The current state of labor regulation in healthcare. Labor standardization in healthcare, you are tired. We are establishing a system of labor standardization in healthcare.
Who establishes the labor standardization system in healthcare institutions?
The labor standardization system in healthcare institutions is established by the employer on the basis of standard labor standards. By virtue of Art. 161 of the Labor Code of the Russian Federation, standard labor standards are developed and approved in the manner established by the federal executive body authorized by the Government of the Russian Federation. In the healthcare sector, such a body is the Russian Ministry of Health. Thus, by order of the Ministry of Health of Russia dated June 2, 2015 No. 290n, standard industry standards of time for performing work related to one patient’s visit to a local pediatrician, a local general practitioner, a general practitioner (family doctor), a neurologist, and an otorhinolaryngologist were established , ophthalmologist and obstetrician-gynecologist. These standard standards are the basis for calculating workload standards, headcount standards and other labor standards for doctors of medical organizations providing primary medical care and primary specialized health care in an outpatient setting.
In turn, according to Art. 163 of the Labor Code of the Russian Federation, local regulations providing for the introduction, replacement and revision of labor standards are adopted by the employer taking into account the opinion of the representative body of employees.
The main local regulatory act in this case is the staffing schedule of the institution.
What are the requirements for the staffing schedule of a medical organization and the calculation of staffing standards?
Currently, when calculating staffing standards, it is first of all necessary to be guided by Decree of the President of the Russian Federation dated May 7, 2012 No. 597 and the order of the Government of the Russian Federation dated November 26, 2012
No. 2190-r, which approved the Program for the gradual improvement of the remuneration system in state (municipal) institutions for 2012-2018.
According to the specified Program for the gradual improvement of the remuneration system, the formation of the staffing level of institutions should be carried out using labor standardization systems, taking into account the need for high-quality provision of state (municipal) services, fulfillment of the volumes of medical care established by the Program of State Guarantees of Free Medical Care to Citizens and the corresponding territorial program.
In accordance with Art. 159 of the Labor Code of the Russian Federation, labor standardization systems are 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 performing the functions and powers of the founder, or with the involvement of relevant specialists in the prescribed manner (clause 16 of the Methodological Recommendations, approved by order of the Ministry of Labor of Russia dated September 30, 2013 No. 504).
It should be noted that in accordance with sub. "g" clause 39 section. X Unified recommendations, approved. By decision of the Russian Tripartite Commission dated December 24, 2014 (Minutes No. 11), the formation of staffing schedules for healthcare institutions must be carried out taking into account the Nomenclature of Positions of Medical Workers and Pharmaceutical Workers, approved. by order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n.
In relation to the staffing standards of organizational and methodological departments of medical organizations in Soviet times, the following orders were developed.
- Order of the USSR Ministry of Health dated 06/06/1979 No. 600 (with amendments and additions).
- Order of the USSR Ministry of Health dated September 26, 1978 No. 900 (with amendments and additions).
- Order of the USSR Ministry of Health dated May 31, 1979 No. 560.
These documents have not been officially canceled by the Russian Ministry of Health and, in accordance with the order of the USSR Ministry of Health dated August 31, 1989 No. 504, are advisory in nature. In this connection, they can be used as a basis for the development of labor standards systems installed in medical organizations. When applying these documents, it should be taken into account that the names of positions of medical and other personnel of healthcare institutions must comply with the Nomenclature of Positions of Medical Workers and Pharmaceutical Workers (approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n).
In relation to determining the standard of staffing units for employees and workers of state and municipal healthcare institutions, one can be guided by the order of the Ministry of Health of Russia dated 06/09/2003 No. 230, which establishes the dependence of the number of staffing units of blue-collar professions on the volume of work according to technically sound standards, and in their absence - according to standards developed by the institution experimentally and statistically.
Thus, the staffing schedule of a medical organization is established by the medical organization itself on the basis of reasonable labor standards and approved by its head (subparagraph “d”, paragraph 33 of section VIII of the Unified Recommendations, approved by the decision of the Russian Tripartite Commission dated December 25, 2013, protocol No. 11) .
It should be especially noted that the staffing table must be uniform and take into account all personnel involved in both the implementation of government tasks and the provision of paid services.
The staffing table is used to formalize the structure, staffing and staffing levels of an organization in accordance with its charter (regulations). The staffing table contains a list of structural units, names of positions, specialties, professions indicating qualifications, information on the number of staff units (Instructions for the use and completion of forms of primary accounting documentation, approved by Resolution of the State Statistics Committee of Russia dated January 5, 2004 No. 1).
According to sub. “c” clause 35 of the Unified Recommendations, approved. By decision of the Russian Tripartite Commission dated December 24, 2014 (Minutes No. 11), the formation of a unified staffing table in an institution is carried out regardless of what types of economic activities the structural divisions of the institution belong to.
In turn, in accordance with clause 10 of the Regulations on the establishment of remuneration systems for employees of federal budgetary, autonomous and government institutions (approved by Decree of the Government of the Russian Federation dated 05.08.2008 No. 583), the staffing table must include all positions (professions) of this institution . At the same time, the wage fund for employees of a federal budgetary institution is formed based on the amount of funds received in the prescribed manner by the federal budgetary institution from the federal budget, and funds received from income-generating activities (clause 11 of Regulation No. 583).
From these provisions of the legislation it follows that institutions draw up a single staffing table, which includes all positions (professions) of this institution, regardless of what funds are used to finance a particular position.
Speaking about the form of staffing, it is worth saying that there are no direct explanations from the federal authorities on this issue. However, since a departmental regulatory act (Order of the Ministry of Health and Medical Industry of Russia dated January 18, 1996 No. 16) approved its own form of staffing for healthcare institutions, in my opinion, this is what should be used.
For example, the relevant departmental regulations have approved schedule forms for subordinate institutions: staffing table, approved. by order of the Federal Agency for Special Construction dated December 3, 2010 No. 540, staffing table, approved. by order of the Federal Agency for State Reserves dated 09.09.2010 No. 180, staffing table, approved. by order of the Federal Customs Service of October 18, 2005 No. 970, staffing table, approved. Methodological recommendations for working with documents in educational institutions (letter of the Ministry of Education of Russia dated December 20, 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 Resolution of the State Statistics Committee of Russia dated January 5, 2004 No. 1 “On approval of unified forms of primary accounting documentation for accounting for labor and its payment,” are not mandatory for use. At the same time, in the information of the Ministry of Finance of Russia dated December 4, 2012 No. PZ-10/2012, it is explained that forms of documents used as primary accounting documents established by authorized bodies in accordance with and on the basis of other federal laws continue to be mandatory for use (for example, cash documents ).
Who should approve the staffing schedule of a medical organization?
A similar responsibility is legally assigned to the head of a medical organization.
Thus, the right of the head of a medical organization to approve the staffing table is secured by the following regulatory legal acts:
- Order of the Ministry of Health and Medical Industry of the Russian Federation dated January 18, 1996 No. 16 “On the introduction of staffing forms for healthcare institutions”;
- Unified recommendations for the establishment at the federal, regional and local levels of remuneration systems for employees of state and municipal institutions for 2015, which were approved by the decision of the Russian Tripartite Commission for the Regulation of Social and Labor Relations dated December 24, 2014, Protocol No. 11 (subparagraph “d” paragraph 33).
In addition, according to sub. “e” clause 8 of the standard form of an employment contract with the head of a state (municipal) institution, approved. By Decree of the Government of the Russian Federation dated April 12, 2013 No. 329, the head has the right to approve in the prescribed manner the structure and staffing of the institution. It is worth noting that, by virtue of Part 3 of Art. 275 of the Labor Code of the Russian Federation, an employment contract with the head of a state (municipal) institution is concluded on the basis of a standard 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 Social and Labor Relations.
It should also be said that by virtue of the direct instructions of the law, namely Part 2 of Art. 13 of Federal Law No. 174-FZ of November 3, 2006, the head of an autonomous institution independently approves the staffing table.
Should the head of a medical organization coordinate the staffing schedule with higher authorities?
In accordance with clause 19 of the Unified Recommendations for the establishment at the federal, regional and local levels of remuneration systems for employees of state and municipal institutions for 2015, approved by the decision of the Russian Tripartite Commission for the Regulation of Social and Labor Relations dated December 24, 2014, Protocol No. 11, The staffing table is approved by the head of the institution and includes all positions of employees (professions of workers) of this institution. In turn, the obligation of the head of a budgetary institution to coordinate the staffing schedule, including information on the number of staff units, with the founder is not established by federal legislation.
At the same time, this obligation may be established for certain types of institutions in the legal act of the founder or enshrined in other agreements regulating issues of remuneration of employees.
According to clause 11 of Regulation No. 583, the wage fund for employees of a federal budgetary institution is formed based on the volume of subsidies received in the prescribed manner by the federal budgetary institution from the federal budget, and funds received from income-generating activities.
Consequently, the procedure for approving the staffing table does not depend on the sources of financing the remuneration of employees of the institution.
Thus, if the obligation to coordinate the staffing table is not established in the legal act of the founder or in other agreements regulating the issues of remuneration of employees, then the budgetary institution develops and approves the staffing table independently. No additional approval is required in this case.
It is especially worth noting that in practice there are also quite often demands from territorial compulsory health insurance funds to coordinate staffing directly with them. It should be said that federal legislation also does not provide for a similar obligation for the heads of a medical organization. In turn, the FFOMS letter dated 04/06/2015 No. 1726/30–4 “On the procedure for creating staffing schedules” directly explains that the structure and staffing levels are established by the head of the medical organization based on the volume of diagnostic and treatment work carried out and the number of the population served, taking into account recommended staffing standards provided for in the procedures for providing medical care. Thus, coordination of the staffing table, approved by the head of the medical organization, with the Federal Compulsory Compulsory Medical Insurance Fund is not required.
What should the head of a medical organization be guided by when calculating staffing standards? Is it possible to apply orders, for example, order of the Russian Ministry of Health dated 06/09/2003 No. 230?
The staffing standards established by order of the Ministry of Health of Russia dated June 9, 2003 No. 230 are recommended; they must be followed when drawing up the staffing table along with the procedures for providing medical care, but the medical organization is not obliged to strictly comply with them.
In accordance with the letter of the Ministry of Health of Russia dated 01/08/2004 No. 14–04/9846, the order of the Ministry of Health of Russia dated 06/09/2003 No. 230 was recognized by the Ministry of Justice of Russia (letter dated 06/26/2003 No. 07/6476-YUD) as not requiring state registration, since it bears an 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 06/09/2003 No. 230 is advisory in nature, since it does not contain binding legal norms.
In addition, in accordance with clause I of the current order of the USSR Ministry of Health dated February 10, 1988 No. 90, heads of healthcare institutions, based on production needs, are allowed to strengthen individual structural units or introduce positions not provided for by the current staffing standards, at the expense of positions in other structural units divisions within the limits of the number of positions and payroll established by the institution. In this case, replacement of positions in any order is allowed. Changes made are made to staffing schedules without approval from a higher health authority.
It should also be noted that economic justification is not a priority in the modern approach to establishing staffing standards:
- In accordance with section IV of the Program for the gradual improvement of the wage system in state (municipal) institutions for 2012-2018. (approved by order of the Government of the Russian Federation dated November 26, 2012 No. 2190-r) the formation of the staffing level of institutions should be carried out using labor standardization systems, taking into account the need for high-quality provision of state (municipal) services (performance of work).
- In accordance with the order of the Ministry of Health of Russia dated June 26, 2014 No. 322, when determining the need for medical personnel, the following are taken into account:
- features of morbidity taking into account the gender and age of the population in a constituent entity of the Russian Federation;
- territorial characteristics of the constituent entities of the Russian Federation (location of the subject in the regions of the Far North and equivalent areas, population density, proportion of the rural population);
- the volume of medical care provided within the framework of the territorial program of state guarantees of free medical care to citizens (TPGG);
- the presence in a constituent entity of the Russian Federation of settlements remote (more than 400 km) from medical organizations where specialized medical care is provided.
In addition, in accordance with sub. 7 paragraph 2 art. 7 of Federal Law No. 174 of November 3, 2006, the charter of an autonomous institution must necessarily reflect the structure and competence of the bodies of the autonomous institution. Thus, if the powers to approve the staffing number of employees of a given institution are not within the competence of the founder or supervisory board, then they belong to the powers of the head of the autonomous institution along with the approval of the staffing table (Clause 2 of Article 13 of the Federal Law of November 3, 2006 No. 174) .
