The work plan and equipment of the teaching room of the LPU. Organizational and methodological department. Research and innovation
Organization of a sanitary asset and its management
Maintaining accounting and reporting documentation
Communication with institutions:
hospital hospital, dispensaries, sanatorium type institutions, SES.
Tracking the health of the population of the site, analysis of morbidity and disability, development of measures to reduce them.
Dispensaries: their types, forms and methods of work. Assessment of the quality of medical examination of the population.
Clinical examination means active dynamic monitoring of the state of health of certain population groups (healthy and sick), taking these groups of people into account for the purpose of early detection of diseases, dynamic monitoring and comprehensive treatment of patients, taking measures to improve their working and living conditions, prevent development and the spread of disease, the restoration of disability and the extension of the period of active life.
The medical examination provides, first of all, the preservation of health in healthy people, the active identification of patients with early stages of the disease and the prevention of cases of disability; its ultimate goal is to preserve and strengthen the health and working capacity of the dispensary contingent. This determines the socio-hygienic essence (significance) of the clinical examination. The dispensary observation method is a function of the attending physicians of the general network of community-based institutions (polyclinics, outpatient clinics) serving the population at the place of residence and place of work, as well as doctors of specialized institutions - dispensaries and SSES centers.
Currently, there are various dispensaries (medical and physical education, dermatovenerological, anti-tuberculosis, narcological, cardiological, oncological, neuropsychiatric, etc.). Dispensaries and dispensaries (offices) carry out mass prevention activities aimed at preventing diseases, keep track of morbidity and mortality from pathology according to their profile, and also carry out treatment measures, patient consultations and organizational and methodological guidance of the work of doctors of the general network to combat the relevant diseases. The tasks of the dispensaries include: conducting training for general practitioners in relevant specialties; the introduction into practice of medical institutions of modern methods of prevention, diagnosis and treatment; promotion of healthy lifestyles.
The main documents that are drawn up for patients who are registered in the dispensary are the outpatient medical record and the follow-up checklist, which records the timeliness of visiting the doctor and passing the next medical examination, the implementation of the prescribed types of treatment, health-improving measures and employment recommendations.
Types of dispensaries: anti-tuberculosis, dermatovenerological, cardiological, medical and physical education, oncological, neuropsychiatric, narcological, endocrinological, ophthalmological, mammological.
Clinic structure, tasks and organization of registry work. The system of doctors.
Primary medical and social assistance to the urban population is provided by outpatient clinics (territorial polyclinics serving the adult population) and maternal and child health institutions (children's clinics and women's clinics).
The main organizational and methodological principles of the work of polyclinics and territorial-medical associations (TMT) are local policing (assigning the normative number of residents to a medical position) and the widespread use of the dispensary method (systematic active monitoring of the health status of certain contingents). The main planning and regulatory indicators governing the work of outpatient clinics are as follows: the standard of policemanism (1700 people per 1 post of general practitioner); load rate (5 visits per hour at a reception in the clinic and 2 - when treating patients at home with a therapist); the standard standard for district physicians (5.9 per 10,000 residents over 14 years old).
The capacity of clinics is measured by the number of visits per shift (more than 1200 visits - I category, less than 250 visits - V category). MHEs, to a greater extent than polyclinics and women's clinics, meet the new principles of organizing and financing primary medical and social care. They can more effectively organize the work of family doctors (order of the Ministry of Health of the Russian Federation No. 237 of 08/26/92). In a number of TMT conditions have been created for family medical care, for example, joint work at the site of a therapist, pediatrician and gynecologist (obstetric-pediatric-therapeutic complex - APTK). Moreover, the indicator of work is not the dynamics of attendance, but changes in the state of public health (reduction in morbidity, disability, infant mortality, the number of advanced oncological diseases, the health status of patients from dispensary groups, etc.).
The main activities of primary medical and social care institutions are: preventive work, medical examination, hygienic training and education of the population, promotion of a healthy lifestyle; diagnostic and treatment work (including examination of temporary disability); organizational and methodological work (management, planning, statistical accounting and reporting, activity analysis, interaction with other healthcare institutions, advanced training, etc.); mass organization work.
The clinic is headed by the head physician. The structure of the clinic includes: a registry, a preventive department, medical and preventive departments and offices, medical and diagnostic departments, administrative and economic units, rehabilitation treatment departments, etc. The continuity of the clinic and hospital is estimated by the number of patients prepared for planned hospitalization and the exchange of documentation before and after their treatment in a hospital.
City Polyclinic it is created as an independent medical and preventive institution, a structural unit of the medical and preventive institution of the city district, or is part of a stationary polyclinic association to provide primary health care to the population on a district basis.
The main objective of the city polyclinic is to reduce morbidity, disability and mortality, sanitary and hygienic education of the population, promotion of a healthy lifestyle.
Doctors work systems:
Alternation system
Two-link
Three link
Brigade method
The approximate structure of the city clinic:
1. The management of the clinic,including AHC
2. Information and analytical department:
Reception desk, information desk
Office methodology (statistics office)
3. Therapeutic and prophylactic part:
District physicians' offices (department)
Specialists' offices (surgical, ENT, ophthalmologic, neurological, infectious diseases, dental department (office)
The publication is intended, first of all, for employees of regional institutions that provide organizational and methodological assistance to medical and preventive institutions of administrative territories, as well as heads of public health at the municipal level, including the head doctors of the Central District Hospital.
