects impacting on the process of developing health services Subjects of pedagogical health in public hospitals in Hai Duong province are the Party Committee, DirectorsBoard, officials and employees of hospitals located under the leadership and direction of the Department of Health and Ministry of Health In particular, it is directly the Party Committee, the Director board of provincial hospitals and district hospitals Related subjects are the State, the state management agencies in the field of health services in setting guidelines, policies, management regulations and creating an environment for health service development The purpose of PTDV in public hospitals is to contribute to the protection, care and improvement of health for the people, directly ensuring human resources, ensuring the sustainable development of the current and future countries The method of health care development in public hospitals is on the basis of closely meeting the needs of patients, health-care subjects in public hospitals must actively implement synchronous measures to improve the quality of care and health protection for people like improving the organization and management capacity of hospitals; improve the quality of human resources; developing new services, increasing scale of health services Development of health services in public hospitals in Hai Duong province is dominated by many factors: objective and subjective; In which, the subjective factors have a decisive influence 23 on the development of health services in public hospitals in Hai Duong province The process of developing health services in public hospitals in Hai Duong province, in the context of international integration, hospitals need to consult the experiences of health care in some countries around the world As in the local provinces, from that, lessons learned from health service development in public hospitals in Hai Duong province were drawn Recently, health services in public hospitals in Hai Duong province have gained important achievements in the process of health care for the people such as: Opportunities to access services The health care of the people is more and more convenient, the indicators of population health have been constantly increased, many indicators are higher than the common level of the whole country The grassroots health network is strengthened; many dangerous epidemics are controlled and repelled; material facilities and technical equipment to serve patients have been gradually improved; the supply of drugs and medical equipment has basically met the essential needs of medical examination and treatment as well as prevention; The level of health staff and the quality of people's health care in the levels has been increasingly improved However, besides the achievements, However, along with the socio-economic development, many issues have been arising and adversely affecting people's health such as environmental pollution, society's vices ; The structure of disease changes in the direction of increasing non-communicable diseases and the risk of outbreaks of emerging dangerous infectious diseases that are at high risk of death now appear in some countries around the world Conditions on facilities and equipment of many medical facilities in the province have not met the requirements of professional activities, not suitable for research and application tasks of high technology implementation.The level of grassroots health workers is still weak, the lack of qualified and in-depth staff, and the lack of doctors, especially at the district and commune levels, is a major problem of the slowly-resolved health sector These limitations have different objective and subjective causes; set for public hospitals in Hai Duong province some issues need to be addressed They are: consolidating and consolidating the network of health service providers, focusing on developing resources to meet people's healthcare needs in the trend of integration and application of scientific and technological achievements in implementing new health services Based on the theoretical and practical framework, the thesis has proposed 03 guiding points and 04 main solutions to develop health services in public hospitals in Hai Duong province Solutions are a unified whole, in which solutions to improve leadership and management of management agencies are decisive solutions; 24 improving the quality of resources is an important solution; Developing new health services and scaling up health services is the motivation for the development of hospitals  ... Public hospitals and medical services in public hospitals 2.1.2.1 Public hospital concept Public hospital is a state-owned hospital and receives grants from the state This type of hospital provides... technology in the past two decades, especially in the fields of information technology, biotechnology, Nano technology, automation has changed fundamentally about thinking and strategy of many countries... recent years, public hospitals in Hai Duong province have constantly renewed the style and attitude of serving patients Along with that is the development of various types of services, in which state