Judicial practice is also of the opinion that the establishment of staffing standards is the right of the head of the institution. Thus, in the appeal ruling of the Tomsk Regional Court dated February 14, 2014 in case No. 33–140/2014, the judicial panel ruled: “In implementing the rights enshrined in the Constitution of the Russian Federation (part 1 of article 34 and part 2 of article 35) the employer, in order to implement effective economic activity and rational property management has the right to independently, under its own responsibility, make the necessary personnel decisions, while ensuring in accordance with the requirements of Art. 37 of the Constitution of the Russian Federation, guarantees of the labor rights of workers enshrined in labor legislation.”
It is especially worth noting that currently the procedures for the provision of medical care, which, according to the current legislation, are mandatory, contain recommended staffing standards for the number of medical personnel. The very fact that these staffing standards are recommended does not oblige the head of a medical organization to strictly adhere to them when drawing up the staffing schedule. It should also be noted that if in the Unified Recommendations for the establishment at the federal, regional and local levels of remuneration systems for employees of state and municipal institutions for 2014, there was an indication of the formation of a staffing table in accordance with the procedures for providing medical care, then similar recommendations for 2015 there is no such indication. Thus, the legislation has not established a strict obligation to use the recommended staffing standards established by the procedures for providing medical care when drawing up the staffing table.
Can the head of a medical organization increase staffing standards, for example, in order to organize income-generating activities?
Yes, the manager has the right to do this. In addition, in a letter from the Russian Ministry of Health dated October 25, 2012
No. 16–5/10/2–3238 “On the direction of methodological recommendations “Determination of the optimal ratio of medical / paramedical / other personnel in state and municipal health care institutions of the general medical network and specialized services” contains clarifications that when determining the optimal ratio of medical / paramedical / other personnel in state and municipal health care institutions of the general medical network and specialized service institutions, it is advisable to take into account factors such as the availability of full-time and occupied positions supported by income-generating activities (paid services). This activity is self-sustaining, and there is no need to monitor the availability and ratio of positions financed through paid medical services and other areas of income-generating activities. For example, additional positions of other personnel help improve the quality of patient care when providing paid medical services.
Should a medical organization introduce separate staffing schedules based on the source of funding (for example, compulsory medical insurance and income-generating activities)?
No, drawing up separate staffing tables is not required in this case. The FFOMS directly points to this in letter No. 1726/30–4 dated 04/06/2015, explaining that a separate establishment of staffing within the framework of activities in the field of compulsory health insurance is not provided for and is not required.
Organizational science (scientific management) at different periods solved the problems of rationalization and optimization of work activity to increase productivity, reduce physical and material costs, combat unemployment, etc. Now these problems are becoming increasingly relevant. Consequently, more attention should be paid to the problems of labor regulation, which will rationalize and optimize various areas of work activity.
The processes occurring in the modern economy, characterized by different dynamics of market relations, represent a new stage in the history of the formation of social and 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 constant growth rate of the gross national product, state control is unconditional, and the effectiveness of the economic course being pursued is confirmed by visible citizens results. For a federal state, the most significant indicator is the socio-economic development of its constituent entities and municipalities, which determines the quality of life of the country's population.
And one of the main areas influencing the quality of life of the population is healthcare, the level of development of which is largely determined by the efficiency indicators of the use of the country’s labor resources.
In healthcare, technologies for the provision of medical services are constantly developing, the structures of the pathology of diseases are changing, which requires constant improvement of methodologies in the field of labor regulation of personnel of medical healthcare institutions.
Quite a lot of attention was paid to the study of labor regulation problems, in particular, intersectoral, sectoral and local regulatory materials were developed on time standards for work performed, workload standards and headcount standards, and research was also carried out to establish and consolidate the composition of work in the form of qualification reference books.
Improving the organization of work in healthcare institutions requires further development of a methodology for determining time standards for medical services, methods for calculating workload standards for medical personnel, and approaches to determining and planning the number of medical personnel.
To achieve the above goal, it is necessary to solve the following tasks:
- the formation of a new system for regulating the work of medical personnel using world standards for technologies for the provision of medical services;
- development of modern methods for developing time standards (labor intensity of work) for the provision of simple and complex medical services;
- developing a methodology for calculating workload standards for medical personnel in healthcare institutions in three areas (outpatient clinics, diagnostic services, hospitals) taking into account the priorities for the development of healthcare in the Russian Federation;
- development of new approaches to determining and planning the number of medical personnel in healthcare institutions.
It should be noted that the basis for the functioning of medical institutions is labor resources, therefore a special role should be given to the organization of labor, which should be based on the management of personnel of medical institutions on the basis of scientific and rational (regulatory) activities. Currently, high organization of work gives better results, which certainly leads to higher dedication of the employee, increased productivity of his work, self-realization under organized leadership, designed to motivate and stimulate the employee by management means 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 relating to the standard of living not only of medical personnel of healthcare institutions, but also of potential employees.
The relationship between labor rationing and the general standard of living
In recent years, research has been carried out by the Federal State Unitary Enterprise "Research Institute TSS" of the Ministry of Health and Social Development of the Russian Federation, intended for healthcare institutions of the Russian Federation.
Based on a comprehensive analysis of the functioning of medical institutions, collected materials and expected prospects, it was revealed: with the help of labor standardization, it is possible to solve many problems relating to the standard of living of medical workers at both the micro and macro levels.
A healthcare institution, using a scientifically based organization of work, manages to increase the effectiveness of all its activities, increase the productivity of its employees, and achieve an increase in the efficiency of medical personnel in performing their duties. In turn, this leads to increased reward for work done in the form of wages and thereby increased purchasing power. And effective activities organized throughout the health care institution as a whole and the high-quality functioning of this institution as a whole lead to the improvement of its activities at the state level. This ensures the possibility of comprehensive influence on the standard of living of the country's population.
Rationing and efficiency
Labor standards must be applied when determining and planning the number of medical personnel. It has a direct impact on the remuneration of primary and auxiliary medical personnel in healthcare institutions.
This direction now plays a key role in shaping the development strategy of healthcare institutions. The effectiveness of the entire healthcare institution as a whole depends on how optimally the composition of medical personnel is formed. Unfortunately, the modern period of development is characterized by an acute problem of both the quality and composition of medical personnel in healthcare institutions.
One of the most pressing problems for public health care institutions is the lack of materials approved at the industry level on labor standards for emergency departments, covering the full scope of medical functions performed. In this regard, the following uncertainties arise in the process of establishing wages and the number of personnel in reception departments:
- lack of labor standards for personnel in emergency departments of public health institutions;
- lack of labor standards for support staff (nurses, orderlies) in emergency departments of public health institutions;
- the need to determine the work intensity of the staff of emergency departments of public health institutions;
- Standard criteria for the operation of emergency departments by type of health care institution have not been developed.
Currently, there are no regulatory documents on the workload of doctors, nursing staff and junior medical staff in emergency departments (with the exception of Order of the USSR Ministry of Health No. 560 of May 31, 1979, which is currently advisory in nature, is significantly outdated, and therefore is not applicable in practice).
All of the above problems make it difficult to develop an adequate remuneration system that takes into account the work intensity of the main and auxiliary staff of the reception departments of public health institutions. As a result, all this affects the quality of medical services provided to the population.
Methodology for calculating labor standards
Almost every medical institution faces the difficulties described above. Individual rates already exist simply because they have always existed, even if the load on them falls. There are no rates for other work and workloads, since the management of the institution, although they are clearly in demand, does not always know how to justify and calculate their need.
For a detailed analysis of the described problems and as a solution, we provide an example of calculating the required rates based on the work actually performed and the time spent by a doctor in the admission department of a public health institution.
Valid Editorial from 02.10.1987
| Name of document | LETTER from the Ministry of Health of the USSR dated 02.10.87 N 02-14/82-14 "ON THE PROCEDURE FOR EXPANDING INDEPENDENCE AND INCREASING RESPONSIBILITY OF HEADERS OF HEALTH BODIES WHEN APPLYING THE ORDER OF THE MINISTRY OF HEALTH OF THE USSR DATED AUGUST 13, 1987 N 955" |
| Document type | letter, methodological recommendations |
| Receiving authority | Ministry of Health of the USSR |
| Document Number | 02-14/82-14 |
| Acceptance date | 01.01.1970 |
| Revision date | 02.10.1987 |
| Date of registration with the Ministry of Justice | 01.01.1970 |
| Status | valid |
| Publication |
|
| Navigator | Notes |
LETTER from the Ministry of Health of the USSR dated 02.10.87 N 02-14/82-14 "ON THE PROCEDURE FOR EXPANDING INDEPENDENCE AND INCREASING RESPONSIBILITY OF HEADERS OF HEALTH BODIES WHEN APPLYING THE ORDER OF THE MINISTRY OF HEALTH OF THE USSR DATED AUGUST 13, 1987 N 955"
Chapter 2. RATING OF WORK OF MEDICAL STAFF OF THE MAIN TYPES OF INSTITUTIONS
2.1. Medical staff working time budget
One of the main indicators when designing labor standards in all types of healthcare institutions and analyzing the volume of work of a position is the working time budget.
Determining the annual working time budget for medical personnel has its own characteristics in contrast to that adopted in the production sector of the national economy.
When planning the number of workers in the main professions in industrial sectors of the national economy, their attendance and payroll composition is taken into account and the methodology for calculating the number of workers, that is, the living labor force, is used to implement the planned plan, taking into account all the factors that prevent the employee from being at the workplace.
Labor rationing in healthcare has its own specifics and is methodically decided according to the job principle, according to which a certain amount of work under certain organizational conditions is provided for by one position, regardless of the number of persons who will perform work in this position during the year. This involves working a certain amount of time during a working day and a number of working days per year. In healthcare institutions, therefore, it is not the number of living labor that is determined, but the number of staff positions.
A medical position is understood as the range of responsibilities and specific volume of work of a doctor for a certain period of working time, regulated by the calculated standards of the doctor’s workload, the duration of working hours and the duration of vacation. Position, as an indicator of a health care plan, is a measure of the volume of work of a doctor in various areas of his activity.
The content of the concept of “medical position” corresponds to the concept of “doctor” as an individual only in the case where one doctor will perform work in one medical position and the balance of working time for this position will fully correspond to the actual working time worked by the doctor during the year in in accordance with established working hours under current legislation.
However, during the year, doctors are absent from work due to illness, pre- and postnatal leave, child care, and sick family members. In addition, medical personnel are often distracted from work related to the provision of medical and preventive care to the population to undergo advanced training and specialization courses, work on various commissions and meetings, and perform state and public duties. In these cases, the head of the institution, during the employee’s absence, has the right to invite another person as his deputy and thereby ensure the completion of the planned amount of work. At the same time, the absence of an employee from work in a healthcare institution does not delay the work of other personnel and the work itself can be performed on another shift. At the same time, the absence in many cases of a sufficient volume of work to introduce full-time positions in a health care institution allows fractional parts of it to be established and occupied by part-time workers. Thus, the presence of part-time work and substitution, which makes it possible to replace a doctor during his absence on vacation, illness and other valid reasons, actually predetermines the difference in the standardization of labor in healthcare from industrial sectors of the national economy.
Calculation of the planned duration of working hours during the year for medical personnel is carried out by excluding weekends and holidays and the duration of vacation from the number of calendar days in the year.
There are 365 calendar days in a year, including 52 weekends and 8 holidays. Since one of the holidays a year usually coincides with a Sunday, 59 weekends and holidays a year are taken into account. The total duration of leave for healthcare workers entitled to one or more types of additional leave is the sum of the main leave of 12 working days and the duration of the additional leave(s). According to the “List of industries, workshops, professions and positions with hazardous working conditions, work in which gives the right to additional leave and a shortened working day” (section “Healthcare”), approved by a resolution of the State Committee of the USSR Council of Ministers on Issues of Labor and Wages and Presidium of the All-Union Central Council of Trade Unions dated October 25, 1974 N 298/P-22, medical workers have additional leave of 6, 12, 18, 24 and 30 working days, depending on their position and place of work. In addition, some employees are provided with additional paid leave in addition to those provided for by this resolution:
Additional paid three-day leave is provided to doctors of local hospitals and outpatient clinics located in rural areas, local therapists and pediatricians of territorial city clinics, visiting teams of stations and departments of ambulance and emergency medical care, air ambulance stations and departments of planned and emergency advisory care for continuous work in the specified institutions and territorial areas over 3 years;
Additional leave is provided to donors after each day of blood donation; mothers with 2 or more children aged 12 years, if the total annual leave does not exceed 28 calendar days; students of higher and secondary specialized educational institutions for the period of performing laboratory work, passing tests and exams.