The organizational and methodological work includes:
Implementation of analytical work to assess the state and dynamics of the development of the health care system of the corresponding administrative territory, the state of public health, the medical and demographic situation and other environmental factors that affect the level of public health;
Organization and improvement of the system of accounting and reporting on the activities of governing bodies and healthcare institutions, the results of functioning, the dynamics of the state of public health;
Development of promising and current plans for the health system of the administrative territory, target programs in priority areas of development, organization of their implementation, monitoring and evaluation of the effectiveness of implementation;
Organization and conduct of targeted inspections, expert evaluation of the activities of individual health services and institutions with on-site visits of experts and the provision of organizational, methodological and advisory assistance;
Determining the needs of medical personnel in various forms of lifelong learning, planning, together with the personnel services of health care authorities, to improve the skills of medical workers, organizing and conducting conferences, seminars, visiting boards, medical councils, meetings, etc .;
Organization of field assistance to rural residents.
In everyday practice, the role of analytical activity is significantly increasing, its quality level is increasing based on the use of modern technologies for collecting and processing statistical data, transmitting medical information, methods of analysis, justification and formation of strategies.
Recently, requirements for the organization of planned work have been significantly increased on the basis of a more complete account of the influence of environmental factors, the conditions for the functioning and development of the industry, and the forecast of the most probable prospects. Strategic planning components are being strengthened. Plans for current activities are built in accordance with the directions for the implementation of strategic goals. A system of plans is being formed that combines various levels of management. The coordination of planned activities with their resource provision is made. The program-targeted approach continues to be widely used to solve complex or interdepartmental problems. At the planning stage, forms of control are determined and criteria for evaluating the effectiveness of the implementation of planned measures used for their implementation of management mechanisms are developed.
The need to intensify the treatment and diagnostic process requires the improvement of innovative activity in health authorities and institutions, its organization on the basis of today's ideas about marketing, business planning of innovations, organizational forms and implementation methods.
Raising the level of treatment and prophylactic and consultative and diagnostic assistance to the rural population in modern conditions provides for strengthening the material and technical base and human resources of rural health care, developing an optimal model of medical care for the rural population in health facilities at various stages of medical care and, as an additional measure, the use of on-site forms of medical care for their intended purpose.
Thus, one of the most important functions of the healthcare management body is delegated to healthcare institutions (republican, provincial, regional hospitals, central district hospitals) - development of draft action plans for the subordinate healthcare system, organization, monitoring and evaluation of their implementation. In this aspect, the provision of organizational and methodological assistance to the rural population, including field assistance, being the main functions of the organizational and method departments of healthcare institutions of the indicated levels and fully corresponding to their area of \u200b\u200bcompetence, is planned independently, and the procedure for adopting the plan reflects the procedure regulated for the hospital units.
The plan of organizational and methodological work (hereinafter referred to as the plan) is a list of specific tasks, determines the order, timing, sequence of events for the planned period of time, establishes specific performers and provides resource, including financial, support for the planned activities, its size and sources of investment .
The plan consists of the main part and applications.
The main part of the plan includes sections:
1. Development of the material and technical base of health care.
2. Training and advanced training of personnel.
3. Preventive work.
4. Organization of identification of socially significant pathology.
5. Improving diagnostic, therapeutic, rehabilitation assistance and the introduction of modern technologies.
6. Sanitary education.
7. Scientific research.
8. Monitoring the implementation of the plan.
Applications should be a set of the following documents:
An analytical report on the state of medical care to the population and the activities of healthcare institutions at the time of development of the Plan
Report on the implementation of the Plan and target programs for the previous year.
Conceptual provisions for the strategic development of healthcare for the long term.
The list of key planned indicators (benchmarks) and justification of the probability of their achievement in the planning period.
Drafts of regulatory documents required for the implementation of planned activities.
Projects of new targeted comprehensive programs for solving interdepartmental problems.
1. Development of the material and technical base of healthcare
The development section of the material and technical base of healthcare covers measures to strengthen and maintain the basic assets of healthcare institutions (buildings, vehicles, support systems, technical and medical equipment, inventory), as well as a list of measures within the framework of the implementation of the restructuring strategy for the medical care system.
As the main activities for the first subsection, the following can be planned:
Construction of new institutions, buildings;
Overhaul and current repairs of buildings and premises;
Landscaping works;
Fleet development;
Technical re-equipment and updating of obsolete equipment, etc.
The second subsection may include activities for:
Liquidation (re-profiling) of low-power hospitals, not equipped with medical personnel, poorly equipped, medical institutions;
Strengthening the outpatient department through the opening of new institutions, offices, receptions, the development of new forms of service in clinics;
Implementation of hospital-replacing technologies (day hospitals, day care hospitals, hospitals at home);
Differentiation of the bed fund according to the intensity of the medical diagnostic process, the creation of beds (departments) of nursing care, hospices, the formation of institutions or departments of a medical and social nature.
The specification of the planned tasks should be carried out in accordance with the strategic goals of the regional and municipal health systems aimed at reorienting medical care from the inpatient to the outpatient level. Attention should be paid to the advisability of not only strengthening, but also modernizing the diagnostic, laboratory and rehabilitation base of outpatient facilities, opening specialized rooms according to the profiles of medical specialties that correspond to the real needs of the population, changing the nature of the activities of existing rooms in accordance with the introduction of new medical technologies services (outpatient surgery, day special hospitals, preventive units, etc.).
The relevance of the problem of supplying medical institutions with consumables also justifies the appropriateness of reflecting ways to solve it in planning documents.
2. Training and advanced training of personnel
This section of the Plan includes a list of the main activities for the training of medical personnel and other health system specialists (economists, accountants, medical equipment maintenance technicians, etc.):
Targeted training of specialists based on targeted orders of regional and municipal governments;
Continuing education of employees at central bases, in the system of GIDUV, in foreign medical centers and other educational institutions with a separation from production;
Continuing education on the job in cycle, intermittent, part-time courses, seminars;
Conducting medical and nursing conferences, congresses, meetings;
Organization of competitions by profession;
Participation in the organization of work of scientific societies.
