Organization and regulation of labor of medical workers LPU. Modern situation with labor ruling in health care. Normation of the labor of medical personnel: specificity, legal support

Organizational science (scientific management) in different periods solved the problems of rationalization, and optimizing labor activities to increase productivity, reduce the physical and material costs, the fight against unemployment, etc. Now these problems are becoming increasingly relevant. Consequently, more attention should be given to the problems of laboring, which will allow rationalize and optimize various areas of employment.

Processes occurring in the modern economy, characterized by various dynamics of market relations, are a new stage in the history of the formation of socio-labor relations. However, social and labor relations, as the experience of developed countries shows, can be effective only when the guarantor is a strong and stable state, the main parameters of which are: a permanent growth rate of gross national product, state-of-government controllability, and the effectiveness of the economic exchange rate is confirmed visible to citizens results. For a federable state, the most significant indicator is the socio-economic development of its subjects and municipalities, which determines the quality of life of the country's population.

And one of the main directions affecting the quality of life of the population is health care, the level of development of which largely determine the indicators of the efficiency of the country's labor resources.

The health care technologies are constantly developing in health care, the structures of disease pathology are changed, which requires constant improvement of methodologies in the field of labor regulation of personnel medical institutions of health care facilities.

The study of the problems of labor regulation was paid to sufficiently much attention, in particular, intersectoral, industry and local regulatory materials on time standards for work performed, load standards and regulations, and studies were conducted on the establishment and consolidation of the composition of work in the form of qualifying directories.

Improving the organization of work in health facilities requires further development of the methodology for determining the norms of time for medical services, methods for calculating the norms of the load of medical personnel, approaches to the definition and planning of the number of medical personnel.

To implement the above purpose, it is necessary to solve the following tasks:

the formation of a new system for regulating the labor of medical personnel with the application of world standards on medical services to the provision of medical services;
development of modern methods for the development of time standards (labor-intensity) for the provision of simple and complex medical services;
formation of a methodology for calculating the norms of medical staff of health care facilities in three areas (outpatient polyclinic reception, diagnostic services, hospitals), taking into account the priorities of health development of the Russian Federation;
development of new approaches to the definition and planning of the number of medical personnel of health care facilities.

It should be noted that the basis of the functioning of medical institutions is labor resources, therefore it is necessary to allocate the organization of labor, which should be based on managing medical institutions based on scientific and rational (regulatory) activities. Currently, the high organization of labor gives higher results, which certainly leads to a higher self-dedication of the employee, improving the productivity of their labor, self-realization under the organized management designed to motivate and stimulate the employee and most importantly ensures the necessary quality of medical services provided.

It is obvious that only management organized on a scientific basis will make it possible to find optimal solutions for many social problems regarding the standard of living of not only medical personnel of health care institutions, but also potential workers.

Relationship of laboring with a common standard of living

In recent years, studies of the FSUE "NII TSS" of the Ministry of Health and Social Development of Russia, intended for health care institutions of the Russian Federation.

Based on the surround analysis of the functioning of medical institutions, assembled materials and expected prospects: with the help of laboring, it is possible to solve many problems related to the living standards of health workers in both micro and on the macro levels.

Healthcare institutions, applying a scientifically based organization of labor, it is possible to increase the effectiveness of all its activities, increase the productivity of their employees, achieve the effectiveness of the effectiveness of their duties with medical personnel. In turn, it leads to an increase in remuneration for the work done in the form of wages and thereby increasing purchasing power. And effective activities organized as a whole to establish a health care and the qualitative functioning of this institution as a whole lead to the improvement of its activities at the state level. Thus, it is achieved the possibility of comprehensive impact on the standard of living of the country's population.

Rationing and efficiency

Labor rationing must be applied in determining and planning the number of medical personnel. It has a direct impact on the labor of the main and auxiliary medical personnel of health care facilities.

This direction is now playing a key role in the formation of a health care provider development strategy. From how optimally formed the composition of medical personnel, the efficiency of the entire health care institution depends on the whole. Unfortunately, an acute problem of both quality and medical personnel of health care facilities is characterized for the modern period of development.

One of the most pressing problems for public health institutions is the lack of materials approved on the sectoral level on labor standards for admission offices covering the full amount of medical functions. In this regard, the following uncertainties arise in the process of establishing the size of wages and the number of personnel of receiving offices:

lack of labor standards staff of adoptive departments of public health care facilities;
lack of labor standards for support staff (nurses, sanitary) adoptive offices of public health care facilities;
the need to determine the labor tensions of personnel of adoptive departments of state health care facilities;
typical criteria for the work of adopted departments by type of healthcare institutions have not been developed.

Currently, there are no regulatory documents on the load of doctors, the middle and junior medical staff of the receiving offices (with the exception of the order of the USSR Ministry of Health No. 560 dated 05/31/1979, which currently wears a recommendatory nature, is significantly outdated, and therefore not applicable in practice).

All the above problems make it difficult to develop an adequate wage system that takes into account the labor tensions of the main and auxiliary personnel of adoptive offices of state health care facilities. As a result, all this affects the quality of the medical services provided to the population.

Methodology for calculating labor rationing

Each medical institution faces the difficulties described above. Separate bets exist simply because they always existed, even if the load falls on them. For other works and loads of bets is not located, since the management of the institution for explicit their demand is not always able to substantiate and calculate their need.

For a detailed analysis of the problems described and as a solution to provide an example of calculating the required rates based on actually performed work and time spent by a doctor's advantage of the GUZ.

Magazine "Main Medical Sister"

Topic: General Questions of personnel work, remuneration of medical workers and motivation, labor protection, social protection, pension provision
Source: Home Medical Sister №8-2008

The main objectives of labor rationing in health care are to determine the cost of labor, load and number of personnel, finding optimal proportions for its various groups when performing one or another work, planning certain areas of health development.

The current state of labor organization in health care is determined by the following trends:
decentralization of labor organization management;
lack of timely revision of existing labor standards and new regulatory documents;
Expanding the scope of use of labor standards, such as the use of them in the practice of pricing, as well as with the economic justification of the territorial programs of state guarantees of free medical care to citizens of Russia, the compilation of municipal orders, etc.

These positions are dictated by the need to determine the laboring technology in health care, a methodological apparatus for the design of labor standards for labor used at the municipal, regional and federal levels of management (application).

Communitary issues of labor rationing *

In health care, as in other sectors of the economy, use well-known methods of laboring of labor, widely represented in special literature. These methods are divided into two groups: analytical and total (Fig. 1).

Analytical, or elemental, method provides for the differentiation of the employment process into separate components, the establishment of the normative costs of working time for each element and design standards of labor, taking into account the rational organization of the labor process in general, the quality of work performed.

Depending on the methods of development of labor standards, an analytical method is divided into analytical and research and analytical.

An analytical research method consists in measuring the cost of time on all components of the employment process in the optimal organizational and technical conditions corresponding to the modern technology of the medical and diagnostic process. The method is related to timekeeping and is used in connection with its significant complexity, duration, the need for special training for its implementation, as a rule, in scientific organizations in the development of industry standards for work.

Depending on the objectives of the study, either timing measurements are used to establish the duration of individual repetitive labor operations, or a photograph of working time in order to determine and eliminate the irrational use of working time, redistribution of functional duties, etc.

Method of photochromic observations includes a combination of timekeeping measurements with a photo of working time.