A necessary element in calculating the annual working time budget for a position is the number of hours worked per day.
For most doctors and nursing staff, a reduced working time is established - no more than 38.5 hours per week, due primarily to the neuropsychic stress of work. Doctors and nurses, as a rule, are assigned a working day of 6.5 hours with six-day working week; junior medical personnel - 7 hours. On the eve of weekends and holidays, the working day is reduced by 30 minutes, and for workers with a 7-hour working day - by 1 hour. In some cases, due to harmful working conditions, for medical for personnel, a working day of 6 hours is established: in tuberculosis and infectious diseases hospitals and departments, psychiatric, psychoneurological, narcological and neurosurgical institutions and departments. In these cases, the working day is not reduced on pre-weekends and holidays. For some medical workers, a working day of even shorter duration is established Thus, for example, doctors of medical labor expert commissions (VTEK) and medical advisory commissions, dentists (except for hospital dental surgeons), dentists and dental prosthetists have a 5.5 hour working day.
In addition to junior medical personnel, the following have a 7-hour working day:
Chief doctors and their deputies;
Doctors and nursing staff of general sanatoriums and rest homes;
Dieticians of all medical institutions and nursing staff of dairy kitchens;
Dental technicians.
Based on the above data on the number of days of work of a position in a year and daily working time, the annual budget of working time of a position, expressed in hours or minutes, is calculated.
As stated earlier, during a doctor’s working day, on average, about 30 minutes. time is spent on work not related to receiving patients or providing them with medical and preventive care, and this time must be taken into account and excluded when calculating the annual working time budget of the position.
Thus, the calculation of the annual working time budget of a position (in hours) is carried out according to the formula:
B = a x (c - c) - d
a - the number of working days of the position in a year;
c - daily working hours;
c - time spent during the day not related to diagnostic and treatment work;
d - reduction of working hours on pre-weekends and holidays (in hours).
When calculating the number of positions of endoscopists, physical therapy nurses, massage nurses, centralized sterilization nurses, etc., the annual time budget is determined, taken into account in conventional units.
Many researchers, analyzing the activities of outpatient clinics, come to the conclusion that the actual annual workload of doctors is lower than planned, while the daily workload of a doctor is often higher than provided for by the standards. This should be attributed both to the insufficiently satisfactory organization of the work of doctors, and to the fact that in fact the doctor works at the reception for a significantly smaller number of days and hours than is provided for by the planned calculations of the workload of a medical position.
Special attention is paid to the problem of studying the loss of working time of medical personnel and ways to reduce them, since incomplete use of working days in a year leads to a decrease in the availability, volume and quality of medical care.
As mentioned above, days of absence of a medical worker from work, with the exception of weekends, holidays and vacations, are not taken into account when calculating the planned working time budget for a position, which is due to the system of substitution and part-time work in force in healthcare.
At the same time, in healthcare institutions it is necessary to analyze the reasons for absenteeism and the possibilities of replacing an absent employee in accordance with current legislation (Fig. 4).
Based on materials from a specially conducted study of the level and structure of lost work time of 765 doctors from 20 outpatient clinics, the number of days one doctor is absent from work during the year averages 41.7 days.
More than half of these losses are due to temporary disability due to illness, pre- and postnatal leave. Specialization and improvement, business trips, performance of government duties account for about 20%, i.e. 9 days.
Full use by the head of the institution of the possibilities of substitution and part-time work while monitoring the completion of the corresponding working time will contribute to a more rational placement of personnel and reduction of the difference between the planned budget of the position’s working time and the indicators of its actual use.
Rice. 4
ANNUAL BUDGET FOR WORKING TIME OF MEDICAL STAFF
2.2. Labor standards for medical personnel in outpatient clinicsThe standardization of labor for medical personnel in outpatient clinics is based mainly on the study of the labor of medical personnel. The design of standards for positions of doctors conducting outpatient visits is carried out according to two leading indicators:
1. The needs of the population for different types of medical care, expressed by attendance indicators.
2. The planned function of a medical position.
The basis for determining the population's need for a particular type of medical care is the intensive attendance indicators developed in scientific research for the long-term period, which reflect the nature of the pathology of the population, the level of morbidity, the demographic situation, as well as the achievements of medical science and the effect of their implementation in healthcare practice. Indicators of the population's need for outpatient care are established on the basis of a comprehensive methodology, including the study of morbidity by attendance, in-depth medical examinations of the population, and the use of expert assessment of the completeness and quality of medical care. However, the lack of distribution of attendance by type of institution (level of service) and the purpose of visit create significant difficulties in their application in normative research work. In addition, morbidity detected as a result of additional medical examinations taking into account the use of the expert method, as a rule, is not realized in the form of appeals from the population to health care institutions. The task of planning, an integral part of which is labor rationing, is the most rational combination of the real capabilities of health care institutions and the desire to maximally satisfy the population's need for medical care.
Determining the population's need for a particular type of medical care for rationing purposes is based on the study of three groups of data:
1. Materials from scientific research into the population’s need for medical care.
2. Performance indicators of doctors of the studied types of institutions in 19 economic and geographical regions of the country, used as bases for collecting materials on labor.
3. Indicators of the performance of medical personnel in specially selected institutions, staffed, using advanced, progressive forms of service, methods of prevention, diagnosis and treatment.
As a rule, the difference in attendance rates between the second and third groups of institutions is 15-20%. For example, the level of population attendance at TB doctors in city dispensaries in institutions of the second group was 168 per 1000 population, and in the third group - 203.
To compare these data with the first group of indicators - the scientifically developed need of the population for a particular type of medical care - an appropriate analysis and clarification of the indicator is required.
This is due to the fact that normative research studies study the attendance of the population in a particular specialty in a specific type of institution. The need is determined as a whole for the entire population at all stages of medical care. Recalculation of indicators taking into account the proportion of urban and rural residents, scientific research data on the distribution of attendance at stages of medical care make it possible to obtain a single total indicator reflecting the population’s need for a particular type of medical care. The implementation of meeting the needs of the population for the type of assistance being studied depends both on the degree of development of the service and on its accessibility.
It is legitimate to compare actual indicators of population attendance with data on needs only in general for all specialties, taking into account the level of development of specialized services, since a possible “underload” in the number of visits in one specialty or another can be compensated to a certain extent by higher performance indicators in another, wider specialty. However, such a comparison cannot claim to be a complete analysis, since the proportionality or possible disproportions in the development of outpatient, inpatient and emergency medical care are not taken into account.
The prospective indicator of the population's need for outpatient services is determined on the basis of data on the actual attendance of the population in the third group of institutions with a retrospective analysis of attendance indicators for a number of previous years (3-5 or more). Then, the average increase in the number of visits per year is calculated as the arithmetic mean using the formula:
| a = | b - b_1 | (2.2.1.) | |
| n |
a is the average annual increase in the number of visits to doctors;
b - level of attendance to doctors of a given accounting year;
b_1 - level of attendance to doctors of the base year, compared with the calculation year;
n is the duration of the base period in years.
In this case, the optimal value of the normative need for a prospective five-year period is determined by the formula:
| H = b + 5a | (2.2.2.) |
N - predicted attendance by the end of the 5-year period.
In some cases, during the formation and development of a new medical specialty, the increase in the number of visits can occur in geometric progression and planning of regulatory needs for the coming period is carried out by extrapolating the exponential growth in attendance:
| H = b x (I + | b_2 | ) | n | <*> | (2.2.3.) | |
| 100 |
b_2 - annual increase in the number of visits in %%;
n is the duration of the planned period in years.
<*>G.A. Popov, 1974
Thus, the value of the attendance indicator taken as the initial value when designing the standard for positions of doctors in outpatient clinics is based on determining the level of attendance and analyzing its dynamics.
The function of a medical position is determined by the amount of work that must be performed within the annual balance of working time for this position.
The labor productivity of a doctor conducting an outpatient appointment, that is, the indicator of his workload, is influenced by various factors: the structure of visits by nosological forms, the nature and severity of the pathology, the ratio of initial and repeat visits, as well as visits made in connection with morbidity, for preventive purposes , dispensary observation, etc.; the doctor’s qualification level, his technical equipment, the presence of assistants, work organization, etc. (Fig. 5). The average time spent on the first visit are integrating values that reflect the influence of various factors related to both the nature of the visit and the age-sex composition of patients, and to the forms and conditions of the organization of doctors’ work. This involves the development of differentiated labor standards and the subsequent calculation on this basis of a single workload, taking into account the diversity of activities of medical personnel.
The final data on labor costs, expressed in time, obtained as a result of aggregation, make it possible to calculate them in the “visit” indicator, the number of which per unit of working time (hour) determines the medical load at an outpatient appointment (60 min: M min = N).
Rice. 5
FACTORS CONSIDERED WHEN DESIGNING LABOR STANDARDS FOR OUTPATIENT POLYCLINIC INSTITUTIONS
Subsequently, a transition is made from indicators of labor costs to the “position” indicator. Currently, the indicator and measure of the volume of outpatient care in health care is the “medical position”.
The number of visits that a physician position must perform in a year is called the function of the physician position. It is expressed by the formula:
| Ф = (A x t_а) + (B x t_b) + (C x t_с) x B | (2.2.4.) |
F - function of the medical position (number of visits);
A, B, C - the doctor’s workload per 1 hour of work in the clinic, during preventive examinations, and providing care at home, respectively;
t_а, t_b, t_с - number of hours of work per day for the given type of work;
The workload of a doctor at an appointment in a clinic and at home is regulated by the calculated standards of service for doctors in outpatient clinics, approved by the USSR Ministry of Health or obtained as a result of scientific research. The annual balance of working time is determined based on the number of working days in a year and the length of the working day, in accordance with current labor legislation. The beginning and end of work, the distribution of working time by type of activity during the accounting period is established by a shift (work) schedule, approved by the administration in agreement with the trade union committee, depending on specific conditions. The work schedule of medical personnel can be very different not only in different healthcare institutions, but also among doctors of the same specialty in the same outpatient clinic. The distribution of a doctor’s working time for outpatient visits and care for patients at home should be differentiated taking into account the size and age composition of the population, the level of morbidity and demand for medical care, and the characteristics of the site.
Since the standards of service for 1 hour of appointment at the clinic, carrying out preventive examinations and providing medical care at home are not equivalent, the function of the medical position differs depending on the work schedule, other things being equal.
Example. If, on average, a local physician spends 4 hours during a working day visiting a clinic, of which 1 hour is spent on preventive examinations, and 2 hours on providing medical care at home, then
Ф = (5 x 3) + (7.5 x 1) + (2 x 2) x 282 = 7473 visits.
With a different work schedule, in the case where a general practitioner allocates 2.5 hours for an appointment at the clinic, 1 hour for preventive examinations and 2.5 hours for providing care at home, the planned function of the medical position will be
Ф = (5 x 2.5) + (7.5 x 1) + (2 x 2.5) x 282 = 7050 visits.
When developing standards for outpatient medical positions, it is necessary to have a stable indicator of a planned medical position, standardized according to all specified parameters. Such requirements are met by converting all types of visits into units equivalent to any one of them, for example, visits to a clinic. The method of conversion to equivalent units is quite widely used in health economics.
The total number of visits in equivalent units is calculated using the formula:
| P = A x 1 + B x K_1+ C x K_2 | (2.2.5.) |
P is the total number of visits in equivalent units;
A is the number of diagnostic and treatment visits to the clinic;
B - number of preventive visits;
C - number of home visits;
K_1,2 is the coefficient for converting the corresponding visits into units equivalent to visits to the clinic.
With this calculation, the planned function of the position of a local general practitioner, regardless of work schedule, will be 8460 visits (5 x 6 x 282).