Work on the training of personnel is planned by the organizational and methodological departments in coordination with the human resources for health in the region (municipality).
3. Preventive work
Planning for preventive work provides for the formation of a list of measures for the following sections:
Vaccine prophylaxis;
Chemoprophylaxis;
Activities in the foci of infection;
Activities at agricultural facilities (livestock, dairy farms, etc.).
All activities included in this section of the Plan are carried out in contact with the bodies of state sanitary and epidemiological surveillance in accordance with current instructions and methodological recommendations in accordance with the established schedule.
4. Organization of identification of socially significant pathology
Measures to organize the identification and medical examination of populations with socially significant diseases (tuberculosis; HIV / AIDS; sexually transmitted diseases (STDs); various forms of drug addiction; mental disorders) include:
An annual survey of contingents subject to periodic examinations and dispensary observation;
Expedited clinical examination of persons with a revealed pathology;
Practical assistance of regional (district) institutions when examining the population of districts;
Registration of the examined and police registration of the revealed pathology;
Conducting systematic consultations on the detection of diseases and providing advice on the diagnosis, treatment and rehabilitation of this group of patients, including in regional, district and central specialized institutions.
The plan is built in the context of the type of pathology in the listed areas of work.
5. Improving diagnostic, therapeutic, rehabilitation assistance and the introduction of modern technologies
The main areas of organizational activities in this section include:
Monitoring the quality of diagnosis and treatment based on the results of consultations conducted by highly qualified specialists in regional (municipal) institutions (units), as well as during trips to subordinate healthcare institutions;
Regulation of taking for dispensary observation and control of contingents of medical examination patients;
Organization of centralized control over the accuracy of death certificates.
Planning can be carried out on the objects subject to control (institutions, services, departments, specialists), on the forms of control (expert assessment of medical documentation), on indicators characterizing the state of the care process (the implementation of individual treatment plans, the provision of continuous medical care, timely hospitalization , consultation, on the validity of the selection of patients for treatment in institutions of a different level, on hospital-replacing technologies), on the activity of medical intervention (surgical treatment), on the results (restoration of the patients' ability to work, timeliness of referral to MSEC) and in the context of other performance indicators.
The implementation section covers modern technologies for prevention, diagnosis, treatment, rehabilitation, which are to be introduced into the activities of health facilities and the corresponding organizational measures for implementation.
6. Sanitary education
Activities covering health education may include:
Creation, distribution, control of activities, development of various organizational forms of public health education - “Universities of Health”, “Schools of Health” in outpatient facilities, “Schools of Recovery” for inpatients;
Preparation of a profiled sanitary asset for home care, primarily from relatives;
The use of various forms of mass distribution of hygienic knowledge among the population (appearances in the media, organization of exhibitions, publication of educational materials);
Organization of meetings with medical workers (lectures, discussions, clarifications, recommendations);
The spread of modern forms of attracting the population to a healthy lifestyle.
7. Research
The planning of research topics is carried out in accordance with the applied tasks of practical health care, which may include certain issues of public health, medical care and the development of strategically important directions for the development of a regional (municipal) health system.
The process of preparing a draft plan and the procedure for its adoption
The plan is developed with the participation of senior specialists of the appropriate level and, upon completion of development, is endorsed by them. The purposefulness of plans and the effectiveness of planned tasks depend on the correct setting of goals, the choice of strategies for achieving them, and the concentration of efforts on selected priorities.
Regional priorities for the development of medical care for the population are determined in accordance with the directions of the state policy in the field of public health, taking into account regional characteristics and resource capabilities. Despite the differences by region in most constituent entities of the Russian Federation, the main areas are similar - tuberculosis; HIV AIDS; diabetes; vaccine prophylaxis; safe motherhood and childhood.
The plan of organizational and methodological work of the republican, provincial, regional hospital, CRH is a structural component of a single plan for the development of regional (municipal) health care, which defines a hierarchical system of long-term and current planning for the activities of management bodies and healthcare institutions of the region (municipality).
The procedure for the adoption of the plan includes its discussion at the medical council of the institution either as an independent issue, or as an integral part of the discussion of the results of the institution, the implementation of targeted programs over the past period. The rules of procedure for the adoption of the plan provides for mandatory participation in the discussion of representatives of the apparatus of the health management body of the appropriate level, and for the central district hospital - representatives of the district administration. The optimal level of hearing for regional institutions is the board of the health management body, if the plan concerns only medical activities, and the regional government, if the plan is comprehensive.
After discussion, a comprehensive plan is approved by the head (deputy) of the administration of the appropriate level, and if the plan is interdepartmental, then by the head of the corresponding health management body. The approved plan is a mandatory binding document.
Control over the implementation of the plan
Current control by quantitative and qualitative criteria for the implementation of the plan is carried out by the organizational method department (office) of the organization that made it up.
It is advisable to supplement sections of the plan in which a list of measures, their levels of execution, dates of responsibility, dates of planned implementation, are provided with columns for, dates of actual execution and costs of their implementation. For control use the data of state statistical reporting. It is verified locally by district curators during planned visits.
Transparency of activities is ensured by the simultaneous public hearing of the curator and those responsible for carrying out the planned activities.
It is methodologically more efficient to hear not one district on the maximum possible number of questions, but several regions on one issue. This allows you to diversify the problem and choose the optimal approaches to solving it, arising from accumulated practical experience.
An important monitoring tool is the semi-annual (depending on the importance of the issue) interim hearing of the execution of the plan in the regional public health administration and administration.
Some examples of private hearing questions include the following:
Organization and effectiveness of examinations of the population and medical examination;
Treatment of patients with chronic diseases;
Conducting anti-epidemic measures;
On the role of regional institutions as organizational and methodological centers;
Information on teaching aids;
Analysis of the work of institutions, etc.
