“OUR goals can only be reached through the vehicle of a plan. There is no other route to success.”
These are not, as one might expect, the words of an expert strategist or a self-help hack. This defense of strategy comes, surprisingly, from the Spanish artist Pablo Picasso, whose own success brought him universal renown and an immense fortune.
It is certainly a principle that leaps to mind when Angels Vietnam team leader Trang Nguyen and her team outline the more-and-better strategy they implement to improve stroke care in her country.
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When Angels started working in Vietnam in 2017, there were only 18 stroke units dotted along the long, narrow S that lies between its nothern border with China and the Cà Mau Peninsula in the south.
This being woefully insufficient in a country with almost 100 million population where stroke was the leading cause of death, the Angels Vietnam team made increasing the number of stroke-ready hospitals their first goal.
It was a painstaking process of building trust, growing confidence by providing training and support, brokering cooperative relationships between hospital departments, and replacing outdated thinking with evidence-based care. But by the end of 2022, there were 98 stroke-ready hospitals that had treated a total of 44,000 stroke patients according to international, evidence-based guidelines.
Better
In 2018, 115 People’s Hospital in Ho Chi Minh City became the first Vietnamese hospital to qualify for the WSO Angels Awards programme, which recognises stroke care excellence and incentivises data collection for quality monitoring.
By 2020 the number of WSO Angels Awards had grown to 49. For the first time it included two diamond awards including one for Bach Mai Hospital in Hanoi that would go on to win it 10 more times.
Vietnam added 77 awards in 2022, the second-highest number of WSO Angels Awards won by any country last year.
Trang explains the connection between awards and stroke care improvement: “We encourage hospitals to see the awards not just as a prize, but as a highly effective instrument for enhancing the quality of stroke treatment. Quality monitoring means hospitals receive valuable feedback that helps them target opportunities for improvement.
“Participating in continuous quality monitoring leads to improved treatment outcomes by shortening treatment times and increasing the number of patients treated in each unit.”
Experience-sharing is one of the tactics Trang and her team rely on. On 18 August this year, for example, Assoc Prof Ton Mai Duy of Bach Mai Hospital (now with 11 diamond awards) spoke about the importance of data-lead performance at a National Quality Monitoring Congress where WSO president-elect Prof Jeyaraj Pandian handed out awards to winning Vietnamese hospitals.
If the numbers are anything to go by (and yes, that is the entire point), the charge towards “better” is well advanced: Vietnam currently has a national average door-to-needle time of 48 minutes.
Networks & EMS
After foregrounding more and better stroke-ready hospitals for the first five years, the strategy has shifted to building a stroke network for Vietnam. There are 1,000 hospitals in the country of which 120 are registered with Angels. The challenge now is to create a hub and spoke model that not only connects primary care centres and comprehensive care centres but also integrates hundreds of frontline hospitals as well as the country’s fledling emergency medical services to ensure stroke patients reach appropriate care faster.
EMS in Vietnam is not yet developed throughout the country. According to a study conducted in Vietnam, approximately 14% of stroke victims use EMS to get to hospitals across the country; fortunately, this percentage is higher in major cities.
The challenge is twofold: to teach the community to call an ambulance when they suspect a stroke, and to develop the EMS.
Trang and her team hope that the EMS Angels Awards will have the same impact on prehospital stroke care as the WSO Angels Awards on hospitals. It’s early days but a pilot involving a single region has yielded immediate success, with EMS centre 115 Da Nang collecting a gold award in Q2 of 2023.
Uvedomelosť
Educating the community about stroke has been on the Angels Vietnam agenda from the outset. Community activities tend to reach a peak around World Stroke Day in October, but are certainly no one-day wonder.
Last year, the Angels team rolled out an innovative programme of activities that included a design competition with the School of Medicine & Pharmacy at Duy Tan University in Da Nang, and a cycle parade with Viet-Tiep Friendship Hospital in the northern city of Hai Phong. The idea is to tailor events to suit the characterictics of each region and ensure the message resonates with audience and achieves maximum impact.
Their creativity and lateral thinking are bearing fruit. Following an event with Military Hospital 175 in Ho Chi Minh City, which drew wide coverage on social and mainstream media, the number of patients receiving recanalisation treatment at this hospital increased by more than 25%. And after a joint campaign with Bach Mai Hospital to target coach stations in Hanoi, a survey conducted one month later showed that the coach drivers’ knowledge of the signs of stroke had increased by 100 percent.
Partnerships
Another strategic priority that is already gathering momentum is working more closely with Vietnam’s ministry of health. In June 2023 the signing of an agreement between Boehringer Ingelheim (sponsors of the Angels Initiative) and Vietnam’s Department of Medical Service Administration drew widespread media coverage. This memorandum of understanding between a leading biopharmaceutical research-oriented corporation and Vietnam’s ministry of health is expected to lead to better diagnosis, treatment and management of cardiovascular, renal, metabolic, pulmonary, and other noncommunicable diseases.
The route to success
Pablo Picasso didn’t take his own advice about planning and as a result much of his fortune was lost after his death because he failed to leave a will. But he did have the wisdom to point out a plan that brings us closer to our goals must be one “in which we fervently believe, and upon which we vigorously act”.
It is true that planning is nothing without execution. And it is equally true that relationships can’t thrive without trust.
Trang and her team always think that although it took time to get there, “the hospitals now think of us as their friends, their partners. We don’t just come to tell them, do this, and then go away. We listen, and we sit with them to find a solution.
“Then, when they succeed with their first case, or their first award, we are there to celebrate with them. They trust us, and we walk beside them.”