It is possible to eliminate the influence of different doctor’s work schedules during the day, month, year on the value of the function of the position and, therefore, the staffing standard indicator using another methodological approach, calculating the weighted average number of visits per 1 hour of work using the formulas:
| P = | 100 | or | (2.2.6.) | ||||||
| m | + | n | + | p | |||||
| M | N | P | |||||||
| P = | 60 | (2.2.7.) | ||||||||||||||
| ( | 60 | ) | x m | ( | 60 | ) | x n | ( | 60 | ) | xp | |||||
| M | + | N | + | P | ||||||||||||
| 100 | 100 | 100 | ||||||||||||||
P - weighted average number of visits per 1 hour of work;
m, n, p - the share of the number of diagnostic and treatment visits, preventive visits and home visits in the overall structure of attendance in %%;
M, N, P - calculated load rate for various types of visits.
The final stage in the development of a normative indicator is the transition from the meter of the volume of activity of a position in the number of visits to the “population” meter, which is more convenient for practical use. The standard is calculated using the formula:
| N = | P x H | (2.2.8.) | |
| F |
N - standard for a medical position;
P - attendance rate per 1 resident per year;
H - population size for which the standard for a medical position is calculated (10 thousand, 100 thousand);
F - planned function of a medical position.
Calculation example. Scientific research has established that the planned number of visits per 1 adult resident per year to a local general practitioner is 4.3, including 2.4 therapeutic and diagnostic, 1.2 preventive and 0.7 visits to provide medical care at home (table 5).
Table 5
Distribution of visits to a local general practitioner per 1 adult resident per year
| NN p/p | Type of visit | Number of visits | Structure of visits in %% | TO | Number of equivalent visits |
| 1 | 2 | 3 | 4 | 5 | 6 |
| 1. | Treatment and diagnostic | 2,4 | 55,8 | 1.0 | 2.4 |
| 2. | Preventive | 1,2 | 27,9 | 0,667 | 0,8 |
| 3. | At home | 0,7 | 16,3 | 2,5 | 1,75 |
| Total: | 4,3 | 100,0 | 4,95 |
1 calculation option (according to formula 2.2.5.). The function of the position of a local general practitioner in conditional outpatient treatment and diagnostic visits is 8460 visits. The planned number of conditional equivalent visits is obtained by multiplying the number of different types of visits (column 3) by the value of the coefficient (column 5) and amounts to 4.95 conditional visits taken into account and then the value of the standard position of a local therapist is equal to 5.9 positions in per 10 thousand adult population:
| N = | 4.95 x 10000 | = 5,9 |
| 8460 |
Calculation option 2 (according to formula 2.2.6). The weighted average number of visits per 1 hour of work of a local general practitioner with this structure of visits will be 4.342:
| P = | 100 | = 4,342 | |||||
| 55,8 | + | 27,9 | + | 16,3 | |||
| 5 | 7,5 | 2 | |||||
The same result is obtained when using formula 2.2.7 when calculating the weighted average load for 1 hour of work.
| P = | 60 | = 4,342 | |||||||||||
| ( | 60 | ) | x 55.8 | ( | 60 | x 27.9 | ( | 60 | x 16.3 | ||||
| 5 | + | 7,5 | + | 2 | |||||||||
| 100 | 100 | 100 | |||||||||||
Hence, the function of the position of a general practitioner will be equal to 7347 visits per year (6 x 4.342 x 282) and the value of the staffing standard will be 5.9 positions of a local general practitioner per 10 thousand adults:
| N = | 4.3 x 10000 | = 5,9 |
| 7347 |
The main task of inpatient medical institutions is to ensure the full scope of examination and treatment of the patient in accordance with material and personnel capabilities during different periods of his stay in the hospital (admission, examination, treatment, discharge) and at various stages of care (resuscitation and intensive care, active treatment, follow-up treatment and rehabilitation treatment) in conditions of continuity of the diagnostic and treatment process throughout the day.
The amount of time spent by medical personnel when serving patients in a hospital is influenced by numerous factors, the main of which are: the composition of patients according to nosological forms of diseases; medical measures corresponding to the period of the patient’s stay in the hospital depending on the order of admission (planned or emergency hospitalization); average length of hospital stay (Fig. 6).
In addition, the degree to which the population's needs for inpatient care are met, all other things being equal, has an indirect impact on labor standards for medical personnel in hospital institutions.
The consolidation of employee workload indicators, depending on the specified factors, to obtain a single weighted average indicator is carried out, as in the case of labor standardization in outpatient clinics, using a stepwise method.
Rice. 6
STANDARD-FORMING FACTORS CONSIDERED IN THE DEVELOPMENT OF LABOR STANDARDS IN HOSPITAL INSTITUTIONS
When carrying out this work, the researcher uses a different sequence of calculations. For example, at the first stage, labor costs for serving patients with various nosological forms of diseases are determined, taking into account the age and sex composition of hospitalized patients by periods of inpatient treatment.
Photochronometric observations, which are usually carried out within two weeks, do not always reveal the true workload of an employee for a number of works performed during the year, especially for rarely carried out instrumental and hardware examination methods. In this case, photochronological observation data are supplemented with timing measurements. If it is impossible to carry them out, data on time costs obtained from workers directly carrying out these manipulations and research are used. The number of these studies during the year is established on the basis of the department’s performance indicators for the calendar year, obtained from the “Maps of the volume of activities of medical personnel of a healthcare institution” based on accounting documentation data.
So, for example, a urologist, according to photographic observations, spends 30 minutes on these types of activities, i.e. on average 1.2 min. per patient being treated. The volume of these studies is determined from the “Map of the volume of activities...”, it is 0.8 examinations per patient, and, therefore, the estimated time spent per patient with an average length of stay in the hospital of 13 days will be 1.85 minutes.
Thus, comparison of direct observation data with the annual volume of an employee’s activity makes it possible to more objectively establish the cost of his labor for certain types of work.
Further calculation of the aggregated indicator is carried out using the formula:
| M + K x M_l x (-2 - | n | ) + M_v | |||
| M = | 7 | (2.3.1.) | |||
| n- | n | ||||
| 7 |
M is the weighted average time spent on direct patient care per examination (in minutes);
M_n is the doctor’s time spent on providing medical care to an admitted patient (in minutes);
M_l - the doctor’s time spent on providing medical care to a patient being treated on the day of examination (in minutes);
M_в - the doctor’s time spent on providing medical care to a discharged patient (in minutes);
K is the coefficient of frequency of medical examinations of patients being treated per doctor’s working day;
N - average duration of inpatient treatment (in days);
7 is the number of days in a week.
As a rule, a doctor examines a patient in a hospital daily, then K = I. In some cases, due to the specifics of medical work and the population served, the number of patient examinations per day deviates from one in one direction or another. Thus, in the intensive care and intensive care units (wards), in the maternity ward, during the working day, the doctor interviews and examines the patient several times. In psychiatric hospitals, sanatoriums, after-care departments, a medical examination is possible once every 2, 3 or more days, in children's sanatoriums - once every 5 days, etc. Therefore, the inspection frequency coefficient is respectively 0.5; 0.3 and 0.2.
This method calculates the doctor’s costs directly related to patient care: interview, examination, provision of medical care and documentation. In the future, the time during the working day spent on other types of work (auxiliary activities, official conversations, transitions, etc.) and personal time is determined.
When rationing the work of medical personnel, the doctor’s work in the evening and at night, on generally established weekends and holidays (the so-called “duty duty”) is also taken into account. Medical care for patients at this time, as a rule, is provided by doctors whose positions are provided for by the staffing standards for a given institution, within the limits of their working hours for the accounting period. Doctors who conduct medical work are involved in this work. Radiologists engaged exclusively in diagnostic work, laboratory assistants, and bacteriologists are not involved in “duty duties.” These doctors may be involved in so-called “duty duties” in their specialties.
“Duty duty,” the duration of which, as a rule, should not exceed 12 hours, is carried out for the hospital as a whole, and in large hospitals, in addition, for a group of departments if there are at least 200 beds in the group. In health care institutions in rural areas and maternity hospitals in cities, “home duty” may be introduced.
The obtained data on the doctor’s time spent on all types of work performed make it possible to calculate them in the “patient” indicator using the formula:
| N_b | T - V - D | (2.3.2.) | |
| M |
Where N_b is a meter for the “patient” indicator (doctor’s workload per working day);
T - duration of the working day for this position (in minutes);
B - average time during the working day not related to direct patient care (in minutes);
D - average time excluded from the duration of the working day for performing “duty duties” (in minutes);
M is the average estimated time to serve 1 patient (from formula 2.2.1.).
Calculation example.
A therapist spends an average of 15 minutes daily. per patient. During the month, 24 hours are provided for “duty”, i.e. daily working hours are reduced by an average of 1 hour; the average time during the working day not related to direct patient care is 0.5 hours, therefore:
To move to the “bed” indicator accepted for calculating the staffing of hospital institutions, the following methodological technique is used. It is known that the planned operating time of a bed per year is not the same in institutions of various types: for city hospitals it is 340 days, for rural hospitals - 320, infectious diseases - 310, maternity hospitals - 300. Thus, during the year, some hospital beds are idle, since not occupied by patients for a number of reasons. Therefore, when moving from the “patient” indicator to the “bed” indicator, it is necessary, taking into account the planned duration of bed occupancy per year, to increase the previously obtained calculated indicator:
| N_k | 365 | x N_b | (2.3.3.) | ||||||
| P | |||||||||
| T = SUM (n_1 x t_1 + n_2 x t_2 +... + n_1 x t_1) | (2.4.1.) |
T - annual volume of activity, expressed in minutes or number of conventional units;
n - number of studies, procedures;
t - in minutes or conventional units per study, procedure.
In cases where one structural unit has estimated time standards, expressed both in minutes and in conventional units, T is determined separately by these indicators.
Calculation of the required number of positions (W) to complete the annual volume of work is carried out according to the formula:
| W= | T | (2.4.2.) | |
| B |
T - corresponds to formula 2.4.1;
B - annual working time budget for the position.
The annual working time budget for medical staff positions in the auxiliary treatment and diagnostic service can be expressed, as indicated in the relevant section, in minutes or in conventional units. Thus, the annual budget of a laboratory doctor, laboratory assistant, doctor and nurse for functional diagnostics is 101,910 min., a radiologist - 66,240 min., a physical therapy nurse is 15,000 conventional physiotherapeutic units, a massage nurse is 8,340 massage units.
As a rule, the indicator by which the standard for the position of medical personnel of the auxiliary treatment and diagnostic service in outpatient clinics is determined is the medical positions conducting outpatient visits, and in hospital and sanatorium institutions - a bed.
The standard for positions of medical personnel in the auxiliary treatment and diagnostic service is calculated using the formula:
| N= | F | (2.4.3.) | |
| W |
N - position standard;
F is the standard indicator (the number of medical positions providing outpatient care or the number of beds);
W - corresponds to formula 2.4.2.
Table 6
CALCULATION OF ANNUAL TIME COSTS OF LABORATORY MEDICAL STAFF FOR LABORATORY RESEARCH
| Name of the study | Number of studies (n) | Time for 1 study per minute. (t) | Total time spent (T) | ||
| for laboratory assistant | for laboratory doctor | for laboratory assistant | for laboratory doctor | ||
| Leukocyte count | 50000 | 2 | 6 | 50000 x 2= 100000 | 50000 x 6 = 300000 |
| Blood group determination | 1000 | 5 | 1000 x 5 = 5000 | ||
| Determination of amylase (diastase) in urine | 20000 | 15 | 20000 x 15 = 300000 | ||
| Study of tumor punctures | 500 | 6 | 14 | 500 x 6= 3000 | 500 x 14 = 7000 |
| Total: | 100000 + 5000 300000 + 3000 = 435000 | 300000 + 7000 = 307000 | |||
An example of calculating the standard for a laboratory assistant position in an outpatient clinic
The amount of work indicated in the previous example, corresponding to 4,268 positions of laboratory technicians, is carried out in a clinic that has 33.75 positions of doctors conducting outpatient visits:
Those. a standard is established at the rate of 1 laboratory assistant position for 8 outpatient doctor positions.
An example of calculating the standard for a laboratory assistant position in a hospital institution
This volume of work, corresponding to 4,268 laboratory technician positions, is performed in a 210-bed hospital.
| F x D x T x H |
N - position standard;
B - annual working time budget for the position;
F - bed turnover;
D - the proportion of patients in need of research and procedures (in %%);
T - average estimated or standard time for 1 study, procedure, examination;
N - number of procedures, studies, examinations per course of treatment.