The timing technique provides for compliance with its rules, the main of which are listed below.

1. It is necessary to comply with the technology of therapeutic and diagnostic process: the organizational forms of work must comply with the modern state of health care, and a specialist, whose activities are observed must have sufficient work experience, high qualifications.

2. A highly qualified specialist who knows the technology of therapeutic and diagnostic process, which is capable of conducting an examination of the amount and quality of assistance has been attracted to the timeliness.

3. Before holding timekeeping, it is advisable to draw up a list (dictionary) of individual labor operations and types of works that are included in the functional responsibilities of the observed, which allows, with statistical processing of materials, to identify the performance of work that is not peculiar to a personnel group.

The classification of labor costs of medical personnel includes

7 activities: basic, auxiliary, other activities, work with documentation, service conversations, personal necessary and unloaded time.

4. The timing of timekeeping should be sufficient to obtain representative data on labor costs for all employment operations.

The required number of timekeeping measurements is determined by the formula recommended by the Research Institute of Labor:

N \u003d 2500 x ((k² x (ku - 1) ²) / (c² x (ku + 1) ²)) (1)

Where n is the number of timekeeping measurements;

K is a coefficient corresponding to a given confidence probability (at a probability of 0.95 K \u003d 2);

Ku is a regulatory coefficient of strokewood;

The required accuracy of observations (%).

In some cases, for example, for accounting for the size of the wage of staff when calculating the cost indicators, there is a need to determine the cost of working time of various personnel groups not on a separate work operation, but for the entire labor process as a whole. This situation is typical for the blood service, when carrying out a complex of work for issuing a particular conclusion by the institutions of state-poidnadzor, etc. In this case, along with the determination of the time of time for individual labor operations fill the technological card.

When conducting regulatory work, it is extremely important to choose a regulatory indicator for work.

The basic requirements for the normative labor indicator are as follows:
accounting of the modern level of the technology of therapeutic and diagnostic process, the form of organization of medical care, working methods;
compliance according to the degree of enlarging the conditions and nature of the activities inherent in the type of establishment;
coverage of the most common options for performing work;
convenience for calculating standards of numbers, compliance with the indicator in the establishment of accounting and reporting documentation;
Providing the necessary accuracy when calculating the number of personnel.

The following indicators correspond to these requirements:
Visit, case of polyclinic service (SPO) in outpatient polyclinic institutions;
Koiko-day, the case of hospitalization, bed in hospital institutions, patient-day in day hospitals;
Specific types of research, procedures, manipulations conducted by medical personnel auxiliary medical diagnostic service.

Determining the cost of time on a more differentiated indicator for laboring, such as separate labor operations in dentistry, simple and complex medical services, can be considered only as an intermediate stage for the formation of the regulatory costs to the specified enlarged indicators recorded in the accounting and reporting documentation of the LPU.

When designing the norms of time, the following mathematicianostatic methods are used: calculation of average values; Grafanalytic processing of the source data, the calculation of the regulatory regression equations (formulas) by the method of multiple correlation; Calculation of regressing regression equations (formulas), taking into account the influence of qualitative factors by the method of multiple correlation using the theory of image recognition, etc.

When designing norms on labor, the so-called normage factors should be taken into account, the degree of influence of which allows organizational and technical, psychophysiological and economic substantiation of regulatory indicators.

The presence or absence of communication between the factors studied and their values \u200b\u200bis established by conducting correlation analysis, with which it is possible to determine to what extent this value depends on changes in other factors.

The correlation analysis method When choosing factors provides for the calculation of pair correlation coefficients, mutual (partial) correlation, multiple correlation, described in detail in the special literature on mathematical statistics.

With statistical processing of historical materials, the costs of one or another type of work are calculated by the formula:

PM \u003d σti × ki, (2)

Where PC is the time spent on a certain type of work;

Ti - time spent on separate labor operations;

Ki - the frequency of the repetition of individual labor operations.

The frequency of the repetition of individual labor operations is established by actual data with the possible correction of this indicator by the expert.

In health facilities, and in some cases, and when designing standards for labor at the federal level, an analytical and settlement method apply. At the same time, the method of calculating the number of personnel is carried out on the basis of industry performance indicators on a particular type of work and the actual volume of activity.

The total method of labor organization does not imply the division of the employment process into the components, it can be applied in connection with its simplicity and accessibility for the operational establishment of labor costs, as well as for rarely conducted works. The total method is divided into statistical, experienced, comparative (interpolation and extrapolation). The main disadvantage of the total method is the lack of an analysis of the internal content of the labor process on the basis of its separate organization.

The development of regulations on labor must be carried out according to certain rules and stages of regulatory work.

At the initial stage, based on existing methodological and regulatory materials, special publications are developing a research methodology. The main directions of work are determined by the materials of the special study of organizational forms of the institution (divisions), personnel, the need for or another medical care, the technologies of therapeutic and diagnostic process, etc.

The main stage of regulatory work is to measure the cost of working time and statistical processing of collected materials, preparation of the draft regulatory document.

The final stage is associated with the economic rationale for labor standards, discussing with experts and its experienced verification.

When discussing and final adoption of the magnitude of the normative indicator, a number of factors take into account a number of factors, and above all - the technology of therapeutic and diagnostic process and the prospects for its implementation in the practice of health care, equipped with modern equipment, the possibility of using recommendations for the maintenance of patients set forth in the standards (protocols) of treatment, and etc.

Of all the regulatory indicators for labor (time standards, the load standards (maintenance), the number of numbers) the fundamental are the norms of time, the remaining data are calculated.

The definition of calculations, the ratio of these indicators and the necessary data for their calculations is schematically represented in Fig. 2.

When forming the norms of time approved in different years in a centralized manner, certain types of activity (basic, auxiliary work, the personal needed time, etc.) included in different ratios. So, in the estimated time standards for visiting included basic and auxiliary activities, and in the norm of time on research carried out in the office of radioisotope diagnostics - all types of activity, including the personal need. In this regard, the coefficient of use of working time on the main activity of different positions takes various values \u200b\u200bpresented in Table 1.

Fig. 2. Stage and necessary data for calculating regulatory performance

Table 1

Coefficient of use of working time positions for basic activities
Job title
The value of the coefficient (in fractions from 1.0)

Outpatient reception doctor, hospital hospital doctor
0,923

Doctor of clinical laboratory diagnostics
0,800

Laberaent, Feldsher-Laberant
0,750

Doctor of ultrasound diagnostics, doctor of functional diagnostics, endoscopist doctor, medical sisters of relevant cabinets, medicinal physical education instructor
0,850

Radiologist
0,900

Radiologist
1,000

Doctor on therapeutic physical education and sports medicine, Methodist instructor
0,692

Massage Medical Sister
0,770

Medical sister on physiotherapy
1,124

The annual budget of the working time position is determined by the established legislation of the Russian Federation, as well as the regime of labor and recreation. It is calculated by the formula:

B \u003d m × d - n - z, (3)

Where b - annual working time budget;

M - the number of hours of work per day at the five-day working week;

D - the number of working days a year in a five-day work week;

N is the number of hours of cutting the duration of the working day or shift in pre-holiday days (during the year);

Z - The number of working hours per vacation period of time, which is determined by multiplying the weekly duration of the working time for the number of vacation weeks.

Example of calculation number 1

The annual working time budget of the doctor of functional diagnostics at a 39 hour work week, a 28-day vacation (among the calendar days), designed for 2007 under formula 3, is 1780.2 hours (39/5 x 249 - 6 - 4 x 39) or 106 812 min (60.0 × 1780.2).

