The purpose of this research is to synthesis policy recommendations for management of the health service system at the tertiary level in North-East of Thailand in order to support the critical epidemic of COVID-19. This research was conducted between September 2021 and February 2022. Four provinces in the public health region 7,8,9 and 10 namely Khon Kaen, Udon Thani, Surin and Ubon Ratchathani were stratified selected. Mix-methods was adopted based upon the Health Care Capacity indicator and six-building blocks together with policies and regulations issued by the Emergency Decree on Public Administration in Emergency Situations and other related measures. The participants were purposively recruited through administrators at a public health region, provinces, hospitals, COVID-19 committees, health professional and responsible for environmental work of Tertiary hospitals within four provinces, and secondary key informants were a group of stakeholders. The research instrument was the health service management assessment form, in-depth interview, focus group, lesson learn form, and relevant document record form. Quantitative data were analyzed by statistical percentage, mean. Qualitative data were analyzed by content analysis. Each interview was digitally recorded, and the data from the interviews were analysed using Nvivo. The findings revealed ten policy recommendations covering ten issues for public sector organizations as follows: 1) A clear policies and utilization are needed; 2) considering a framework for expanding health professionals; 3) developing a large-scale centralized database system and connecting the use of sharing-data network with public health sectors; 4) establishing a public health region as a juristic person for the development and flexible service; 5) providing training programs to continuously upskill personnel's potential; 6) having a committee to consider the risk compensation of health professionals working during COVID-19 with all health sectors covered by a good moral and fairness and equality 7) Providing clear and accurate information and having public relations which covering target groups and easy to access 8) establishing guidelines for vaccine administration management in accordance with the context and having a committee to consider the compensational payment 9) all hospitals should have the resources planning with an effective strategy, and 10) having a clear organized-screening and health service standards in all public health sectors which participate in raising awareness of people's self-management. This will result in the management system for the management of the health service system at tertiary level to support the outbreak of the COVID-19 crisis in the future.