Formula 2.4.4. It is convenient in that its components can be used to a certain extent to evaluate the organization of the diagnostic and treatment process, the completeness and quality of medical care for patients, and make adjustments based on expert assessments. This formula is applicable mainly when conducting scientific research.
Calculation example
In the hospital, the bed turnover is 20, of all patients, 30% need therapeutic massage, the number of conventional units of massage per procedure is 2.2 units; An average of 12 procedures are performed per course of treatment
| N= | 8340 x 100 | = 52.6 beds |
| 20 x 30 x 2.2 x 12 |
Those. The post of massage nurse is established for 50 beds.
When changes are made to one of the indicators, the standard changes. So, if the selection of patients for treatment is determined not at 30, but at 60%, then the standard position will be 25 beds, with a decrease in the average number of procedures from 12 to 10-60 beds, etc.
In a number of cases, when rationing the work of paramedical personnel of the auxiliary treatment and diagnostic service, a ratio standard is used. Thus, the number of positions for x-ray technicians is established according to the number of positions for radiologists.
Keywords
LABOR RATING/ LABOR STANDARDS / STATE (MUNICIPAL) INSTITUTIONS / EFFECTIVE CONTRACT / INDICATORS AND CRITERIA FOR PERFORMANCE EVALUATION / LOCAL REGULATION ACT / STATE (MUNICIPAL) INSTITUTIONS/ NORMING OF THE LABOR / LABOUR NORMS / EFFICIENT CONTRACT / INDEXES AND CRITERIA OF EVALUATION/LOCAL NORMATIVE ACTannotation scientific article on economics and business, author of the scientific work - Kadyrov F.N.
Despite the recommendations issued by the Russian Ministry of Labor, the editors are often asked to talk about the system labor rationing, on the rights of healthcare institutions in matters labor rationing etc. Today we are publishing the first material on this topic. This topic will be continued in future issues. Questions labor rationing are becoming increasingly relevant due to the need to establish indicators and criteria for assessing the performance of employees as part of the introduction effective contract. Logically labor rationing must precede the introduction effective contract. However labor rationing a complex and lengthy process, which must also occur continuously. Therefore, these processes largely run in parallel. The starting document for institutions (along with the recommendations of state (municipal) bodies should be local regulatory act System Regulations labor rationing in the institution.
Related topics scientific works on economics and business, the author of the scientific work is F. N. Kadyrov.
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The order for developing the regulation on labor system norms in a state (municipal) healthcare institution
Questions with regards to the labor norming standards are becoming gradually relevant due to the necessity of establishing indexes and criteria for evaluating employee activity efficiency in the frames of introducing an efficient contract. Logically speaking, norming of the labor should come first before introducing the efficient contract. However, norming the labor is a complex and time-consuming process, which has to run consistently on an ongoing basis. Therefore, these processes, to a large extent, develop parallel one to another. The starting document for institutions (along with the recommendations of state (municipal) bodies has to become a local normative act Resolution regarding the system of norming the labor in institution.
Text of scientific work on the topic “The procedure for developing Regulations on the labor standardization system in a state (municipal) health care institution”
From the editor:
Despite the recommendations issued by the Ministry of Labor of Russia, the editors are often asked to talk about the labor standardization system, the rights of healthcare institutions in matters of labor standardization, etc. Today we are publishing the first material on this topic. This topic will be continued in future issues.
Chief editor N.G. Kurakova
F.N. Kadyrov,
Federal State Budgetary Institution "TsNIIOIZ" of the Ministry of Health of Russia, Moscow, Russia
PROCEDURE FOR DEVELOPMENT OF REGULATIONS ON THE SYSTEM OF LABOR STANDARDS IN A STATE (MUNICIPAL) HEALTH INSTITUTION
UDC 614:338.26
Kadyrov F.N. The procedure for developing regulations on a labor standardization system in a state (municipal) healthcare institution (FSBI "TsNIIOIZ" of the Ministry of Health of Russia, Moscow, Russia)
Annotation. Issues of labor standardization are becoming increasingly relevant due to the need to establish indicators and criteria for assessing the performance of workers as part of the introduction of an effective contract. Logically, labor rationing should precede the introduction of an effective contract. However, labor standardization is a complex and lengthy process, which must also occur continuously. Therefore, these processes largely run in parallel. The starting document for institutions (along with the recommendations of state (municipal) bodies should be a local regulatory act - Regulations on the labor standardization system in the institution.
Key words: labor regulation, labor standards/labor, state (municipal) institutions, effective contract, indicators and criteria for evaluating activities, local regulations.
The main regulatory documents relating to labor standards in an institution include:
Labor Code of the Russian Federation (Chapter 22).
Decree of the Government of the Russian Federation of November 11, 2002 No. 804 “On the rules for the development and approval of standard labor standards.”
Order of the Government of the Russian Federation of November 26, 2012 No. 2190-r “On approval of the Program for the gradual improvement of the wage system in state (municipal) institutions for 2012-2018.”
Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30, 2013 No. 504 “On approval of the method-
Issues of labor standardization are becoming increasingly relevant due to the need to establish indicators and criteria for assessing the performance of workers as part of the introduction of an effective contract. The basic document for developing a labor standardization system for institutions (along with the recommendations of state (municipal) bodies should be a local regulatory act - the Regulations on the labor standardization system in an institution (hereinafter referred to as the Regulations).
These issues are discussed in most detail in the Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30, 2013 No. 504 “On approval of methodological recommendations for the development of labor standardization systems in state (municipal) institutions” (hereinafter referred to as the Recommendations).
However, the Recommendations do not cover all aspects of the problem under consideration. In addition, they do not take into account the specifics of the healthcare sector. Therefore, the purpose of this publication is to analyze and summarize normative and methodological materials on the issues of labor standardization in health care institutions and to develop proposals for the procedure for developing and content of the Regulations on the labor standardization system in health care institutions.
Within the framework of the adopted labor standardization system, the main types of labor standards are: time standards, production (load) standards, service standards and number standards.
In addition to labor standards, there are also labor standards. The fundamental differences between them are that labor standards are calculated in relation to specific conditions for performing a standardized process for certain values
factors. And the standard is the calculated value of the costs of working time, material and monetary resources used in labor regulation and planning. Labor standards are established for various types of standardized or average organizational and technical conditions. An example of such standards are staffing standards, which are used to calculate the number of staff positions when drawing up the staffing table.
Labor standards are established for a specific job and are systematically revised. Labor standards are repeatedly used to calculate labor standards and are valid without revision for a long time, since changes in organizational, technical and other conditions for a set of works occur more slowly than in specific workplaces.
There are the following standards: labor standards, time standards, number standards.
Let's look at labor standards in more detail.
Labor rationing establishes the measure of labor to perform a certain amount of work, that is, reasonable standards for the expenditure of working time to perform various works.
The expression of the measure of labor is labor standards:
Time standards;
Load standards;
Production standards;
Service standards;
Number standards.
From various aspects, they characterize the labor costs necessary to perform a certain amount of work by workers of appropriate qualifications in certain organizational and technical conditions.
Time standards are the expenditure of working time to perform a unit of work (function) or provide a service by one or a group of workers of appropriate qualifications (regulated continuation).
efficiency of performing a unit of work in certain organizational and technical conditions). Time standards are expressed in seconds, minutes, hours, conventional units, conventional units of labor intensity (UCET-s).
Load standards - the amount of work performed per unit of time under certain organizational and technical conditions. Load indicators include the number of visits per hour, patients per day, number of studies, procedures per day, month, year (function of a medical position), etc.
The production rate is the number of products produced per unit of working time. Production standards are expressed in volume or cost terms. In healthcare, volumetric natural production indicators are not widespread (with the exception of UETs). Cost indicators can include such indicators as the cost of services provided, profit, conditional profit, etc.
Load standards and production standards in healthcare are often used interchangeably, or load standards are considered as production standards in relation to healthcare (as a sphere of non-material production).
Service standards are the number of objects (workplaces, equipment, areas, etc.) that an employee or group of appropriately qualified employees are required to service during a unit of working time.
The differences between load (output) standards and service standards are that the service standard is the number of production facilities that an employee or group of workers with appropriate qualifications must service during a unit of working time in certain organizational and technical conditions.
Moreover, the amount of work for each individual object is not regulated either by time or by established units (unlike
depending on production or load standards) - it is calculated on average and depends on specific conditions, so in some cases in practice, in principle, it can be equal to zero.
The production units that serve as service objects in healthcare are usually a bed or a person.
Therefore, service standards are the number of beds or people served by a given doctor, nurse, etc., while workload standards reflect precisely the volume of work: the number of visits, patients discharged, etc. per doctor, etc.
The task of establishing service standards is to achieve normal functioning of the facility, while the task of establishing load (output) standards is to determine the value of the indicator characterizing the amount of work without linking it to a specific facility.
Number standards are the established number of employees of a certain professional and qualification composition necessary to perform specific production, management functions or volumes of work.
Time norms and load (service) norms have an inverse mathematical relationship.
The employer is responsible for the state of labor standards in the institution. The organization of work related to labor standardization, including carrying out organizational and technical measures, introducing rational organizational, technological and labor processes, improving the organization of work, can be carried out either directly by the head of the institution, or in the prescribed manner can be entrusted by the head to one of his deputies.
The development (definition) of a labor standardization system in an institution should be carried out by specialists with the necessary knowledge and skills in the field
organization and regulation of labor. Taking into account the number of employees and the specifics of the institution’s activities, in order to perform work related to labor standardization, it is advisable to create in the institution a specialized structural unit (service) for labor standardization, for example, a labor standardization department. In its absence, work related to labor standardization may be entrusted to a structural unit (employee) in charge of economics, labor organization and wages (for example, labor and wages department, economic planning department) and/or staffing the activities of the institution (HR department, etc.).
The titles of the positions of the relevant departments may be different: economist, engineer, etc. In particular, the Qualification Directory of Positions of Managers, Specialists and Other Employees, 4th edition, supplemented (approved by Resolution of the Ministry of Labor of the Russian Federation of August 21, 1998 No. 37) (with amendments and additions), contains positions such as “Labor standardization engineer " and "Timekeeper".
In general, labor standardization (including analysis of the standards used, their revision, etc.) should logically precede the conclusion of an employment contract (additional agreement to the employment contract) as part of the introduction of an effective contract. This is due to the following:
The introduction of an effective contract involves the establishment for employees of indicators and criteria for assessing the effectiveness of their activities, which in many cases are based on labor standards (workload indicators, etc.);
The procedure for notifying employees about changes in labor standards generally coincides with the procedure for notifying employees about changes in the terms of an employment contract when an effective contract is introduced, which makes it advisable to combine these procedures.
However, labor standardization is a complex and lengthy process, which must also occur constantly. Therefore, in practice, these processes largely run in parallel. In this regard, it is permissible to introduce an effective contract within the framework of previously used labor standards (which may be revised later) or even without specifying specific labor standards (in this case, in the concluded employment contract or additional agreement to the employment contract, an entry is made that the employee in labor standards will be determined in accordance with the established procedure).
In accordance with Article 162 of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code), local regulations providing for the introduction, replacement and revision of labor standards are adopted by the employer taking into account the opinion of the representative body of workers.
Therefore, it is recommended to establish a labor standardization system in an institution in the Regulations on the institution’s labor standardization system, which is either approved by a local regulatory act of the institution, taking into account the opinion of the representative body of workers, or is included as a separate section in a collective agreement. In the first case, the Regulations are approved by an order for the institution, which may be called: “On approval of the Regulations on the labor standardization system in the institution” (hereinafter referred to as the Order).
The order must be adopted taking into account the opinion of the representative body of workers (trade union organization, etc.). In this regard, the draft order should be sent for approval to an organization that is a representative body of employees of this institution.
The procedure for taking into account the opinion of the elected body of the primary trade union organization when adopting local regulations is established by Article 372 of the Labor Code.
The elected body of the primary trade union organization no later than five working days
from the date of receipt of the draft local regulatory act, sends the employer a reasoned opinion on the draft in writing.
If the reasoned opinion of the elected body of the primary trade union organization does not contain agreement with the draft local regulatory act or contains proposals for its improvement, the employer may agree with it or is obliged, within three days after receiving the reasoned opinion, to conduct additional consultations with the elected body of the primary trade union organization workers in order to achieve a mutually acceptable solution.