The submitted total labor approaches are used in all types of health facilities. However, the organizational and technical conditions for their functioning determine the need to consider the characteristics of labor rationing on the main types of institutions and staff groups.
Labor rationing of middle and junior medical personnel

The rationing of the labor of middle and junior medical personnel of outpatient polyclinic institutions

The posts of medium and younger medical personnel in the outpatient clinical institutions are set by the number of posts of outpatient receptions of a particular specialty (to calculate the number of medical sisters and the relevant categories of the corresponding cabinets). The posts of outpatient reception doctors include all positions of the doctors of outpatient polyclinic institutions. In addition to posts of doctors of clinical laboratory diagnostics, bacteriologists, radiologists, radiologists, physiotherapists, reflexotherapists, manual therapy, endoscopists, anesthesiologists-resuscitations, statisticals, and medical care doctors (offices) of medical care at home , on therapeutic physical education, sports medicine, functional or ultrasound diagnostics, healthy and healthy and district pediatricians, as well as leaders of all ranks.

The need to allocate medical posts on the outpatient reception is due to the fact that, depending on their number, according to regular regulations, the number of posts of doctors and the average medical personnel of auxiliary and some other medical and diagnostic units are determined:
The total number of posts of outpatient reception doctors: medical sisters of a procedural office, medical recorders (for calculating the number of medical sisters of the procedural office, medical recorders);
the total number of posts of doctors (for calculating the number of medical statistics);
Changing the work of the unit or institution (to calculate the number of manifolds of procedural, vaccination cabinets, registry);
The number of population and its individual contingents (to calculate the number of nurses of vaccination cabinets, medical sisters to collect breast milk, etc.);
The mixed procedure for establishing posts: to calculate the number of paramedics or medical seisters of the filter in the children's urban clinic (work change and number of children).

Most of the current standards of outpatient polyclinic institutions currently approved more than 25 years ago: regular standards of urban and children's urban clinics located in cities with a population of over 25 thousand people, identified by the Order of the USSR Ministry of Health from 11.10.1982 No. 999, in cities and towns of urban type with population up to 25 thousand people. Order of the USSR Ministry of Health from 09/26/1978 No. 900. In 2001, an order was approved on staff regulations for children's clinics, which are part of urban and children's city hospitals, health patients with hospitals (Order of the Ministry of Health of Russia of October 16, 2001 No. 371), However, the lack of validity of the main provisions of this order makes it unacceptable for health care practice.

By the nature and volume of the activities of the average medical personnel established for the doctors of outpatient reception in different specialties, these posts can be divided into the following groups:
Medical sisters are carried out with a doctor outpatient reception of patients;
Along with an outpatient admission, together with a doctor, medical sisters of precious doctors-therapeutors, pediatrician doctors, general practitioners (family medicine) also perform the appointment of a doctor for the provision of relevant medical and diagnostic and preventive care to the house of the population. Medical sisters of surgeon doctors, orthopedic traumatologists carry out dressings, overlay and removal of plaster, etc.

The first group includes most of the posts of nurses of the doctors of outpatient reception. The regulatory ratio of medium and medical personnel in this group is usually 1: 1, i.e., one position of the doctor is planned one position of a medical sister. At the same time, according to the specialties of doctors as neurology, endocrinology and dentistry, this ratio is violated and in accordance with the current regular standards for one position of the doctor of these specialties, 0.5 of the medical sister is set. It is difficult to find a logical explanation to such regulations, and in the absence of relevant recommendations on the sectoral level, heads of health care facilities on the basis of the rights to form the number of personnel of the LPU, it is advisable to set the number of medium-sized medical personnel on these specialties corresponding to the medical personnel. Order of the Ministry of Health and Social Development of Russia dated 04/14/2006 No. 289 This provision for a children's dental clinic is corrected, and the posts of medical examinations of medical sites are established at the rate of 1 Position for each Position of the dentist's children's doctor, a dental surgeon and orthodontist. Such a standard is fully consistent with the modern technologies of the medical and diagnostic process in dentistry when using modern composite materials, the work of "four hands" and the ethically legal standards for receiving the patient in a separate office.

In recent years, in connection with the introduction of compulsory health insurance in the territories, where payment is carried out for individual medical services, the classifiers of medical services are developed and approved, in which the corresponding time norms are established for a doctor and a medical sister. The expediency of such a separate settlement of the time of time for the specialties, where the regulations identified an equal number of doctors and medium medical personnel, causes greater doubts. For example, in one of the classifiers on otolaryngology, where according to regular standards, one position of the medical sister was established for one position of the doctor, the time spent on the front tamponade of the nose (including after bleeding) were determined in the amount of 2.0 coats for a doctor and 1.5 coats for a medical sister, i.e. 20 and 15 minutes, respectively. It is unlikely that a medical sister, having completed the procedure earlier a doctor, will assist another patient without an appropriate medical examination and appointments. The situation is complicated when the specified cost of working time is less than a medical sister. For example, to replace the cystostomomic drainage, the urologist has been installed 3.0 hours, that is, 30 minutes, and the medical sister is 4.0 even, that is, 40 min. After completing this operation, the doctor will take the following patient without a medical sister, which can lead to a violation of the technology of the medical and diagnostic process, which provides for the joint work of a doctor and a medical sister, or expect within 10 minutes the completion of the medical sister of this employment operation.

Thus, the establishment of different standards of time on separate labor operations for a doctor and a medical sister is confirmed with the industry standards for labor, which determine the relationship between the number of medical sisters and outpatient reception doctors for a particular specialty.

Moreover, as noted in the recommendations, determining the cost of time for individual labor operations, as well as simple and complex medical services can be considered only as an intermediate stage for the formation of regulatory costs to a more enlarged indicator, fixed in the reporting and accounting documentation of the LPU, i.e. . at visit.

The regulatory number of junior medical personnel posts also differentiate in the specialties of outpatient reception doctors. Thus, in urban clinics located in the cities with a population of over 25 thousand people, the posts of the Sanitarks are established at the rate of 1 Position for each post of a surgeon doctor, traumatologortopeda, infectious examiner; For every 2 posts of doctors on therapeutic physical education, allergologists-immunologists; For every 3 posts of other doctors leading outpatient reception.

Normation of labor of middle and junior medical personnel of hospital institutions

The rationing of the labor of middle and junior medical personnel of hospital institutions has certain features that are listed further:
the need to ensure round-the-clock maintenance of patients in the hospital;
An indicator that serves the basis for calculating the number of posts is the number of beds;
Setting the load standards (maintenance) on the patient's stay in hospital or shift.

The regulations of the number of middle and younger medical personnel of hospital institutions are among the number of beds for one position, or one round-the-clock post. Depending on this, the time rate is set either on the day of the position, or for a day.

The laboring of the labor of medical personnel of hospital institutions is carried out in stages according to the scheme represented in Fig. 2.

Stage I. The normative costs of working time medical personnel of hospital institutions are determined by 1 patient per day or per day. The patient's stay in the hospital for calculating the normative indicators on the work is differentiated as follows:
day receipt;
treatment day;
Extract day.

Time costs are typically based on timekeeping.