Plan Implementation Summary Report
The final report on the implementation of the plan is prepared either in tabular or descriptive form by sections of it and includes the following headings:
Planned tasks to be solved;
Baseline indicators at the beginning of the planning period;
Activities undertaken (a, b, c, etc.);
Current year results;
Efficiency mark.
An explanatory note is compiled on the report with an analysis of the results achieved, and in the absence or insufficient effectiveness of the measures taken, an analysis of the reasons, a critical assessment of the defects in the activities and possible measures to improve their quality.
A report on the implementation of activities according to the plan of organizational activities by the departments of the institution that oversees subordinate medical institutions is provided at the request of the organizational and methodological department (office) in a timely manner according to the profile of the department, indicating the performers on the following aspects:
Preparation of questions for hearing at meetings, boards of management (planned / unscheduled, level);
Writing market reviews on the profile of units;
Issue of teaching materials on the supervision zone (which ones);
Pedagogical work (courses, seminars, lectures, individual training of specialists);
Business trips to the supervised territories (where, purpose, duration, planned / unscheduled, team / individual, what assistance was provided);
Participation in meetings, conferences, congresses, etc. (which, topic of speech, level regional, interregional, international).
In analyzing the implementation of the plan, they strive not so much for setting new tasks as for determining the effectiveness of already known approaches to solving the problems posed.
The publication was prepared on the basis of methodological recommendations “Planning of organizational and methodological work and the organization of field assistance to medical institutions” of 15.10.2002 N 2002/107.
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
CENTRAL SCIENTIFIC RESEARCH INSTITUTE
HEALTH ORGANIZATIONS AND INFORMATIZATIONS
I affirm
First Deputy Minister
A.I. VYALKOV
October 15, 2002 N 2002/107
GUIDELINES
ORGANIZATIONAL AND METHODICAL WORK PLANNING
AND ORGANIZATION OF EXIT CARE HEALTHY -
PREVENTIVE INSTITUTIONS
These methodological recommendations present methodological approaches tested in the administrative territories of Russia to the planning of organizational and methodological work in the main areas of public health and the organization of field medical care.
The proposed approaches can be used by employees of regional institutions that provide organizational and methodological assistance to medical and preventive institutions of administrative territories, as well as heads of public health at the municipal level, including the head physicians of the Central District Hospital.
The recommendations can be applied in the organization of the pedagogical process in the preparation of health care organizers and advanced training of leading personnel, especially specialists in organizational and methodological work.
Organization - developer:
Central Scientific Research Institute of Health Organization and Informatization of the Ministry of Health of the Russian Federation.
Authors:
MD, prof., member - correspondent. RAMS V.I. Starodubov, MD, prof. Yu.V. Mikhailov, MD, prof. R.A. Khalfin, Ph.D. T.A.Siburina, MD Yu.A. Korotkov, MD, prof. A.A. Kalininskaya, Ph.D. T.I.Eremicheva, Ph.D. V.A. Magnitsky, Ph.D. S.I.Shlyafer, candidate of medical sciences V.K.Popovich, doctor of medical sciences G.Ch. Makhakova, Ph.D. E.M. Gudanova, Ph.D. N.P. Soboleva, M.D. Duganov, Ph.D. E.V. Mezentsev, V.I. Nazarov, M.Yu. Potemkina, MD, prof. V.N.Ektov, I.A. Sizova, D.N. Muraviev.
INTRODUCTION
Russian health care has changed significantly in the last decade. Reforms expanded the economic independence of the heads of medical institutions. The importance of organizational and methodological work in organizing and improving the quality of the medical and diagnostic process is growing. The reorganization of management of organizational and methodological activities in accordance with the main strategic directions of development of the industry is becoming extremely urgent.
In accordance with the Concept for the Development of Health Care and Medical Science in the Russian Federation, further improvement of the organizational and methodological work in healthcare is aimed at:
- improving the quality of medical care to the population, strengthening the preventive component in the activities of healthcare institutions;
- ensuring state guarantees in the provision of qualified medical assistance to the rural population through the strengthening of primary health care and the development of on-site forms of medical care;
- improving the efficiency of resource use, the formation of rational systems of phased medical care and the introduction of resource-saving technologies;
- expanding the impact of health on the formation and implementation of state policy in the field of public health at all levels of government;
- coordination of interaction between various services and departments in solving complex medical and social problems.
Realization of the set goals will require significant changes in the organizational and methodological work, which is an integral part of the management of the system of regional and municipal healthcare management.
The planning of organizational and methodological work is built in accordance with modern ideas about its essence. The concept of organizational and methodological work includes:
- carrying out analytical work to assess the state and dynamics of the development of the health care system of the corresponding administrative territory, the state of public health, the medical and demographic situation and other environmental factors that affect the level of public health;
- organization and improvement of the system of accounting and reporting on the activities of governing bodies and healthcare institutions, the results of functioning, the dynamics of the state of public health;
- development of promising and current plans for the health system of the administrative territory, targeted programs in priority areas of development, organization of their implementation, monitoring and evaluation of the effectiveness of implementation;
- organization and conduct of targeted inspections, expert evaluation of the activities of individual health services and institutions with on-site visits of experts and the provision of organizational, methodological and advisory assistance;
- determination of the needs of medical personnel in various forms of lifelong learning, planning, together with the personnel services of health care authorities, of further training for medical workers, organizing and conducting conferences, seminars, visiting boards, medical advice, meetings, etc .;
- Organization of field assistance to rural residents.
In everyday practice, the role of analytical activity significantly increases, its quality level increases through the use of modern technologies for collecting and processing statistical data, transmitting medical information, analysis methods, justification and formation of strategies.