If agreement is not reached, the disagreements that arise are documented in a protocol, after which the employer has the right to adopt a local normative act, which can be appealed by the elected body of the primary trade union organization to the relevant state labor inspectorate or to the court. The elected body of the primary trade union organization also has the right to initiate the procedure for a collective labor dispute in the manner established by the Labor Code.
The State Labor Inspectorate, upon receipt of a complaint (application) from the elected body of the primary trade union organization, is obliged to conduct an inspection within one month from the date of receipt of the complaint (application) and, if a violation is detected, issue the employer a mandatory order to cancel the local regulatory act.
The structure of the Regulations is not strictly regulated. However, in accordance with paragraph 22 of the Recommendations, it is proposed to include the following sections in the Regulations:
a) “Labor standards applied in the institution”;
b) “Procedure for implementing labor standards”;
c) “The procedure for organizing the replacement and revision of labor standards”;
d) “Measures aimed at compliance with established labor standards.”
In our opinion, at the stage of starting systematic work on standardizing labor in an institution, the structure of the Regulations should be somewhat different. Indeed, according to the Recommendations, section a) “Labor standards applied in the institution” should contain not only references to the standard labor standards used in determining labor standards, but also the applied methods for determining the number norm based on the standard time norm, the number norm based on the standard norm maintenance and service standards based on standard time standards (if calculations were made).
However, one of the tasks of standardization is precisely the systematization of the standards used, carrying out calculations, deciding in which cases (in which departments, etc.) standard labor standards are used, and in which - those developed in the institution itself, etc. d. In other words, at the current stage, the Regulations should primarily determine the directions and methods of standardization, and not consolidate the results of standardization (which, in fact, do not yet exist).
Therefore, we propose a slightly different structure of the Regulations on the labor standardization system in an institution, which is given below. In the future, the structure of the Regulations may be closer to that provided for in the Recommendations. Thus, we propose a section “Timekeeping Procedure”, which is more methodological than organizational in nature. It is important due to the novelty of timing issues for most institutions. In the future, this section, like some others, may be excluded.
In addition, the proposed version of the Regulations provides for the creation of a Labor Standards Commission, which is not mentioned in the Recommendations. In practice, the functions of this commission may
Manager
be broader than those proposed, including issues of rationing consumables (detergents, food, etc.). In this case, it is advisable to use the following (broader) name of the commission: “Commission on Standardization” (without using the word “labor”).
Below is a sample of the Order for a healthcare institution “On approval of the Regulations on the labor standardization system in the institution” (it does not contain samples of all documents approved by the Order). It can be used not only in state (municipal) healthcare institutions, but also in medical organizations that have other organizational and legal forms.
Please note that the example of creating a special
cial division - the department of labor standards. In practice, due to the small size of institutions, limited financial resources, etc. Such departments will not be created in all institutions. As mentioned above, in such cases these functions should be assigned to employees of other departments.
In conclusion, we note that in regulatory legal acts and other materials on labor standardization, phrases like: “in order to introduce rational organizational, technological and labor processes” are often found. In relation to healthcare, these conditions are, in particular, the conditions provided for by the procedures for the provision of medical care in order to implement standards of medical care, clinical recommendations, etc.
1. Margulis A.L., Shipova V.M., Gavrilov V.A. Number of positions in health care facilities. Methodological and regulatory materials for calculating the number of positions and drawing up staffing schedules for medical institutions. - M.: AGAR, 1997. - 72 p.
2. Reference information: “Labor Standards” (Material prepared by ConsultantPlus specialists). - http://base.consultant.ru/cons/cgi/online.cgi?req=home#doc/ /LAW/148265/4294967295/0.
3. Shipova V.M. Staffing of hospital care in modern conditions/deputy chief physician: medical work and medical examination.
2009. - pp. 12-22.
4. Shipova V.M., Belostotsky A.V., Kindarov Z.B., Ermolova M.V. The current state of the regulatory framework for labor in healthcare // 3 Deputy Chief Physician: medical work and medical examination. - 2010. - No. 6. - pp. 22-28.
5. Shipova V.M., Gavrilov V.A. Staffing of a healthcare institution // Edited by Academician of the Russian Academy of Medical Sciences O.P. Shchepina. - M.: GRANT, 2001. - 160 p.
6. Shipova V.M., Gavrilov V.A., Margulis A.L. Labor standards for medical personnel (instructions for conducting regulatory research work).
M.: VNII im. ON THE. Semashko, 1987. - 130 s.
7. Shipova V.M., Gaidarov G.M., Belostotsky A.V., Kindarov Z.B. Modern approaches to compiling the staffing schedule of health care facilities // Ed. Academician of the Russian Academy of Medical Sciences O.P. Shchepina. - Irkutsk: NTsRVKh SB RAMS, 2010. - 52 p.
8. Shipova V.M., Kindarov Z.B. Complex issues of planning the number of medical personnel in hospital institutions to fulfill the volume of medical
Qing assistance within the framework of the state guarantee program for 2010 // Deputy Chief Physician: medical work and medical examination. - 2010. - No. 4. - pp. 22-27.
9. Shipova V.M., Margulis A.L., Gavrilov V.A. Methodological recommendations for determining the number of medical personnel positions in the context of the transition to health insurance. - M., Research Institute named after. H.A. Semashko RAMS, 1993. - 50 p.
10. Shipova V.M., Minin O.G., Frolova Yu.V. Planning the number of doctors in hospital institutions (units) in modern conditions // Children's Hospital. - 2011. - No. 2. - P. 8-10.
11. Shipova V.M., Minin O.G. Planned and normative indicators for inpatient care for 2013//Deputy. Ch. doctor - 2013. - No. 4. - pp. 20-26.
(name of institution)
PRICING 3
(locality)
□6 approval of the Regulations on the labor standardization system in the institution
In order to develop a labor standardization system in an institution, taking into account the opinion of workers (representative body of workers) (protocol No._from_)
I ORDER:
1. Approve
Regulations on the labor standardization system in the institution (Appendix No. 1);
Regulations on the Labor Standards Commission (Appendix No. 2);
Form of notification of changes in labor standards (Appendix No. 3);
Regulations on the labor standardization department;
Staffing table of the labor regulation department.
2. Put this order into effect from “_”_20_g.
3. Entrust control over the implementation of this order to the Deputy Chief Physician for Economic Affairs_.
Chief physician
(signature)
(full name)
Appendix No. 1
REGULATIONS ON THE LABOR STANDARDING SYSTEM
IN THE INSTITUTION
1. General Provisions
This Regulation on the system of labor standards in an institution (hereinafter referred to as the Regulations) was developed on the basis of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code), Decree of the Government of the Russian Federation of November 11, 2002 No. 804 “On the rules for the development and approval of standard labor standards”, Order of the Government of the Russian Federation dated November 26, 2012 No. 2190-r “On approval of the Program for the gradual improvement of the wage system in state (municipal) institutions for 2012-2018”, Methodological recommendations for federal executive authorities on the development of standard industry labor standards approved by the Order of the Ministry of Labor Russia dated May 31, 2013 No. 235, Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30, 2013 No. 504 “On approval of methodological recommendations for the development of labor standardization systems in state (municipal) institutions.”
In accordance with the Labor Code (Article 159), employees are guaranteed:
State assistance to the systemic organization of labor regulation;
Application of labor standardization systems determined by the employer taking into account the opinion of the representative body of employees or established by a collective agreement.
The labor standard system is developed taking into account the organizational and technical conditions for performing technological (labor) processes in institutions (equipment and materials used, technologies and methods of performing work, other organizational and technical factors that can significantly affect the value of the labor standard).
The labor standardization system in the institution determines:
Labor standards applied in the institution by type of work and workplace when performing certain types of work (functions) (hereinafter referred to as labor standards), as well as methods and means of establishing them;
The procedure and conditions for introducing labor standards in relation to specific production conditions and the workplace;
The procedure and conditions for replacing and revising labor standards as new equipment, technology is improved or introduced and organizational or other measures are carried out to ensure an increase in labor productivity, as well as in the case of the use of physically and morally outdated equipment;
Measures aimed at compliance with established labor standards.
The main goals of the labor standardization system in an institution are:
Creating the conditions necessary for the introduction of rational organizational, technological and labor processes (procedures for the provision of medical care, standards of medical care, clinical protocols, etc.), improving the organization of work;
Ensuring a normal level of intensity (intensity) of labor when performing work (providing state (municipal) services);
Improving the efficiency of medical care.
Organization of work related to labor standards includes:
Carrying out organizational and technical activities;
Introduction of rational organizational, technological and labor processes;
Improving work organization.
Labor standards are used in the process
development of remuneration systems in the institution and preparation of employment contracts with employees.
When developing a labor standardization system, labor standards are determined in relation to technological (labor) processes and the organizational and technical conditions for their implementation in the institution.
Analysis of the labor process based on the standard of provision of state (municipal) services (standard of medical care), dividing it into parts;
Selection of the optimal technology and labor organization, effective methods and techniques of work;
Design of equipment operating modes, work techniques and methods, workplace maintenance systems, work and rest modes;
Determination of labor standards in accordance with the characteristics of technological and labor processes, their implementation and subsequent adjustment as the organizational and technical conditions for the implementation of technological (labor) processes change (procedures for the provision of medical care, standards of medical care, clinical recommendations, etc.).
When carrying out this work, the approaches established in the methodological recommendations for federal executive authorities on the development of standard industry labor standards are used, approved
required by Order of the Ministry of Labor of Russia dated May 31, 2013 No. 235 (in terms of organizing work and calculating labor standards) and in other materials on standardization.
When purchasing new equipment in accordance with the established procedure, institutions are recommended to carry out a comparative calculation of the impact on labor standards of the implementation of the purchased equipment. In this case, it is recommended to provide for a comparison of the characteristics of the purchased equipment with the characteristics of the equipment used in the development of standard labor standards (in the absence of standard labor standards, with the equipment used in the institution).
Along with labor standards established in an institution for an indefinite period, temporary and one-time labor standards can be applied for stable organizational and technical conditions for the implementation of technological (labor) processes.
Temporary labor standards are established for the period of mastering certain jobs in the absence of approved regulatory materials for labor standardization.
The validity period of temporary labor standards determined by the institution is recommended to be set to no more than 3 months.
One-time labor standards are determined by the employer for individual jobs of a one-time nature (unscheduled, emergency).
The basic requirements for labor standards and norms are as follows:
Taking into account the current level of development of medical science, organization of medical care, labor organization, equipment, compliance with appropriate technologies of the diagnostic and treatment process;
Compliance in terms of the degree of aggregation with the conditions and nature of the work of a particular type of institution, division or employee, ensuring the necessary accuracy when establishing staffing standards - the degree of aggregation of standards depends
Manager
on the influence of the main standard-forming factors and the need to take them into account in the standard indicator;
Coverage of the most common options for performing work, convenience for calculating staff positions.
3. Analysis of the labor standards used and organizational and technical conditions
Work on labor standardization begins with an analysis of the state of affairs with standardization in the institution, which includes:
Inventory of used labor standards;
Analysis of organizational and technical conditions for performing technological (labor) processes.
When analyzing the organizational and technical conditions for performing technological (labor) processes in an institution, the following should be taken into account:
Technologies and methods used;
The degree of provision of procedures for the provision of medical care, the applied standards of medical care;
Parameters of operation and maintenance of the equipment used;
Working conditions in the workplace;
Forms of labor organization, work and rest schedules, including regulated breaks;
Other parameters: characteristics of the work performed, rationality of division and cooperation of labor, etc.
4. Use of standard labor standards
When determining labor standards, an analysis is carried out of the existing standard (intersectoral, sectoral, professional and other) labor standards approved by federal executive authorities in accordance with Decree of the Government of the Russian Federation of November 11, 2002 No. 804 “On the rules for the development and approval of standard labor standards” (hereinafter referred to as standard labor standards), and their correlation with actual
technical organizational and technical conditions for the implementation of technological (labor) processes in the institution.
In the absence of standard norms established in accordance with the above order, norms that are advisory in nature, established by current orders of the executive authorities of the USSR and the Russian Federation in the field of healthcare, as well as norms recommended specialized scientific organizations (Semashko Research Institute, TsNIIOIZ, etc.).
Based on standard labor standards, appropriate labor standards can be determined for application in the institution.