The calculation of the weighted average performance of the working time of the medical sister or nurse, working daily, on the patient's stay in the hospital (Tent) is carried out by the formula:

Tent \u003d (tp + t l x 0,825 (m - 2) + tv) / (m x 0,825), (4)

Where TP is the cost of a medical sister's time or a doctor on a patient on arrival day;

TL - the time spent on the patient during the treatment period per day;

TB - time spent on the patient for his discharge day;

M- average duration of inpatient treatment (in days).

The formula introduced a coefficient of 0.825, showing the reduction of the number of days of work of the medical sister or agencies during the entire period of stay at the expense of festive and weekend days. When calculating the coefficient, 12 festive and 52 days off when working at the six-day work week:

(365-52-12) / 365 ≈ 0,825.

At the specified mode, i.e., medical sisters are working every day, carrying out individual care for seriously ill, dressing, procedural, buffetic and sanitaries.

Example of calculation number 2

The length of the medical sister's time for organizing individual care for seriously ills per 1 day of the patient's stay is 100 minutes per day of receipt, 80 min daily during the treatment period and 70 minutes per day of discharge. The weighted average indicator with an average duration of a patient's stay equal to 13 days, calculated by formula 4, is 83.5 minutes.

(100 + 80 × 0.825 × (13 2) + 70) / (13 × 0,825) ≈ 8.4.

In the separation of about 10% seriously ill, therefore, this indicator per hospitalized is 8.4 minutes (83.5: 10).

Most of the middle and younger medical personnel of hospital institutions work around the clock. At the same time, the 2-selected system of maintenance is introduced.

The use of a 2-power system provides for the maintenance of patients with a doctor and a medical sister. At the same time, the steamed medical sister completely and directly serves the patient, and the sanitary card performs only sanitary and hygienic functions in the wards and utility rooms. Forced fulfillment of the functions of the younger medical personnel with celative medical sisters, for example, on the cleaning of premises in the absence of a proper number of senios, certainly worsens the quality of medical care and contradicts sanitary and hygienic requirements.

With a 3-power system, a doctor, a nurse and a nurse participate in the maintenance of patients.

The calculation of the weighted average costs of the working time of the medical sister or nurse per day of the patient's stay in the hospital (TSUT) is calculated by the formula, similar to formula 4, but excluding the coefficient of 0.825:

Touch \u003d (tp + t l x (m - 2) + tv) / m, (5)

All the designations correspond to the formula 4 with the calculation not on the day, but for the day of staying patient in the hospital.

Weighted average time costs are calculated separately on patients who received in a planned manner and for emergency testimony, and for the separation of the surgical profile, in addition, on the operated and non-operated patients. Then, taking into account the specific gravity of emergency hospitalization and operational activity, the indicator of the average cost of the time of the medical sister or nitrate per patient is determined. This method of calculation allows you to simulate the effective indicator of the average time spent per patient according to the separation profile, depending on the change in the main working conditions: increase or decrease the amount of emergency hospitalization, the number of operational interventions, changes in the average duration of the patient's stay in the hospital, etc.

Example of calculation number 3

The costs of the working time of the medical sister per patient per day in the hospital stay in the hospital, which received emergency testimony and in a planned manner, are presented in Fig. 3.

Calculations of the time spent per patient per day carried out according to Formula 5 show that they received in a planned manner with an average length of stay equal to 12 days, they will be 40.8 minutes:

(73.8 + 34.6 (12 2) + 70.2) x 12 ≈ 40.8.

Fig. 3. Cost of working time to the store medical sister

The costs of working time on patients who were erected, with an average length of stay in the hospital, equal to 8 days, will be 107.4 minutes:

(396,6 + 60,8(8 2) + 97,8) / 8 ≈ 107,4.

The average time spent at 10 percent emergency hospitalization is 47.5 minutes:

(107.4 × 10 + 40.8 × 90) / 100 ≈ 47.5.

The average time spent at 30% emergency hospitalization will be 61.8 minutes:

(107.4 × 30 + 40.8 × 70) / 100 ≈ 61.8.

Thus, an increase in the specific gravity of hospitalization for emergency testimony from 10 to 30% leads to an increase in the cost of the working time of the medical sister per patient per day from 47.5 to 61.8 min, i.e. by 30%.

Stage II. Estimated load standards (maintenance) for medical personnel of hospital institutions expressed among those serviced patients per day or per day by the formula:

NB \u003d (in x k) / t, (6)

Where NB is the load standards on the medical staff hospitals;

In the daily working hours of medical personnel (at the six-day working week) or daily working time;

K - the coefficient of use of the working time of the middle medical personnel on the main and auxiliary activities;

T - average time spent per patient per day (from formula 5). The main activity of medical personnel is, as a rule, work carried out directly with the patient, i.e., the time of direct contact of the personnel with the patient, namely the fulfillment of various kinds of procedures and manipulations. However, some categories of medical personnel are not completely in contact with patients, such as a nurse-cleaner with a two-way service system, so the main activity for them is the implementation of the direct production task.

All preparatory work, produced to fulfill the main activity and carried out both in the presence and in the absence of a patient, is auxiliary activity: preparation and cleaning of the workplace, preparation for manipulation, procedure, transition to another compartment, etc.

During the working day, personnel need a short-term rest, food reception, sanitary and hygienic events. These costs belong to the personal need.

Inter-sectoral Methodological materials recommend to remove approximately 10% of working time to the personal need. Experience in standardization of labor in health care shows that the coefficient of working time for basic and auxiliary activities for most positions of medical personnel (except for auxiliary medical diagnostic service) is 0.923, i.e. from 6.5 hours of working days about 30 min. Other types of work :

(6,5 - 0,5) / 6,5 = 0,923.

For further calculations, the coefficient of 0.9 can be taken.

Example of calculation number 4

The estimated medical sibling norms for the organization of individual care for severely ill with the cost of working time per hospitalized are 8.4 min (example of calculation No. 2). The load standards (maintenance) calculated by formula 6 are 42 hospitalized:

(6.5 × 60 × 0.9) / 8.4 ≈ 42.

Example of calculation number 5

Estimated load standards for a medical sister at the cost of working time per patient per day equal to 47.5 min (an example of calculation No. 3), determined by formula 6, are 27 hospitalized:

(24 × 60 × 0.9) / 47.5 ≈ 27,

And with costs equal to 61.8 min, - 21 patients:

(24 × 60 × 0.9) / 61.8 ≈ 21.

III stage. The standing of the post of medical personnel of a hospital institution, expressed among the number of beds for one position, is calculated by the formula:

NK \u003d (NB x 365) / R, (7)

Where Nk is the number of beds, incidental for one position;

NB - load among patients per day (from formula 6);

R is a planned number of beds of Koyki in the year.

The value of R in formula 7 is:
For urban, regional hospitals - 330-340 days;
For hospitals located in the countryside, 320 days;
For infectious hospitals - 310 days;
For maternity homes - 300 days.

Example of calculation number 6

The standing of a medical sister's position for organizing individual care for seriously ill patients of the branch of a city hospital, calculated by formula 7, at the cost of time per patient per day, equal to 8.4 min (Example No. 2) and the number of patients serviced equal to 42 (Example of calculation No. 4) is 45 beds ((42 x 365) / 340) for one position.

Example of calculation number 7

To ensure the activities of the ward nurse department in the conditions of the city hospital at the cost of working time per patient per day, equal to 47.5 min (example of calculation No. 3), and the settlement standards of the load of 27 patients (an example of calculation No. 5), a 24-hour post is required by 29 Coutes ((27 x 365) / 340), and at costs equal to 61.8 min and load standards, 21 patients - a 24-hour post per cauit ((21 x 365) / 340).