Recently, requirements for the organization of planned work have been significantly increased on the basis of a more complete account of the influence of environmental factors, the conditions for the functioning and development of the industry, and the forecast of the most probable prospects. Strategic planning components are being strengthened. Plans for current activities are built in accordance with the directions for the implementation of strategic goals. A system of plans is being formed that combines various levels of management. The coordination of planned activities with their resource provision is made. The program-targeted approach for solving complex or interdepartmental problems continues to be widely used. At the planning stage, forms of control are determined and criteria for evaluating the effectiveness of the implementation of planned measures used for their implementation of management mechanisms are developed.
The need to intensify the treatment and diagnostic process requires the improvement of innovative activity in health authorities and institutions, its organization on the basis of today's ideas about marketing, business planning of innovations, organizational forms and implementation methods.
Raising the level of treatment, prophylactic and consultative and diagnostic assistance to the rural population in modern conditions provides for strengthening the material and technical base and human resources of rural health care, developing an optimal model of medical care for the rural population in health facilities at various stages of medical care and, as an additional measure, the use of on-site forms of medical care for their intended purpose.
Thus, one of the most important functions of the health care management body is delegated to health care institutions (republican, regional, regional hospitals, central district hospitals) - the development of draft action plans for the subordinate health care system, organization, monitoring and evaluation of their implementation. In this aspect, the provision of organizational and methodological assistance to the rural population, including field assistance, being the main functions of the organizational and method departments of health facilities of the indicated levels and fully corresponding to their area of \u200b\u200bcompetence, is planned independently, and the procedure for adopting the plan reflects the procedure regulated for the hospital units.
Description (formula) of the method: an improved system of planning the organizational and methodological work of the regional level health facilities and the central district hospital is proposed, which includes proposals for the composition of the main activities, requirements for the preparation of planning documents, the adoption procedure, as well as a description of the mechanisms for their implementation and forms of implementation control.
CONTENT AND STRUCTURE
ORGANIZATIONAL AND METHODICAL WORK PLAN
The plan of organizational and methodological work (hereinafter the PLAN) is a list of specific tasks, determines the order, timing, sequence of events for the planned period of time, establishes specific contractors and provides resource, including financial, support for the planned activities, its size and sources of investment.
The plan consists of the main part and applications.
The main part of the plan includes sections:
1. Development of the material and technical base of healthcare.
2. Training and advanced training of personnel.
3. Preventive work.
4. Organization of identification of socially significant pathology.
5. Improving diagnostic, therapeutic, rehabilitation assistance and the introduction of modern technologies.
6. Sanitary and hygienic education.
7. Scientific research.
8. Monitoring the implementation of the plan.
Applications should be a set of the following documents:
- An analytical report on the state of medical care to the population and the activities of healthcare institutions at the time of the development of the Plan.
- Report on the implementation of the Plan and target programs for the previous year.
- Conceptual provisions for the strategic development of healthcare for the long term.
- A list of key planning indicators (benchmarks) and justification of the probability of their achievement in the planning period.
- Drafts of regulatory documents required for the implementation of planned activities.
- Drafts of new targeted integrated programs for solving interdepartmental problems.
1. Development
material and technical base of healthcare
The development section of the material and technical base of healthcare covers measures to strengthen and maintain the fixed assets of healthcare institutions (buildings, vehicles, support systems, technical and medical equipment, inventory), as well as a list of measures within the framework of the implementation of the restructuring strategy for the medical care system.
As the main activities for the first subsection, the following can be planned:
- construction of new institutions, buildings;
- carrying out capital and current repairs of buildings, premises;
- work on the improvement of the territory;
- development of the fleet of vehicles;
- technical re-equipment and updating of obsolete equipment, etc.
The second subsection may include activities for:
- liquidation (re-profiling) of low-power hospitals, not equipped with medical personnel, poorly equipped, medical institutions;
- Strengthening the outpatient department through the opening of new institutions, offices, receptions, the development of new forms of services in clinics;
- introduction of hospital-replacing technologies (day hospitals, day care hospitals, hospitals at home);
- differentiation of the bed fund according to the intensity of the medical and diagnostic process, the creation of beds (departments) of nursing care, hospices, the formation of institutions or departments of a medical and social nature.
The specification of the planned tasks should be carried out in accordance with the strategic goals of the regional and municipal health systems aimed at reorienting medical care from the inpatient to the outpatient level. Attention should be paid to the advisability of not only strengthening, but also modernizing the diagnostic, laboratory and rehabilitation base of outpatient facilities, opening specialized rooms according to the profiles of medical specialties that meet the real needs of the population, changing the nature of the activities of existing rooms in accordance with the introduction of new medical technologies services (outpatient surgery, day special hospitals, preventive units, etc.).
The urgency of the problem of supplying medical institutions with consumables also justifies the appropriateness of reflecting ways to solve it in planning documents.
2. Training and advanced training of personnel
This section of the Plan includes a list of the main activities for the training of medical personnel and other health system specialists (economists, accountants, medical equipment maintenance technicians, etc.):
- targeted training of specialists based on targeted orders of regional and municipal governments;
- advanced training of workers at central bases, in the system of GIDUVov, in foreign medical centers and other educational institutions with a separation from production;
- continuing education on the job in cycle, intermittent, full-time courses, seminars;
- Conducting medical and nursing conferences, congresses, meetings;
- organization of contests by profession;
- participation in the organization of work of scientific societies.
Work on the training of personnel is planned by the organizational and methodological departments in coordination with the human resources for health in the region (municipality).
3. Preventive work
Planning for preventive work provides for the formation of a list of measures for the following sections:
- vaccine prophylaxis;
- chemoprophylaxis;
- measures in the foci of infection;
- measures at agricultural facilities (livestock, dairy farms, etc.).