Labor standards can be determined for a separate type of work, an interrelated group of work (enlarged labor standard) and a completed set of works (comprehensive labor standard). An example would be labor standards for a patient treated in a hospital. The degree of consolidation of labor standards is determined by the specific conditions of the organization of medical care and labor.
Labor standards can serve to establish a standardized task (a set amount of work that an employee or group of employees performs per work shift or other unit of working time).
Indicators such as the number of patients treated in the department, financial plan, etc. can serve as a standardized task.
When determining labor standards based on standard labor standards, comprehensively justified labor cost standards established for homogeneous work are used in relation to standard technological (labor) processes and standard organizational and technical conditions for their implementation in healthcare (for example, a medical visit).
If the organizational and technical conditions for performing the technology coincide with them,
ical (labor) processes in the institution, standard labor standards are used.
A similar decision is made if the existing differences in the organizational and technical conditions for performing technological (labor) processes cannot significantly affect the labor standard. The decision on the significance of differences in organizational and technical conditions for performing technological (labor) processes is made taking into account the opinion of the representative body of workers.
Comprehensively justified standards for labor costs provide for progressive operating modes of equipment, rational techniques and methods of labor, organization and maintenance of workplaces, optimal employment of workers, maximum use of workplace opportunities, high quality of products (works, services), preservation of the health and performance of workers. In this case, the criteria used are a comparison of the existing organizational and technical conditions with the conditions provided for in the procedures for providing medical care, standards of medical care, equipment sheets, etc.
When creating more progressive organizational and technical conditions for the implementation of technological (labor) processes or their non-compliance with standard labor standards, it is recommended to use standard labor standards as a basis for determining and justifying labor standards by adjusting them taking into account the actual organizational and technological conditions for performing technological (labor) processes in the institution.
When planning measures to improve the efficiency of the provision of state (municipal) services, it is recommended to use standard labor standards as a standard:
For institutions in which organizational and technical conditions are below the level for which the standard standards are designed;
When studying working time costs and analyzing working time losses.
After taking measures to change the organizational and technical conditions for performing technological (labor) processes, labor standards in the institution can be revised in the manner prescribed by law.
In the absence of standard labor standards for certain types of work and workplaces, the corresponding labor standards are developed in the institution, taking into account the recommendations of the organization exercising the functions and powers of the founder, or with the involvement of relevant specialists in the prescribed manner.
5. Timing procedure
To determine the time spent on a particular repeating operation, for example, on individual studies, manipulations, surgical interventions, medical appointments, etc., time measurements are used.
Timing refers to the analytical and research method of labor standardization, which consists of measuring the time spent on all constituent elements of the labor process in optimal organizational and technical conditions that correspond to modern technology of the diagnostic and treatment process.
To carry out timing, statistical tools are being developed:
Dictionary (list) of types of activities and labor operations,
Observation sheet,
patient card,
Reference data map for observation sheet.
In this case, a unit of observation is determined (for example, time spent per patient for individual diseases or on average with a doctor of a given specialty; time spent per hospitalized patient on a planned basis, for emergency reasons or on average per patient according to the profile of the department, regardless of the order of admission, etc. .d.).
The experience of labor standardization in healthcare shows that when designing standards for a particular position, a 2-week period of photochronological observations of 2-3 positions is sufficient.
When conducting time measurements, the volume of observations is limited, as a rule, to 30 studies and manipulations of the same type.
In a number of cases, for example, when calculating cost estimates, developing incentive measures, etc. there is a need to determine the working time costs of various groups of personnel not for a single labor operation, but for the entire labor process (for example, the time spent on treating one patient in a hospital).
When carrying out timing, the following basic rules must be observed:
Timing should be carried out by a sufficiently qualified specialist who is well aware of the technology of the diagnostic and treatment process.
In the process of time-lapse observations, an examination of the volume and quality of work is carried out, an assessment of the compliance of therapeutic and diagnostic measures with the diagnosis and health status of the patient;
Before conducting photographic observations, a list (dictionary) of labor operations specific to the position and specialty of the observed person is compiled;
When processing time-based statistical data, the frequency of certain types of work, the structure of the working day, etc. are regulated.
6. Calculation of the number of employees
Calculation of the staffing number of workers is part of the labor standardization process, which consists in establishing staffing standards - the number of workers required to perform a certain amount of work.
The number of employees is calculated based on:
Standard labor standards, which in this case include staffing standards;
By calculation method based on the values of other standards (time standards, load standards, service standards).
The institution establishes the applied methods for determining the size norm (based on the standard time norm, norms adopted in the institution, staffing standards, etc.).
7. Labor standardization as part of the introduction of an effective contract
When concluding an employment contract with an employee, he must be familiar with labor standards. If the employee has established time standards for performing work (providing services) or service standards, it is recommended that the employment contract with the employee indicate that their implementation is carried out within the limits of the working hours established for him.
It is advisable in the employment contract with the employee, concluded within the framework of the introduced effective contract, to clearly state that the employee’s responsibility is to comply with labor standards, stipulating what exactly is the labor standard for this employee (the volume of services provided in certain units, the cost of services provided, etc. .), as well as the magnitude of these norms.
8. The procedure for introducing, replacing and revising labor standards
Labor standards - production standards, time standards, number standards and other standards - are established in accordance with the achieved level of equipment, technology, organization of production and labor (Article 160 of the Labor Code).
Workers are notified of the introduction of new labor standards no later than two months before their entry into force. Within the same period of time, workers are notified of the correction of erroneous labor standards (labor standards, when established, were incorrectly
organizational and technical conditions for performing technological (labor) processes are taken into account or inaccuracies are allowed in the application of regulatory materials or in carrying out calculations).
Taking into account the opinion of the representative body of workers about the reduction of erroneous labor standards, workers can be notified in a shorter period of time.
The form of notification of the introduction of new labor standards is determined by the institution independently. In this case, it is recommended to indicate previously existing labor standards, new labor standards, and the factors that served as the basis for the introduction of new labor standards or their adjustments.
Before introducing new labor standards, it is necessary to instruct and train workers in the most effective techniques and methods of performing work, and both individual and group forms of their implementation can be used.
When carrying out work to master labor standards, an analysis of the degree of mastery of work by each employee is carried out based on data on the implementation of standards.
When mastering labor standards in connection with the introduction of new equipment and technology, when, along with mastering rational labor techniques, workers need to acquire new theoretical and practical knowledge, workers are trained.
When mastering new types of work (including the introduction of medical care standards, etc.) or when the actual organizational and technical conditions for performing technological (labor) processes do not correspond to those designed in the newly introduced labor standards, correction factors are applied.
The period for conducting an analysis to determine the feasibility of revising the applicable labor standards is at least once every five years. Based on the results of the analysis, a decision may be made to maintain the established standards.
labor or the development of new labor standards. Until new labor standards are introduced, previously established ones continue to apply.
Labor standards may be revised as new equipment, technology, and organizational or other measures are improved or introduced to ensure an increase in labor productivity, as well as in the case of the use of physically and morally outdated equipment.
Other grounds for revising labor standards are not established by labor legislation.
Excessive fulfillment of labor standards by individual employees, including due to a high level of personal professional qualities, the use of new work methods on their initiative and the improvement of workplaces cannot be considered as a basis for revising the labor standards established in the institution.
In other words, the achievement of a high level of production (provision of services) by individual workers through the use of new work methods and improvement of workplaces on their initiative is not a basis for revising previously established labor standards.
The revision of erroneous labor standards is carried out as they are identified, taking into account the opinion of the representative body of workers.
9. Organization of work on labor standards
The organization of work related to labor standardization is entrusted to the Deputy Chief Physician for Economic Affairs.
Work related to labor standardization is assigned to the labor standardization department.
To facilitate labor standardization in the institution, a Commission is created
The purpose of the Commission is to plan work on labor standardization and collegial assessment of labor standards proposed for implementation.
The objectives of the Commission are:
Approval of the work plan for labor standards;
Preliminary consideration of proposals from the labor standardization department for the establishment and revision of labor standards, the use of standardization methods, etc.;
Making proposals for the use of standard labor standards.
The Commission includes, according to position:
Head of HR Department;
Legal Advisor;
Labor safety engineer.
The decision of the commission is made by a simple majority of votes. In case of equal votes for and against the proposed decision, the vote of the chairman (acting chairman) of the Commission is decisive.
The commission formalizes its decision in a protocol.
Draft orders for an institution, agreed upon at a meeting of the Commission and documented in minutes, do not require additional approval by officials of the institution. In this case, in the sheet
approval of the project, only the number and date of the minutes of the Commission meeting are indicated and the signature of the chairman or secretary of the Commission is affixed.
10. Measures aimed at compliance with established labor standards
The efforts of both the workers themselves and the manager, as well as other officials of the institution (hereinafter referred to as the Administration of the institution), should be directed towards fulfilling labor standards.
The administration of the institution takes measures aimed at compliance with established labor standards, including ensuring normal conditions for employees to comply with labor standards. Such conditions include, in particular:
Good condition of premises, structures, machines, technological equipment and accessories;
Timely provision of technical and other documentation necessary for work;
Proper quality of materials, tools, other means and items necessary to perform the work, their timely provision to the employee;
Working conditions that meet labor protection and production safety requirements.
If these measures are not followed, employees have the right to file claims against the Administration of the institution in accordance with labor legislation.
The following measures are applied to employees aimed at complying with labor standards:
1. Moral and ethical.
2. Disciplinary.
3. Economic.
Moral and ethical measures of influence include:
Encouragement (public recognition, gratitude, praise, nomination for certificates, awards, etc.);
Condemnation (negative assessment, condemnation of the team, etc.).
Disciplinary measures are applied in accordance with labor legislation, including, in particular, disciplinary sanctions. Compliance with labor standards is the responsibility of the employee - Article 21 of the Labor Code, dedicated to the rights and responsibilities of the employee, establishes that the employee is obliged to comply with established labor standards. In accordance with Article 192 of the Labor Code, for committing a disciplinary offense, that is, failure or improper performance by an employee through his fault of the labor duties assigned to him, the employer has the right to apply the following disciplinary sanctions:
1) remark;
2) reprimand;
3) dismissal for appropriate reasons.
Accordingly, for failure by an employee to fulfill his labor duties in the form of failure to comply with labor standards, a disciplinary sanction may be imposed on him in the form of a remark or reprimand, and if he continues to fail to fulfill his labor duties, he may be dismissed.
Economic measures of influence are based on material incentives
in accordance with the accepted wage system, deductions from wages in cases provided for by law, etc.
When deciding on the application of enforcement measures to employees for failure to comply with labor standards, the question of whose fault the labor standards were not met must be considered.
In accordance with Article 155 of the Labor Code, in case of failure to comply with labor standards or failure to fulfill labor (official) duties through the fault of the employer, remuneration is made in an amount not lower than the average salary of the employee, calculated in proportion to the time actually worked.
In case of failure to comply with labor standards, failure to fulfill labor (official) duties for reasons beyond the control of the employer and employee, the employee retains at least two-thirds of the tariff rate, salary (official salary), calculated in proportion to the time actually worked.
In case of failure to comply with labor standards or failure to fulfill labor (official) duties due to the fault of the employee, payment of the standardized part of the salary is made in accordance with the volume of work performed.
Appendix No. 2
REGULATIONS ON THE COMMISSION FOR LABOR STANDARDS
1. General Provisions
1.1. This Regulation on the Labor Standards Commission (hereinafter referred to as the Commission) was developed in order to implement the Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30
2013 No. 504 “On approval of methodological recommendations for the development of labor standardization systems in state (municipal) institutions” and provides for the procedure for the formation, main tasks, functions and rights of the Commission.
1.2. In its work, the Commission is guided by legislative and other regulatory legal acts of the Russian Federation on labor, regulation and labor protection, a collective agreement, and local regulatory legal acts of the institution.
1.3. The commission is an integral part of the labor standardization management system in the institution.
1.4. The work of the Commission is based on the principles of social partnership, which is expressed by the inclusion of a representative of workers (trade union organization) in the Commission and taking into account the opinion of the representative of workers during the work of the Commission.
1.5. The Commission includes, according to position:
Deputy Chief Physician for Economic Affairs - Chairman of the Commission;
Chief Accountant - Deputy Chairman of the Commission;
Head of the Labor Standards Department - Secretary of the Commission;
Deputy Chief Physician for Medical Affairs (Chief Medical Officer);
Head of HR Department;
Chairman of the trade union organization of the institution - by agreement;
Legal Advisor;
Labor safety engineer.