The calculation of the number of positions to ensure the work of the round-the-clock post is carried out by the formula:

DPost \u003d (24 × 60 × 365) / b, (8)

Where the referee is the number of posts to ensure the work of the round-the-clock post;

B - the annual budget of the work time position.

The annual working time budget (B in Formula 8) is calculated by Formula 3, presented in the Methodological Recommendations "Development of labor rationing technology in health care."

In accordance with Art. The 350 Labor Code of the Russian Federation for medical workers has been established by the abbreviated duration of the working week - not more than 39 hours. Decree of the Government of the Russian Federation of February 14, 2003 No. 101 due to the special working conditions for a number of categories of medical personnel, an abbreviated duration of the working week, component of 24, 30, 33 and 36 hours, was established.

In accordance with the clarification of the Ministry of Labor of Russia dated December 29, 1992 No. 5, approved by the decision of 29.12.1992 No. 65, the daily period of working time is calculated on the calculated schedule of the five-day working week with two weekends on Saturday and Sunday. The duration of the working day is determined by dividing the weekly duration of working time for 5 days.

In accordance with Art. 95 TK RF Duration of the working day or shift, directly preceding the non-working holiday day, decreases by 1 hour.

At the coincidence of the weekend and non-working day, the day off is transferred to the next day after the holiday. In order to rational use by workers of the weekend and non-working days, the Government of the Russian Federation has the right to transfer the weekend to other days. As a rule, as a result of such transfers, there are 7 or 8 pre-holiday days during the year. Currently, the number of non-working holidays in the Russian Federation is determined by the Law of the Russian Federation of December 29, 2004 No. 201 "On Amendments to Article 112 of the Labor Code of the Russian Federation":
1, 2, 3, 4 and 5, New Year's holidays;
January 7 - Christmas of Christ;
February 23 - the Day of Defender of the Fatherland;
March 8 - International Women's Day;
May 1 - Spring and Labor holiday;
May 9 - Victory Day;
June 12 - Day of Russia;
November 4 - the Day of People's Unity.

When calculating the number of workers, festive non-working and pre-holiday days a year, it is advisable to use the production calendar.

In 2008 - 250 business days for the five-day work week, 7 of pre-holiday days.

In connection with the adoption of the Labor Code of the Russian Federation, a transition was carried out on the calculation of labor leave in calendar days (Art. 115 of the Labor Code of the Russian Federation), but the duration of leave remained the same. In the calculations of the annual budget, vacation time is advisable to determine as a product of the weekly duration of working time for the number of weeks.

Example of calculation number 8

The annual budget of the working time Position of the Medical Sister of the City Hospital at the 39-hour Weeking Week, a 28-day holiday (among the calendar days), calculated for 2008 by Formula 3, is 1787 h: (39/5) × 250 - 7 4 × 39 \u003d 1787 h, or 107 220 min (60.0 × 1787).

In tab. 2 presents the final data of the calculation of the annual budget of the working time of the posts of medical personnel with different modes of labor and recreation.
table 2

Annual budget of working time posts of medical personnel in 2008 with different modes of labor and recreation
Working week's duration, h
Annual budget (h) with leave duration (in calendar days)

28
35
42
49
56

24
1097
1073
1049
1025
1001

30
1373
1343
1313
1283
1253

33
1511
1478
1445
1412
1379

36
1649
1613
1577
1541
1505

39
1787
1748
1709
1670
1631

Example of calculation number 9

The number of posts for medical sisters to ensure the work of a round-the-clock post at the annual working time budget, equal to 1787 h (example of calculation No. 8), calculated according to formula 8, is 4,916 positions ((24 x 366) / 1787)

Table 3 shows the final data of the calculation of the number of medical personnel posts with different modes of labor and recreation to ensure the work of the round-the-clock post in 2008

Table 3.

The number of medical personnel posts with different modes of labor and recreation to ensure the work of the round-the-clock post in 2008
The duration of the working week (h)
Number of posts per 1 post with duration of vacation (in calendar days)

28
35
42
49
56

24
8,007
8,186
8,374
8,570
8,775

30
6,398
6,541
6,690
6,847
7,010

33
5,813
5,943
6,079
6,221
6,370

36
5,327
5,446
5,570
5,700
5,837

39
4,916
5,025
5,140
5,260
5,386

The calculation of the number of posts in a particular department is carried out by the formula:

Dotod \u003d (DP × K) / p, (9)

Where dotd is the number of posts in the department;

DP is the number of posts per 1 post;

K - the number of beds in the department;

P - number of beds for 1 post (according to the standard).

Example of calculation number 10

In the compartment for 30 beds with a regulatory indicator, which constitutes 20 beds per 1 post, and the number of the posts of a medical sister (ward) to ensure the work of one round-the-clock post, equal to 4,916 positions (at the 39-hour week and 28 days of vacation), 7,374 POST OFFICE MEDICAL SECURITY:

(4,916 × 30) / 20 \u003d 7.374.

The calculation was carried out according to formula 9.

Features of the standardization of middle and younger medical personnel in day hospitals

In recent years, random-intensive types of care are obtained. The regular standards of the medical staff of day hospitals establishes the post of senior medical sister (regardless of the total number of beds). Positions of nurses are introduced at the rate of 1 Position for 15 beds, the posts of ceiling agencies or junior medical care sisters are established according to the posts of nurses (order of the Ministry of Health of Russia of 09.12.1999 No. 438).

The amount of work of secondary and junior medical personnel is associated with the need to organize the care and implementation of medical purposes during the daytime, and in different institutions, the opening hours of the day hospital are determined depending on the specific local conditions and range from 5 to 9 h daily. In some cases, a two-chaired work of the day hospital is practiced. When calculating, it is necessary to take into account the number of days of the day hospital per year: in a five-day or six-day working week, without weekends and holidays, etc.

The calculation of the number of medium and junior medical personnel in day hospitals can be performed on the basis of these photochricultural observations. However, given the complexity of photographic surveillance observations to determine the norms of time in health facilities, it can be recommended to use the existing regulatory framework for these personnel groups through hospital institutions, but taking into account the time of the day hospital.

Planning the number of ward nurses, junior nurses for patient care, ceiling agencies, celestial sanitary-cleaners of hospital institutions are carried out by establishing round-the-clock posts on a specific number of beds. When organizing the work of this personnel, the load rate (maintenance) during the daytime, as a rule, increase, in the night - decrease. For example, when planning a single post on 20 beds in the daytime, you can set the load of 15 beds, and in the night - 40-50 beds.

However, differences in the composition of patients in the day hospital compared to a conventional hospital department, the mobility of patients and self-service ability allow us to be taken as the basis for planning the number of medium and younger medical personnel in the day hospital. The total value of the number of bed numbers for one post.

The calculation of the number of posts of the elegant nurses, ceiling agencies in day hospital are carried out by the formula:

Dmitne \u003d X (T / W) X (K / N), (10)

Where ddvnun is the number of posts of ward nurses and emergency sites in day hospital;

The referee is the number of medical sisters or senses to ensure the work of the round-the-clock post;

T - the number of hours of day hospital over the year;

W is the number of hours of work around the clock post per year;

K - the number of beds in day hospital;

N is a regulatory number of beds in a hospital with a 24-hour stay at 1 post.

