The validation of organisational culture assessment instrument in healthcare setting: results from a cross-sectional study in Vietnam.

BACKGROUND: Organisational culture (OC) has increasingly become a crucial factor in defining healthcare practice and management. However, there has been little research validating and adapting OCAI (organisational culture assessment instrument) to assess OC in healthcare settings in developing countries, including Vietnam. The purpose of this study is to validate the OCAI in a hospital setting using key psychometric tests and confirmatory factor analysis (CFA). METHODS: This is a cross-sectional study. Self-administered structured questionnaire was completed by 566 health professionals from a Vietnamese national general hospital, the General Hospital of Quang Nam province. The psychometric tests and CFA were utilized to detect internal reliability and construct validity of the instrument. RESULTS: The Cronbach's alpha coefficients (α-reliability statistic) ranged from 0.6 to 0.8. In current culture, the coefficient was 0.80 for clan and 0.60 for adhocracy, hierarchy and market dimension, while in expected culture, the coefficient for clan, adhocracy, hierarchy, and market dimension was 0.70, 0.70, 0.70 and 0.60, respectively. The CFA indicated that most factor loading coefficients were of moderate values ranging from 0.30 to 0.60 in both current and expected culture model. These models are of marginal good fit. CONCLUSIONS: The study findings suggest that the OCAI be of fairly good reliability and construct validity in measuring four types of organisational culture in healthcare setting in resource-constrained countries such as Vietnam. This result is a first step towards developing a valid Vietnamese version of the OCAI which can also provide a strong case for future research in the field of measuring and managing organisational culture.

Strengthening pharmacy practice in vietnam: findings of a training intervention study.

OBJECTIVE: To assess the effectiveness of a training and supportive supervision intervention in strengthening the capacity of pharmacy staff in Vietnam to deliver client-oriented, accurate healthcare information and appropriate services for childhood diarrhoea and emergency contraceptive pills (ECP). METHODS: Pre- and post-intervention study using a cross-sectional design. Pharmacy staff participated in 3 days of training on customer relations, good pharmacy practice, childhood diarrhoea and ECP over a period of 1 month, consisting of lectures, discussion, question-and-answer sessions and role-playing. We compared baseline and 6-month post-intervention surveys to ascertain changes in knowledge, attitudes and practice of pharmacists, using univariate statistics to find significant differences. RESULTS: More than 1200 pharmacists received training and supportive supervision. After interventions, pharmacy staff knowledge was significantly improved on most of the measured indicators. Knowledge of dehydration symptoms for diarrhoea increased from 19% to 88%, and for side effects of ECP increased from 27% to 77%. While assessment of actual practice revealed that this knowledge was not always used, significant improvement was observed. Before interventions, 12% gave information on dehydration symptoms but 45% did so afterwards. The proportion giving information on side effects of ECP increased from 13% to 54%. CONCLUSIONS: Providing a programme of training and supportive supervision is an effective way to improve knowledge and practice of pharmacists at private pharmacies in Vietnam. These improvements have the potential to lead to better community health care.

Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam.

BACKGROUND: Vietnam introduced the Health Care Fund for the Poor in 2002 to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities. It is often argued that effects of financing reforms take a long time to materialize. This study evaluates the short-term impact of the program to determine if pro-poor financing programs can achieve immediate effects on health care utilization and out-of-pocket expenditure. METHOD: Considering that the program is a non-random policy initiative rolled out nationally, we apply propensity score matching with both single differences and double differences to data from the Vietnam Household Living Standards Surveys 2002 (pre-program data) and 2004 (first post-program data). RESULTS: We find a small, positive impact on overall health care utilization. We find evidence of two substitution effects: from private to public providers and from primary to secondary and tertiary level care. Finally, we find a strong negative impact on out-of-pocket health expenditure. CONCLUSION: The results indicate that the Health Care Fund for the Poor is meeting its objectives of increasing utilization and reducing out-of-pocket expenditure for the program's target population, despite numerous administrative problems resulting in delayed and only partial implementation in most provinces. The main lessons for low and middle-income countries from Vietnam's early experiences with the Health Care Fund for the Poor are that it managed to achieve positive outcomes in a short time-period, the need to ensure adequate and sustained funding for targeted programs, including marginal administrative costs, develop effective targeting mechanisms and systems for informing beneficiaries and providers about the program, respond to the increased demand for health care generated by the program, address indirect costs of health care utilization, and establish and maintain routine and systematic monitoring and evaluation mechanisms.