All activities included in this section of the Plan are carried out in contact with the bodies of state sanitary and epidemiological surveillance in accordance with current instructions and methodological recommendations in accordance with the established schedule.
4. Organization of identification of socially significant pathology
Measures to organize the identification and medical examination of populations with socially significant diseases (tuberculosis; HIV / AIDS; sexually transmitted diseases (STDs); various forms of drug addiction; mental disorders) include:
- annual survey of contingents subject to periodic examinations and medical observation;
- accelerated clinical examination of persons with a revealed pathology;
- Practical assistance of regional (district) institutions in the survey of the population of areas;
- registration of the examined and police records of the revealed pathology;
- conducting systematic consultations on the detection of diseases and providing advice on the diagnosis, treatment and rehabilitation of this group of patients, including in regional, district and central specialized institutions.
The plan is built in the context of the type of pathology in the listed areas of work.
5. Improving diagnostic, therapeutic,
rehabilitation assistance and the introduction of modern
technology
The main areas of organizational activities in this section include:
- monitoring the quality of diagnostics and treatment based on the results of consultations conducted by highly qualified specialists in regional (municipal) institutions (units), as well as on trips to subordinate healthcare institutions;
- regulation of taking for dispensary observation and control of contingents of medical examination patients;
- Organization of centralized control over the accuracy of death certificates.
Planning can be carried out on objects subject to control (institutions, services, departments, specialists), on forms of control (expert assessment of medical documentation), on indicators characterizing the state of the care process (implementation of individual treatment plans, provision of continuous medical care, timely hospitalization , consultation, on the validity of the selection of patients for treatment in institutions of a different level, on hospital-replacing technologies), on the activity of medical intervention (surgical treatment), on the results (restoration of the patients' ability to work, timeliness of referral to MSEC) and in the context of other performance indicators.
The implementation section covers modern technologies for prevention, diagnosis, treatment, rehabilitation, which are to be introduced into the activities of health facilities and the corresponding organizational measures for implementation.
6. Sanitary education
Activities covering health education may include:
- the creation, distribution, control of activities, the development of various organizational forms of public health education - “Health Universities”, “Health Schools” in outpatient facilities, and “Schools of Recovery” for inpatients;
- preparation of a profiled sanitary asset for home care, primarily from among relatives;
- the use of various forms of mass distribution of hygienic knowledge among the population (appearances in the media, organization of exhibitions, publication of educational materials);
- organization of meetings with medical workers (lectures, discussions, clarifications, recommendations);
- the spread of modern forms of attracting the population to a healthy lifestyle.
7. Research
The planning of research topics is carried out in accordance with the applied tasks of practical health care, which may include certain issues of public health, medical care and the development of strategically important directions for the development of a regional (municipal) health system.
The process of preparing the draft Plan and its procedure
the adoption of
The plan is developed with the participation of senior specialists of the appropriate level and, upon completion of development, is endorsed by them. The purposefulness of plans and the effectiveness of planned tasks depend on the correct setting of goals, the choice of strategies for achieving them, and the concentration of efforts on selected priorities.
Regional priorities for the development of medical care for the population are determined in accordance with the directions of the state policy in the field of public health, taking into account regional characteristics and resource capabilities. Despite the differences by region in most constituent entities of the Russian Federation, the main areas are similar - tuberculosis; HIV AIDS; diabetes; vaccine prophylaxis; safe motherhood and childhood.
The plan of organizational and methodological work of the republican, provincial, regional hospital, CRH is a structural component of a single plan for the development of regional (municipal) health care, which defines a hierarchical system of long-term and current planning for the activities of government bodies and healthcare institutions of the region (municipality).
The procedure for the adoption of the plan includes its discussion at the medical council of the institution either as an independent issue, or as an integral part of the discussion of the results of the institution, the implementation of targeted programs over the past period. The rules of procedure for the adoption of the plan provides for mandatory participation in the discussion of representatives of the apparatus of the health management body of the appropriate level, and for the central district hospital - representatives of the district administration. The optimal level of hearing for regional institutions is the board of the health management body, if the plan concerns only medical activities, and the regional government, if the plan is comprehensive.
After discussion, a comprehensive plan is approved by the head (deputy) of the administration of the appropriate level, and if the plan is interdepartmental, then by the head of the corresponding health management body. The approved plan is a mandatory binding document.
8. Monitoring the implementation of the plan
Current control by quantitative and qualitative criteria for the implementation of the plan is carried out by the organizational method department (office) of the organization that made it up.
It is advisable to supplement sections of the plan in which a list of measures, their levels of execution, dates of responsibility, dates of planned implementation, are provided with columns for, dates of actual execution and costs of their implementation. For control use the data of state statistical reporting. It is verified locally by district curators during planned visits.
Transparency of activities is ensured by the simultaneous public hearing of the curator and those responsible for carrying out the planned activities.
It is methodologically more efficient to hear not one district on the maximum possible number of questions, but several regions on one issue. This allows you to diversify the problem and choose the optimal approaches to solving it, arising from accumulated practical experience.
An important monitoring tool is the semi-annual (depending on the importance of the issue) interim hearing of the execution of the plan in the regional public health administration and administration.
Some examples of private hearing questions include the following:
- organization and effectiveness of population examinations and medical examinations;
- treatment of patients with chronic diseases;
- carrying out anti-epidemic measures;
- on the role of regional institutions as organizational and methodological centers;
- information on teaching aids;
- analysis of the work of institutions, etc.
Plan Implementation Summary Report
The final report on the implementation of the plan is prepared either in tabular or descriptive form by sections of it and includes the following headings:
- planned tasks to be solved;
- initial indicators at the beginning of the planning period;
- measures taken (a, b, c, etc.);
- results of the current year;
- efficiency mark.