Example of calculation No. 11

The hospital of the daytime stay of the therapeutic profile on 25 beds is open from 10 to 18 hours, i.e. 8 hours daily within 303 days (at the six-day working week). Therefore, T \u003d 2424 h (8 × 303). The round-the-clock post of the Klative Medical Sister in the Therapeutic Office of the City Hospital is installed on 20 beds, manifold-cleaners - for 30 beds (with a two-beared service system). According to Table 3, 4,916 positions are required to ensure the work of the round-the-clock post (at the 39-hour working week and 28 days of vacation). Calculations according to formula 10 show that in this day hospital in 2008 it is necessary 1.696 posts of nurses and 1,131 posts.

In accordance with the procedure for rounding posts to the staffing schedule, 1,75 posts of the Balant Medical Sister and 1.25 post-cleaner retirement were introduced.

Ruling of the labor of the middle and junior medical personnel of the auxiliary medical and diagnostic service of the LPU

The normalization of the labor of the middle and junior medical personnel of the auxiliary medical and diagnostic service is carried out mainly according to the same stages as other personnel, but it has certain features.

The stage is to determine the estimated time standards for individual research, manipulation, procedures.

The current regulatory documents that determine these labor indicators are usually approved 15-20 years ago. The list of regulatory documents is given in the annex to this publication. The development of a regulatory document before it is approved is about 3-5 years, therefore, the data given in them correspond to the equipment used in health institutions more than 20 years ago. At the same time, a rather intensive replacement of equipment occurs in a number of services, especially in recent years due to the introduction of the National Health Project. At the same time, changes in the technologies of diagnostic studies associated with an increase in the permits of equipment and the new possibilities of studying the pathological process lead to Changes in the labor costs of personnel on their conduct, and these changes may be aside both increasing and reducing the rules of time. All this determines the need and relevance of regulatory work on the development of time standards for diagnostic research on modern equipment.

Such work at the federal level now, unfortunately, are not conducted.

Stage II. The load standards (maintenance) of the medical personnel of the auxiliary medical and diagnostic service are expressed in the number of research or in the time budget, for which the regulatory number of studies can be conducted, procedures, manipulations for the change of work, month, quarter, year. As a rule, use the annual period of time.

The load standards (maintenance) for medium medical personnel, for which the time standards are established for individual studies, procedures of the auxiliary medical and diagnostic service are determined by the formula:

N Nerge auxiliary \u003d b × k, (11)

Where N nuclei helpers the load standards of the auxiliary medical and diagnostic service;

B - the annual budget of the work time position;

K - the utility utilization utility factor.

Such posts include a laboratory assistant, a medical laboratory assistant, a medical sister on massage, physiotherapy, a nurse of the department (Cabinet) of functional research.

Annual budget (B in formula 11) can be expressed both in units of time measurement (min, h) and in conventional units.

The coefficient K in Formula 11 has different values \u200b\u200bfor each service and is directly dependent on the structure of the estimated time and the ratio of different components of this indicator. For example, only basic activities are included in the estimated time standards for laboratory studies, and 20% of working time is discharged to other types of work. The value of the coefficient K is presented in Table 1.

Example of calculation number 12

The annual budget of the working time Positions of the Medical Sister for Massage at the 39-hour Web Week and 28 Calendar Days of Vacation is 107,230 min, or 10 722 Conditional massage units (1 conditional massage unit \u003d 10 min). The load rate (maintenance) calculated by formula 11 is 8256 SL. units. (10 722 × 0.77).

III stage. The calculation of the number of positions by volume of work is carried out by the formula:

D \u003d T / N HEAGE EPU, (12)

Where d is the number of posts;

T - the cost of working time on research, procedures for a certain period of time, as a rule, for the year;

N HEAGE ASU - Estimated load standards (maintenance) from formula 11.

The costs of working time one or another support service for one or another period of time (T in Formula 12) are determined by the summation of the work of time for each study for the number of these studies, as a rule, during the year. The number of studies are set by writing the necessary information from the primary documentation or during the current accounting. This methodological technique is associated with the fact that the reporting documentation contains a group of research, procedures, manipulations, and normative indicators for work are established for each specified unit.

Example of calculation number 13

Medical massage sister during the year held 1000 procedures of segmental massage of the cervical spine, 500 - massage brushes and forearm, 8000 - neck. The cost of time on the first of these species is 3.0 conditional massage units, on the second and third - 1.0 conditional massage unit. The total costs are 11,500 conventional massage units (3.0 × 1000 + 1.0 × 500 + 1.0 × 8000). The calculation conducted by Formula 12 shows that 1,393 medical sisters for massage (11,500: 8256) should be introduced to perform this amount of work in the staffing schedule (11,500: 8256), rounded - 1.5 positions.

Indicators for planning the number of posts of secondary medical personnel of auxiliary medical diagnostic service in accordance with regular standards are:
The number of posts of outpatient reception doctors or the number of beds (to calculate the positions of laboratory technicians, laboratory assistant, medical sisters for massage, medicinal physical education instructors); the number of posts of the support service of the appropriate specialty (to calculate the posts of radically climbers, medical sisters of ultrasound diagnostics);
the amount of work (to calculate the posts of medical sisters on massage, instructors on therapeutic physical education);
population (to calculate the posts of the medical sisters of the Cabinet of Functional Diagnostics during the monitoring of the population);
availability of the appropriate cabinet (to establish a position of the medical sister of the Cabinet of Functional Diagnostics); institution (to establish a laboratory assistance in the center of the general medical (family) practice);
Change of work for calculating x-ray posts.

Indicators to establish the numbers of the junior medical personnel of the auxiliary medical diagnostic service are:
The number of medical and (or) medium medical personnel of the relevant division; For example, the position of the laboratory sanitary facilities is established at the rate of 1 position for 4 posts of doctors and laboratory technicians, the natives of the X-ray Cabinet - respectively, the posts of radiologists; Sanitarys of the physiotherapy office (Cabinet) - at the rate of 1 Position for 2 medical seisters for physiotherapy (for most types of institutions);
number of beds; For example, the positions of the X-ray Cabinet (separation) of regional, regional hospitals are set at the rate of 1 position at 300 beds;
availability of the relevant cabinet; For example, the position of sanitary cards of the functional diagnostics of the precinct hospital is established at the rate of 1 position for each office;
shift work; For example, the position of the X-ray Cabinet of the Urban Polyclinic is installed on the X-ray Cabinet in shift.

Thus, the application of outlined methodological approaches to the standardization of the Labor of Middle and Junior Medical Personnel allows the scientific substantiation of industry-specific labor standards, to calculate the number of personnel of health care facilities in accordance with specific local conditions, forms and methods of organizing medical care to the population and will contribute to rational alignment and Using frames.

Who establishes a laboring system in health facilities?

The laboring system in health facilities is established by an employer based on standard labor standards. By virtue of Art. 161 TK RF, standard labor standards are developed and approved in the manner established by the authorized government of the Russian Federation by the federal executive authority. In the health sector, such a body is the Ministry of Health of Russia. So, by the order of the Ministry of Health of Russia of 02.06.2015 No. 290n, typical sectoral norms of time for the execution of work related to visiting one patient of a Pediatric Pocletian doctor, a medical practitioner, doctor, doctor, a neurologist, a non-corrugated doctor, doctor, doctor , ophthalmologist and doctor-gynecologist doctor. These standard standards are the basis for calculating the load standards, the number of numerical norms and other norms of medical organizations that provide primary medical and primary specialized health care in outpatient conditions.