The personal (surname) composition of the Commission is approved by order of the chief physician.
Nomination of representatives of institution employees to the commission is carried out on the basis of a decision of the trade union committee.
Other employees of the institution may be involved in the work of the Commission with an advisory voice.
2. Functions of the Commission
2.1. The purpose of the Commission is to facilitate the organization of labor standardization in an institution by planning work on labor standardization, collegial assessment of labor standards proposed for implementation, etc.
2.2. The Commission performs the following functions:
Coordination of a work plan for labor standardization in the institution;
Preliminary consideration of proposals from the labor standards department to establish and revise labor standards;
Making proposals for the use of standard labor standards;
Ensuring public control over the state of working conditions and safety regulations directly at workplaces, implementing measures to improve working conditions and standards provided for by the collective agreement (agreement);
Informing employees of the organization about the state of labor standards in the institution and ongoing activities to improve labor standards;
Consideration of proposals from the Administration of the institution, representatives of workers and individual workers on labor standardization issues;
Creation of a system of measures aimed at compliance with established labor standards.
3. Procedure of the Commission
3.1. The Commission is headed by the Chairman of the Commission.
3.2. The Deputy Chairman of the Commission, upon instructions or in agreement with the Chairman of the Commission, as well as during his absence, performs his functions and has the right to sign documents in the absence of the Chairman.
3.3. The secretary of the commission carries out:
Operational control over the implementation of plans, decisions and recommendations of the Commission;
Carrying out the instructions of the chairman or deputy chairman of the Commission;
Preparation of draft work plans of the Commission, recommendations, decisions, conclusions of the Commission on relevant issues, monitors their passage and necessary approvals;
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Notifying members of the Commission, as well as specialists involved in working with it, about the time and place of events (meetings of the Commission, etc.);
Keeping minutes of Commission meetings;
By agreement in the prescribed manner, he may represent the Commission at public events, in public organizations, and carry out the necessary communications with the media.
3.4. The commission carries out its activities in accordance with the regulations and work plan developed by it, which are reviewed and approved at its meetings and are an integral part of the institution’s work plan.
3.5. Meetings of the commission are held as necessary, but at least once a quarter, and are considered valid if more than half of the commission members participate in their work.
3.6. Decisions of the commission are made by open voting by a majority of votes in the presence of a quorum and are advisory in nature. In case of equality of votes for and against the proposed decision, the vote of the chairman of the Commission (acting chairman) is decisive.
3.7. The commission formalizes its decisions in protocols.
3.8. Draft orders for an institution, agreed upon at a meeting of the Commission and documented in minutes, do not require additional approval by officials of the institution. In this case, only the number and date of the minutes of the Commission meeting are indicated in the project approval sheet and the signature of the chairman or secretary of the Commission is affixed.
3.9. The commission reports on the work done to the Administration and staff of the institution at least once a year. The Chairman of the Commission informs the trade union committee about the decisions made by the Commission.
3.10. The activities of the commission are ensured (including, if necessary, financed) by the Administration of the institution. By agreement of the Administration of the institution with the trade union organization, the activities of the Commission may be fully or partially financed by the employee representative (trade union organization).
4. Rights of the Commission
The commission has the right:
4.1. Receive information from the Administration of the institution:
On the state of working conditions in the workplace, industrial injuries and occupational diseases, the presence of harmful production factors and measures to protect against them, the existing risk of damage to health;
About the labor standards and labor standards used.
4.2. Hear at commission meetings:
Messages from the administration of the institution, heads of structural divisions and other employees of the institution about the labor standards used, their implementation, etc.;
Proposals for improving labor standards in an institution.
4.3. Participate in the preparation of proposals for a section of the collective agreement on issues within the competence of the Commission.
4.4. Submit proposals to the Administration of the institution to encourage employees of the organization for active participation in work on labor standards.
4.5. Freely visit workplaces and relevant services of the institution to clarify issues within the competence of the Commission;
4.6. Assist in resolving labor disputes related to violations of labor regulation legislation and changes in working conditions.
Manager
Appendix No. 3 NOTICE OF CHANGES IN LABOR STANDARDS
To a department employee
institutions _
job title_
In accordance with Art. 162 of the Labor Code of the Russian Federation, we inform you that
that due to the introduction of new equipment (_), reducing labor costs
to perform one study, at least two months from the date of familiarization
You with this notice (namely from _ 20_g.) instead of previously existing norms
labor (load) -_ new labor standards (load) are introduced, namely_.
(manager position)
Notification received_
(signature, full name of the manager)
(employee signature)
KadirovF.N. The order for developing the regulation on labor system norms in a state (municipal) healthcare institution (FSHI “Health Organization and Informatics” Ministry of Health Care of Russia, Moscow, Russia) Annotation. Questions with regards to the labor norming standards are becoming gradually relevant due to the necessity of establishing indexes and criteria for evaluating employee activity efficiency in the frames of introducing an efficient contract. Logically speaking, norming of the labor should come first before introducing the efficient contract. However, norming the labor is a complex and time-consuming process, which has to run consistently on an ongoing basis. Therefore, these processes, to a large extent, develop parallel one to another. The starting document for institutions (along with the recommendations of state (municipal) bodies has to become a local normative act - Resolution regarding the system of norming the labor in institution.
Keywords: norming of the labor, labor norms, state (municipal) institutions, Efficient contract, indexes and criteria of evaluation, local normative act.
Healthcare 2014
REGIONS WILL RECEIVE 29.57 BILLION. RUBLES FOR MEDICINE PROVISION OF SEPARATE CATEGORIES OF CITIZENS
The volumes of federal subsidies provided to regional budgets in 2014 to provide certain categories of citizens with necessary medicines, medical products, as well as specialized medical nutrition products for disabled children have been clarified. The corresponding Order No. 1492-r dated 08/09/2014 was signed by Prime Minister Dmitry Medvedev.
A total of 29.57 billion rubles are allocated for these purposes. The largest volume of subsidies is provided for Moscow (4.66 billion), St. Petersburg (1.29 billion), Moscow (1.24 billion), Sverdlovsk (973.9 million) and Rostov regions (719.5 million). .).
The issue of labor standardization in healthcare is given serious attention at the level of the Ministry of Health and Social Development.
For proper adaptation and effective use of personnel, the opportunity has arisen with new knowledge and experience to address the issues of labor standardization in budgetary institutions.
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The main thing in the article
Regulations on labor standards
The main treatment group, which is directly related to the volume of planned government targets, should be revised or adapted to the conditions in each medical institution.
The Ministry of Health has issued several methodological recommendations related to the standardization of labor of subjects and state municipal medical institutions.
When preparing the regulations, we are guided by the concept of “planned function of a medical position.”
This is a given standard of time, output, workload (depending on the specifics of performing medical activities), which is communicated to each performer and is a signal for his effective work.
! in the System Chief Physician.
Standards exist for all groups of doctors providing diagnostic and treatment services. These standards have been approved for the entire paraclinic group.
However, changes in the organizational and economic conditions of the activities of state-owned, autonomous, budgetary institutions make it necessary to make adjustments to previously adopted labor standards in healthcare.
Firstly, planned volumes of activity are communicated to medical organizations. Secondly, the main source of financing is compulsory health insurance, with its own approach to invoicing and its own requirements for insurance coverage of medical activities.
Today, these requirements are strictly tied to the implementation of federal standards.
The rationing of the “paraclinic” service, along with existing standards for the performance of certain labor operations, must be monitored and linked to the real conditions in which the medical organization operates.
Often, regulations on labor standards begin to be developed to make adjustments to the standards of the paraclinic group or to establish new temporary standards related to diagnostic and treatment services.
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How to set up part-time work
in the System Chief Physician
Last year, in certain areas of work of specialists from the “paraclinic” group (for those providing services in outpatient clinics), the Ministry of Health issued Order No. 290n. It establishes approaches to determining the standard time for visiting.
The text of the document contains recommendations and standards for the duration of the appointment for a number of specialists: ophthalmologist, otolaryngologist, general practitioner, pediatrician, etc. That is, not the entire group of paraclinic specialists is covered through the standard labor standards in healthcare adopted by the Ministry of Health.
Therefore, you should think about the internal establishment of standards in a local regulatory act - “Regulations on labor standardization”.
Labor regulation in healthcare: sources of methodological recommendations
The methodological foundations for improving remuneration in the Russian healthcare system are laid down by the regulatory legal acts of the President of the Russian Federation and the Government of the Russian Federation, regulatory legal acts and recommendations of the Ministry of Labor and Social Development of the Russian Federation and the Ministry of Health of the Russian Federation.
A set of measures to provide the healthcare system of the Russian Federation with medical personnel is based on the principles of a systematic approach and is carried out in 3 strategic directions:
- Improving the planning and use of industry human resources.
- Improving the system of training specialists with medical and pharmaceutical education.
- Formation and expansion of material and moral incentives for medical workers.
Labor rationing in a healthcare institution
According to clause 16 of the Methodological Recommendations, approved. By order of the Ministry of Labor of Russia dated September 30, 2013 No. 504, in the absence of standard labor standards, institutions can independently develop appropriate labor standards, taking into account the recommendations of the organization exercising the functions and powers of the founder, or with the involvement of relevant specialists in the prescribed manner.
Labor standards developed in a budgetary institution are enshrined in the Regulations on the institution’s labor standardization system, which is either approved by a local regulatory act taking into account the opinion of the representative body of workers, or is included as a separate section in the collective agreement (Article 162 of the Labor Code of the Russian Federation, clause 20 of the Methodological Recommendations) .
To use as a basis for developing systems for rationing the work of medical personnel, you can be guided by the corresponding procedures for the provision of medical care.
So, for example, standard standards in healthcare regarding the workload of an obstetrician-gynecologist during consultative and outpatient visits are established in paragraph 2 of the note to Appendix No. 2 of Order No. 572n of the Ministry of Health of Russia dated November 1, 2012.
To obtain the weighted average time spent by a doctor per visit in a particular specialty, the following calculations were carried out:
- The structure of visits by age groups was calculated;
- A weighted average cost was then calculated according to this structure.
- The results of the calculations are presented in the table. Ready-to-download table of weighted average time costs
doctors of various specialties for visits in the “Chief Physician” System.
In addition, standards for the workload of medical personnel in the constituent entities of the Russian Federation can be established by the relevant regional regulations and territorial program of state guarantees of free provision of medical care to citizens.
Thus, in accordance with the letter of the Ministry of Health of Russia dated December 12, 2014 No. 11-9/10/2-9388, in order to determine the number of medical workers required to provide inpatient medical care under the territorial program, one should take into account the workload standards proposed by this letter, as well as regulatory values of the average duration of treatment for 1 patient in a hospital and established standards for the volume of bed days in the context of specialized departments of hospital institutions, differentiated by levels of medical care.
As a basis for developing labor standardization systems for non-medical personnel, one can be guided by the Orders of the USSR Ministry of Health of June 6, 1979 No. 600, of September 26, 1978 No. 900, of May 31, 1979 No. 560 (these orders have not been officially canceled and in accordance with Order of the Ministry of Health of the USSR dated August 31, 1989 No. 504 are advisory in nature) as well as Order of the Ministry of Health of the Russian Federation dated June 9, 2003 No. 230, which establishes the dependence of the number of staff units of working professions on the volume of work according to technically sound standards, and in their absence - according to standards developed by the institution experimentally and statistically.
Labor regulation in healthcare: methods
It is necessary to decide by what method the institution will establish internal standards. Regulatory and advisory documents are offered to us to choose from.
Analytical method. During the modernization program, new units of medical equipment were purchased for all services. This makes it possible to revise the labor standards of an employee working under the “doctor-equipment-patient” scheme.
The equipment has changed, which means the requirements for the time spent on medical work must also be changed. The analytical method allows us to establish how this has developed in practice in connection with changes in organizational and technical working conditions. On the basis of which we derive an average standard, coordinate it with the trade union organization and, preferably, with a higher one.
The second method, which is just as good and often used, is photography of working hours. A specially created commission is approved by order of the chief physician and is guided in its work by the regulations on labor standards and the calendar plan for carrying out activities.
From the very beginning until the end of the working day, the commission monitors all the functions performed by a particular specialist. “Photographs” all its functions and records them in a special document.
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