An explanatory note is compiled on the report with an analysis of the results achieved, and in the absence or insufficient effectiveness of the measures taken, an analysis of the reasons, a critical assessment of the defects in the activities and possible measures to improve their quality.
A report on the implementation of activities according to the plan of organizational activities by the departments of the institution that oversees the subordinate medical and preventive institutions is provided at the request of the organizational and methodical department (office) in a timely manner according to the profile of the department, indicating the performers in the following aspects:
- preparation of questions for hearing at meetings, boards of management (planned / unscheduled, level);
- writing market reviews on the profile of units;
- release of teaching materials in the supervision zone (which ones);
- pedagogical work (courses, seminars, lectures, individual training of specialists);
- business trips to the supervised territories (where, purpose, duration, planned / unscheduled, team / individual, what assistance was provided);
- participation in meetings, conferences, congresses, etc. (which, topic of speech, level regional, interregional, international).
In analyzing the implementation of the plan, they strive not so much for setting new tasks as for determining the effectiveness of already known approaches to solving the problems posed.
Organizational and methodological assistance to institutions
health care
Organizational and methodological activities are carried out by leading (head) institutions of the federal, regional and district levels of health care and it consists in providing practical assistance to supervised services and healthcare institutions on a wide range of issues relating to the organization and improvement of the quality of the medical and diagnostic process, improvement of prevention, and technological improvement of activities , management optimization, including improving planning.
Institutions of federal subordination provide planned assistance primarily to institutions at the regional level, but, if necessary, at the district level. Leading institutions at the regional level provide organizational and methodological assistance to municipal institutions, practically help both the central district hospitals (inter-district centers) and primary health care institutions.
Diagnostic, treatment and rehabilitation medical care for patients who apply to institutions is regulated by the job descriptions of the respective units and the institution's internal rules. The plan of organizational measures coordinates the organizational, methodological and practical assistance provided by employees of all departments of the institution to the supervised institutions both directly on the basis of the institution and during field trips. It outlines the range of responsibilities in the performance of the department’s own work (office).
The organizational and method department (office) of the leading (head) health facility is designed to solve mainly three large blocks of tasks:
1. The formation of the staff of the institution of commissions and field teams. Organization of planned visits of curators and curator teams to the areas of territories, inter-district centers for organizational, methodological, advisory and practical assistance; listening to their reports, recording the work done, creating and maintaining in working condition the district file of recommendations.
2. Development of materials of strategic (program), operational (plans), directive value (orders) for the administrative apparatus of the regional (for regional institutions) or district level (for the central district hospital):
- to monitor the implementation of directive documents of the administrative apparatus of the federal, regional, district, municipal levels;
- on the organizational support of the work of municipal councils, commissions (in conjunction with the administration of the institution, designated responsible);
- to popularize the best practices for improving the health of the population (together with leading experts).
3. Preparation of a consolidated annual report, its analysis, execution of conclusions based on the results of business surveys, collections of key indicators of medical institutions and public health (with the participation of leading experts).
Organization of field medical assistance to residents
rural areas
The low density of the rural population, the employment of personal subsidiary plots, the seasonality and urgency of basic agricultural work, the remoteness of medical (especially specialized) care from the patient’s place of residence, the poor development of transport communications at considerable distances, the high cost of travel — all this reduces the level of accessibility and hospitalization of the rural population .
Unsatisfactory working conditions in the agricultural sector, which in most industries do not meet sanitary and hygienic requirements due to non-compliance with sanitary norms and rules, contribute to the occurrence of diseases, which, with low detectability and insufficient treatment, leads to the development of neglected cases, chronic pathology, and high mortality. More often than in cities, brucellosis, intestinal infections, diseases of the musculoskeletal system, respiratory diseases (dust bronchitis), and vibration disease are found in the village. This implies the need to intensify exit forms of organizational, advisory and practical assistance from regional and inter-district institutions. In this case, one should take into account the long separation of qualified specialists from the performance of their duties in their main work, the unsettledness of their life upon departure, irregular working hours.
Emergency and emergency care for patients with complex pathology, in particular, requiring surgical interventions, is provided year-round by the emergency and planning and advisory care department of regional (regional, republican, district) hospitals or the Center for Disaster Medicine by means of air ambulance (airplane, helicopter) or fixed vehicles. 27% of rural residents in the population account for more than 67% of patients served by ambulance aircraft. The average republican rate is 1.7 trips per 1000 rural population, the maximum level reaches 4.4.
Planned assistance is provided to specialists of the Central District Hospital, curators, specialists from hospitals and consultative clinics of constituent entities of the Russian Federation.
To provide assistance to rural hospitals, by the order of the regional healthcare management body, both full-time and freelance specialists of regional (regional, republican) institutions - hospitals (adults and children), maternity hospitals, dispensaries, AIDS control centers and medical prevention are assigned to regional and city health-care facilities , Sanitary and Epidemiological Supervision, as well as inter-district diagnostic and treatment centers.
The volume and nature of planned assistance to health facilities for servicing the rural population depends on the type of supervising institution and its financial capabilities. The provision of highly qualified specialized care is provided by the emergency and planning advisory assistance departments of regional clinical hospitals.
All these structures provide assistance to the Central District Hospital, district hospitals, district hospitals, rural medical outpatient clinics, FAPs and feldsher points, nursing hospitals, and regional ambulance stations.
The content of the assistance provided by regional institutions to the district is:
- coordination of health management;
- implementation of strategic decisions of the health care management apparatus;
- systematization of organizational and methodological work of municipal health systems;
- practical assistance to the management and specialists of the Central District Hospital, other institutions at the municipal level;
- Strengthening intra-departmental quality control of medical care;
- Strengthening expert work at all levels;
- conducting seminars, etc.