In turn, according to Art. 163 TK RF Local regulations providing for the introduction, replacement and revision of labor standards, are accepted by the employer, taking into account the opinion of the representative body of workers.

The main local regulatory act in this case is the staffing of the institution.

What are the requirements for a staffing schedule of medical organization and the calculation of full-time regulations?

Currently, when calculating full-time standards, it is primarily necessary to be guided by the Decree of the President of the Russian Federation of 07.05.2012 No. 597 and the order of the Government of the Russian Federation of November 26, 2012
No. 2190-P, approved by the program of phased improving the wage system in state (municipal) institutions for 2012-2018.

According to the specified program of phased improvement of the wage system, the formation of a staffing of institutions should be carried out using laboring systems, taking into account the need for the qualitative provision of state (municipal) services, the fulfillment of medical care issues established by the program of state guarantees of free provision of medical care to citizens and the relevant territorial program.

In accordance with Art. 159 of the Labor Code of the Russian Federation the laboring system is determined by the employer, taking into account the opinion of the representative body of workers or are established by a collective agreement. Institutions can independently develop appropriate labor standards, taking into account the recommendations of the organization that operates and the powers of the founder, or with the involvement of relevant specialists in the prescribed manner (p. 16 of the methodological recommendations, approved. Order of the Ministry of Labor of Russia from 09/30/2013 No. 504).

It should be noted that in accordance with the sub. "F" n. 39 section. X Unified Recommendations, UTV. By the decision of the Russian trilateral commission of 12/24/2014 (Minutes No. 11), the formation of full-time health care facilities should be carried out, taking into account the nomenclature of the posts of medical workers and pharmaceutical workers, approved. Order of the Ministry of Health of Russia of December 20, 2012 No. 1183N.

The following orders were developed for the full-time regulations of the organizational and methodological departments of medical organizations in Soviet times.

Order of the Ministry of Health of the USSR from 06.06.1979 No. 600 (with changes and additions).
Order of the Ministry of Health of the USSR from 09/26/1978 No. 900 (with changes and additions).
Order of the Ministry of Health of the USSR from 05/31/1979 No. 560.

These documents of the Ministry of Health of Russia are not officially canceled and in accordance with the Order of the USSR Ministry of Health of August 31, 1989 No. 504 are a recommendatory nature. In this connection, they can be used as a basis for the development of labor exchange systems installed in medical organizations. When applying these documents, it should be borne in mind that the names of the posts of medical and other personnel of health institutions must comply with the nomenclature of medical professionals and pharmaceutical workers (approved by the order of the Ministry of Health of Russia of December 20, 2012 No. 1183N).

Regarding the identification of the standard of staff units of employees and workers and public and municipal healthcare institutions, it is possible to be guided by the order of the Ministry of Health of Russia of 09.06.2003 No. 230, which establishes the dependence of the number of full-time units of working professions from the work on technically sound standards, and in their absence - on the norms, Developed by the institution of experimentally statistical means.

Thus, the staffing of a medical organization is established by the most medical organization on the basis of reasonable labor standards and is approved by its leader (sub. "D" clause 33 spec. VIII of uniform recommendations, approved by the Russian trilateral commission of 25.12.2013, Protocol No. 11) .

It should be especially noted that the staffing must be united and take into account the entire personnel involved in the implementation of the State Region and in the provision of paid services.

A regular schedule is used to design the structure, staffing and staffing of the organization in accordance with its charter (position). A regular schedule contains a list of structural divisions, names of posts, specialties, professions indicating qualifications, information on the number of full-time units (guidelines for the application and filling of the forms of primary accounting documentation, approved. Resolution of the State Statistics Committee of Russia dated January 05/2004 No. 1).

According to sub. "B" p. 35 uniform recommendations, approved. By the decision of the Russian trilateral commission of 12/24/2014 (Minutes No. 11), the formation of a single staff schedule in the institution is carried out regardless of which the types of economic activity include structural units of the institution.

In turn, in accordance with paragraph 10 of the Regulations on the establishment of wage systems for employees of federal budget, autonomous and official institutions (approved. Decree of the Government of the Russian Federation of 05.08.2008 No. 583) The staff schedule should include all positions (professions) of this institution . At the same time, the Fund of remuneration of employees of the federal budgetary institution is based on the amount of funds entering the established procedure to federal budget institution from the federal budget, and funds coming from the income-generating activities (paragraph 11 of provisions No. 583).

From these provisions of the legislation, it follows that institutions make up a single staffing schedule, which includes all positions (professions) of this institution, regardless of which funds are funded by one or another.

Speaking about the form of a staff schedule, it is worth saying that there are no direct explanations of the federal authorities on this issue. However, since for health facilities a departmental regulatory act (order of the Ministry of Health of Russia of January 18, 1996 No. 16) approved its form of staff schedule, in my opinion, it should be used.

Thus, for example, the relevant departmental regulations approved the forms of schedules for subordinate institutions: a staff schedule, approved. Order of the Federal Agency for Special Construction of 03.12.2010 No. 540, staff schedule, approved. Order of the Federal Agency for State Reserves from 09.09.2010 No. 180, staff schedule, approved. Order of the Federal Customs Service of October 18, 2005 No. 970, staff schedule, applied. Methodical recommendations for working with documents in general education institutions (a letter of the Ministry of Education of Russia of 20.12.2000 No. 03-51 / 64), and others.

From January 1, 2013 in connection with the entry into force of the provisions of the Federal Law of December 6, 2011
No. 402-FZ "On Accounting" "Unified forms for accounting for labor and its payment, approved by the Resolution of the State Statistics Committee of Russia from January 05/2004 No. 1" On approval of unified forms of primary accounting documentation for labor accounting and its payment "are not mandatory for use. At the same time, in the information of the Ministry of Finance of Russia dated 04.12.2012 No. PZ-10/2012 is explained that the forms of documents used as primary accounting documents established by authorized bodies continue to be obligatory for use, established by authorized bodies in accordance and on the basis of other federal laws (for example, cash documents. ).

Who should approve the staffing of a medical organization?

A similar duty is entrusted to the head of the medical organization.

So, the right of the head of the medical organization to approve the staff schedule is enshrined by the following regulatory acts:

by the order of the Ministry of Health and Medical Industry of the Russian Federation of January 18, 1996 No. 16 "On the introduction of forms of staff of health care institutions";
Unified recommendations for establishing in the federal, regional and local levels of wage systems of state and municipal institutions for 2015, which were approved by the decision of the Russian Tripartite Commission on the Regulation of Socio-Labor Relations dated December 24, 2014, Protocol No. 11 (sub. "D" p. 33).

In addition, according to sub. "E" of paragraph 8 of the standard form of an employment contract with the head of the state (municipal) institution, approved. Decree of the Government of the Russian Federation of 04/12/2013 No. 329, the head is entitled to approval in the prescribed manner of the structure and staffing of the institution. It should be noted that by virtue of Part 3 of Art. 275 of the Labor Code of the Russian Federation The employment contract with the head of the state (municipal) institution is based on the typical form of an employment contract approved by the Government of the Russian Federation, taking into account the opinion of the Russian Tripartite Commission for the Regulation of Socio-Labor Relations.

