Vietnam

The context: Bringing structured advances to a high-performing healthcare system

Vinmec Healthcare System is a highly sophisticated private hospital network in Vietnam dedicated to academic healthcare. The organization intentionally invests in innovation, and it recruits physicians and nurses who are open to growth, change and new ways of doing things. With a clear drive toward clinical excellence, Vinmec represents the kind of capable, forward-thinking institution that is well positioned to accelerate improvement.

The challenges: Bringing individuals and systems on board for the future

Even highly advanced organizations face a universal challenge: translating evidence-based medicine into consistent, reliable daily workflows.

• Clinical decisions relied heavily on "experience-based" medicine. Rather than being guided by consistent protocols, decisions often depended on senior clinicians' knowledge of what had worked over the course of their careers. Younger and midcareer physicians could read international guidelines, but change was slow.
• Resistance to change existed at the individual level. The organization was eager for progress, and Vinmec hospitals intentionally recruit clinicians who are open to advancing medicine. However, when change requires adopting new routines in high-stakes situations, progress depends on trust, alignment and proof that improvement is achievable.
• Language and topicality barriers. Educational materials were largely in English and often outdated.
• Specialist shortages and workload concerns. Specialist support was limited, increasing workload for nurses, especially for respiratory-related tasks.
• Time and coordination constraints. Best practices such as spontaneous awakening trials — structured daily pauses or reductions in sedation to assess readiness for waking and ventilator recovery — were difficult to execute consistently due to time and coordination demands.
• Lack of electronic systems. Documentation was largely paper based, limiting access to actionable performance data and analysis.

These challenges are common even in high-performing systems. Vinmec's strengths — experienced clinicians and eagerness for growth — made thoughtful implementation strategies even more important.

Our advisory approach: Implementation through small, meaningful changes

CERTAIN: Global Critical Care and Emergency Medicine Program leaders recognized that this was not a knowledge gap; it was an implementation opportunity. The system's highly experienced mentors were reinforcing long-standing practices and were understandably hesitant to change. Sustainable change would require alignment, not replacement.

Rather than introducing protocols, we focused on building a team-based mindset and using practical strategies that empowered younger and midcareer clinicians and engaged senior decision-makers. This included:

• Standardized care through structure, not control. The CERTAIN Program introduced practical tools and checklists designed to turn evidence-based guidance into everyday routines and habits.
• Improved teamwork and communication. We focused on strengthening Vinmec's care teams through consistent communication, role clarity and data-informed decision-making, particularly in high-acuity or complex clinical situations.
• Small steps to build momentum. Rather than attempting quick changes, we focused on introducing manageable quality improvement initiatives that were small enough to complete easily, but meaningful enough to demonstrate progress.
• Local champions for sustainability. CERTAIN leaders prioritized train-the-trainer development. The goal was to strengthen internal coaching capacity so improvement could continue organically without relying on external advisors.
• Increased engagement. We engaged participants through in-person, small group collaboration. Diem N. Vu, M.D., a Mayo Clinic critical care specialist and CERTAIN Program alumnus, helped lead the Vinmec engagement. "Progress accelerated when frontline teams had space for focused discussions and problem-solving," she observes.

What changed: Cultural shifts and practice improvements based on trust and safety

Through structured tools, relationship-building and implementation support, Vinmec's participation in the CERTAIN Program led to measurable cultural shifts.

• Constructive conversations about barriers to care. By creating a psychologically safe environment, Dr. Vu and local leaders were able to identify gaps openly. Increased trust created room for change.
• A stronger culture of measurement. The CERTAIN Program helped teams create simple, day-to-day measurement approaches that were feasible in a paper-based environment. Dr. Vu says, "The Vinmec team was very receptive to a data-oriented approach. Their minds began to change when we talked through data collection." To enact a more data-driven approach, Vinmec teams began tracking practical measures such as how many patients were intubated and extubated every day. While straightforward, these metrics created a foundation for trend analysis, rapid testing of changes and scalable improvement.
• Increased confidence through simulation and feedback. Simulation-based learning and expert-led feedback created a safe environment for physicians and care teams to practice complex clinical scenarios, strengthening confidence, clinical judgment and teamwork.
• Emergence of local champions. Train-the-trainer efforts enabled local leaders to extend improvements beyond the ICU. "The program also helped build local capacity for sustaining improvement efforts beyond the formal training period," adds Dr. Tri.

What we learned: Targeted structure amplifies excellence

Our engagement with Vinmec reinforced an important principle: Highly capable organizations may be the most ready to benefit from structured implementation support. When institutions already possess strong talent, leadership commitment and openness to growth, targeted structure can accelerate progress significantly.

Vinmec's commitment to excellence positioned them not simply to adopt improvement strategies, but to amplify them. Our role was to provide the structure and momentum that helped translate that commitment into consistent, team-based ICU care.