It should also be said that by virtue of the direct indication of the law, namely part 2 Art. 13 of the Federal Law of 03.11.2006 No. 174-FZ, the head of the autonomous institution independently approves the staff schedule.

Should the head of a medical organization coordinate a staffing schedule with higher authorities?

In accordance with paragraph 19 of the Unified Recommendations on the establishment of state and municipal wage systems for the regional and local levels, approved by the decision of the Russian Tripartite Commission on the Regulation of Socio-Labor Relations dated December 24, 2014, Protocol No. 11, The staffing schedule is approved by the head of the institution and includes all positions of employees (professions of workers) of this institution. In turn, the responsibility of the head of the budget institution to coordinate the staffing schedule, including information on the number of full-time units, with the founder of federal legislation is not established.

At the same time, the indicated duty may be established for certain types of institutions in the legal act of the founder or enshrined in other agreements governing the wages of employees.

According to paragraph 11 of Regulation No. 583, the Foundation for the remuneration of employees of the federal budgetary institution is formed on the basis of the amount of subsidies entering the established procedure to a federal budget institution from the federal budget, and funds coming from income-generating activities.

Consequently, the procedure for approving the staffing schedule does not depend on sources of financing remuneration of employees of the institution.

Thus, if the duty to coordinate the staffing schedule is not established in the legal act of the founder or in other agreements governing the remuneration of workers' remuneration, the budgetary institution develops and approves a regular schedule. Additional matching is not required in this case.

It is especially worth noting that in practice, the requirements of the territorial funds of compulsory medical insurance are also quite often found on the coordination of the staff schedule directly with them. It should be said that federal legislation also does not provide a similar duty for the heads of the medical organization. In turn, in a letter of FFOMs from 04.04.2015 No. 1726/30-4 "On the procedure for the formation of full-time schedules", it is clear that the structure and staffing number are established by the head of the medical organization based on the amount of medical and diagnostic work and the number of serviced population, taking into account Recommended full-time standards provided by the procedures for medical care. Thus, the harmonization of a staffing schedule approved by the head of a medical organization, not required with TFOMS.

What should be guided by the head of the medical organization when calculating full-time regulations? Is it possible to apply orders, such as the order of the Ministry of Health of Russia of 09.06.2003 No. 230?

Full-time regulations established by the Order of the Ministry of Health of Russia dated 09.06.2003 No. 230 are recommended, they need to be guided by the preparation of a staffing schedule along with the procedures for providing medical care, however, a medical organization is not obliged to observe them.

In accordance with the letter of the Ministry of Health of Russia of January 08/2004 No. 14-04 / 9846 Order of the Ministry of Health of Russia dated 09.06.2003 No. 230 recognized by the Ministry of Justice of Russia (letter dated 26.06.2003 No. 07/6476-YUD) not in need of state registration, since it is organizational Character and does not contain legal norms. Accordingly, as follows from the above letters, the order of the Ministry of Health of Russia dated 09.06.2003 No. 230 is a recommendatory nature, since it does not contain mandatory legal norms.

In addition, in accordance with paragraph I of the current order of the Ministry of Health of the USSR of 10.02.1988 No. 90, heads of health care institutions, based on the production need, it is allowed to strengthen individual structural units or to introduce posts not provided for for them by existing staffing standards, due to the posts of other structural Divisions within the established establishment of the number of posts and the wage foundation. At the same time, it is allowed to replace posts in any order. The changes made are entered into regular schedules without coordination with the superior health authority.

It should also be noted that the economic rationale is not put by a priority in a modern approach to establishing full-time standards:

In accordance with section IV of the phased improvement program of the wage system in state (municipal) institutions for 2012-2018. (appliance. Order of the Government of the Russian Federation of November 26, 2012 No. 2190-p) The formation of a staff number of institutions should be carried out using laboring systems, taking into account the need for the qualitative provision of state (municipal) services (performance).
In accordance with the order of the Ministry of Health of Russia of 26.06.2014 No. 322 in determining the need for medical personnel, it is taken into account:

features of morbidity, taking into account gender and age of the population in the subject of the Russian Federation;
territorial features of the subjects of the Russian Federation (the location of the subject in the regions of the Far North and region equivalent to them, the population density, the proportion of the rural population);
the amount of medical assistance provided within the framework of the territorial program of state guarantees of free provision of medical care to citizens (TPGH);
availability in the subject of the Russian Federation of settlements, remote (more than 400 km) from medical organizations, where specialized medical care is provided.

In addition, according to sub. 7 p. 2 art. 7 of the Federal Law of 03.11.2006 No. 174 in the Charter of the Autonomous Institution necessarily reflect the structure and competence of the authorities of the autonomous institution. Thus, if the authority on the approval of the staff of the employees of this institution is not attributed to the competence of the founder or the Supervisory Board, they refer to the authority of the head of the autonomous institution along with the statement of the staffing schedule (paragraph 2 of Article 13 of the Federal Law No. 174) .

Judicial practice also adheres to the opinion that the establishment of full-time regulations is the right to the head of the institution. Thus, in the appellate definition of the Tomsk Regional Court of 14.02.2014 in case No. 33-140 / 2014, the judicial board decided: "Implementing the Constitution of the Russian Federation (Part 1 of Art. 34 and Part 2 of Art. 35) of the right, an employer for the purpose of implementing Effective economic activity and rational property management has the right to affect its responsibility to take the necessary personnel decisions, while ensuring in accordance with the requirements of Art. 37 of the Constitution of the Russian Federation enshrined by labor legislation guarantees of labor rights of employees. "

It is especially worth noting that currently in the procedures for medical care, which, according to current legislation, are mandatory for execution, contains the recommended full-time regulations of the number of medical personnel. The fact that these full-time standards are recommended, does not oblige a medical organization to strictly adhere to them in the preparation of a staffing schedule. It should also be paid to that if in uniform recommendations for establishing in the federal, regional and local levels of remuneration systems of state and municipal institutions for 2014, it was an indication of the formation of a staffing schedule in accordance with the procedures for providing medical care, then in similar recommendations on 2015. There is no such indication. Thus, strict responsibilities are used in drawing up a staff schedule recommended standard standards set by the procedures for providing medical care, the legislation is not established.

Can the head of a medical organization increase full-time regulations, for example, with the aim of organizing income generic activities?

Yes, the head has the right to do it. In addition, in a letter of the Ministry of Health of Russia of October 25, 2012
No. 16-5 / 10/2-3238 "On the direction of the Methodological Recommendations" Determining the optimal ratio of medical / secondary medical / other personnel in state and municipal health institutions of the general medical network and specialized services "contains clarification that when determining the optimal ratio of medical / Middle Medical / Other Staff in the State and Municipal Healthcare Institutions of the General Medical Network and Institutions of Specialized Services It is advisable to take into account such factors such as the availability of full-time and employed posts contained at the expense of income-generating activities (paid services). This activity is self-sufficient, and there is no need to monitor the presence and ratio of posts funded by paid medical services and other areas of income-generating activities. For example, additional positions of other personnel contribute to improving the quality of patient service when providing paid medical services.

Should separate staff schedules on the source of financing (for example, OMS and income generating) are administered in a medical organization?

No, the compilation of certain staff schedules in this case is not required. This directly indicates FFOMS in a letter dated 04/06/2015 No. 1726/30-4, explaining that the individual establishment of a staff schedule as part of the activities in the field of compulsory medical insurance is not provided and is not required.

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