The main tasks of the curators when leaving for the districts are to determine how the agreements between the administration of the municipality and the regional health management body are implemented in the field of public health; board decisions and orders; how the security regime is observed in the health facilities of the district. The curator provides organizational and methodological assistance and implements standards of medical care, organizes monitoring of their compliance.
The main specialists of regional institutions should introduce modern technologies and disseminate best practices. In addition to visits by chief specialists, the supervision of rural hospitals is carried out by specialists of regional institutions and departments of higher educational institutions of a medical profile.
In the constituent entities of the Russian Federation, various organizational forms of assistance are applied from the institutions of regional subordination to the medical and preventive institutions of the districts. The division of assistance by type is conditional. We can only talk about the prevalence of one or another component: expert - advisory, organizational - methodological or directly practical participation in the medical and diagnostic process.
Advice on the diagnosis, treatment and rehabilitation of patients is provided in the polyclinics of the Central District Hospital, in district hospitals, at home, in the hospital. Noteworthy is the experience of the Novosibirsk region in organizing round-the-clock support by the Center for remote electrocardiography on the basis of the regional hospital for diagnostic and advisory work in all areas of the region and part of district hospitals. In the Stavropol Territory, on the basis of inter-district soundproof rooms and large CRHs, there are visiting teams of specialists from the centers of audiology, hearing aids and phoniatrics of the clinical hospital.
Organizational and methodological assistance is provided by the main staff and freelance specialists of the regional (regional, republican, district) level. The most experienced, highly qualified specialists are involved in field work.
According to the instructions of the administrative apparatus of the region (region, republic, district), the quality of medical assistance to the rural population in municipal institutions (CRH, UB, FAPs) is monitored during the preparation of medical councils, visiting boards, meetings, and conferences; studying the material - technical and personnel potential, the possibilities of licensing the services of the central hospital; the results of response to complaints of the population are monitored. At the same time, methodological assistance is also being provided.
Field hospital medical councils with the participation of heads of administrations and the medical community of the districts justify themselves, where they discuss the results of an expert evaluation of the activities of the district services according to a unified methodology, as well as organize an advisory appointment of patients with specialists of regional institutions.
In order to improve the quality of nursing, to ensure normative acts with the participation of representatives of the regional Council of Sisters, conferences and inter-district reviews are organized (for example, in the Kursk region).
With the participation of the teaching staff of the departments of medical institutes, academies, universities, field conferences are held, incl. scientific - practical, seminars, meetings.
In the course of providing primarily practical assistance, comprehensive, targeted, preventive examinations and medical examinations of the population are organized, expedition trips are carried out. The CRH specialists monthly examine the population served by district hospitals and FAPs.
The participation of specialists from regional institutions in the work of draft commissions is of practical importance.
The Stavropol Territory has accumulated experience in servicing people involved in harvesting. During field work in the countryside, field teams are assigned to field camps for routine inspections of machine operators, field breeders, and educational work to prevent injuries, poisoning, and infectious diseases.
Every month, according to the schedule, teams of doctors of Perinatal leave
center of the Lipetsk region for examination of women of childbearing age with
risk factors and pregnant.
Of great practical importance are planned surgical operations, including outpatient, selection of patients for additional examination and treatment in adult and children's regional institutions.
Possible forms of field work:
- individual visits of specialists are often unplanned - at the request of the municipal health facility; the practice of emergency call of necessary specialists is expanding at the request of the head physician of the institution at the expense of the host party;
- trips of teams of 2-5 specialists (adults and children), who are preferred during planned work, as they are more cost-effective than individual trips; in the structure of trips - brigade 77% versus 23% - individual;
- mobile (outpatient) outpatient clinics (polyclinics): the teams formed in their structure serve adult patients and children according to a plan approved by the head physician and agreed with the territorial public health authorities.
This form of public service has become firmly established. A team of 5-7 specialists is completed taking into account the wishes of the districts and works on average for four days (the first and fourth - in the Central District Hospital, one each in district hospitals). The population is notified in advance about the composition of the brigade through the media (regional newspapers, radio), through paramedics.
In the Voronezh region, consultations account for 84.7% of the structure of planned field assistance; participation in inter-district conferences, seminars, meetings - 6%; educational and methodological assistance - 4%; on the instructions of the main health department - 2.2%; comprehensive inspections - 1.75%; MPI licensing - 1.3%. Single trips - 33.8%. The proportion of visits of the main freelance specialists amounted to 6.2%.
On average, the number of visiting teams consists of 5-6 people: specialists in therapeutic, surgical, pediatric, obstetric and gynecological, paraclinical profiles, organizational and methodological work, neurologist, ophthalmologist. The composition of the team of specialists is completed taking into account the interests of the region, if necessary, expanded at the expense of other specialists, in particular TB specialists, dermatovenerologists, etc.
In preparation for a planned departure to the regions of the region, an analysis of the epidemic situation in the region is carried out; study of the quality and effectiveness of outpatient care, in particular to the rural population, by level (regional institutions, the Central District Hospital, rural medical outpatient clinics); assessment of staffing of doctors and nursing personnel, their qualifications.
Prior to the arrival of the brigade, in the districts of the region a stream of patients is formed, mainly a dispensary group, as well as a group for receiving operative care from an ophthalmologist, traumatologist, and oncologist at the rate of 2-3 - operations per visit. It is necessary to equip traveling teams with equipment for examining and treating adults and children.
During the visit, patients are examined in the central district hospital, and, if necessary, in FAPs, in rural medical outpatient clinics and district hospitals.
The duration of the business trip varies from a few hours to 10 days, averaging 2.4 days. According to the Samara region, each specialist in two days of work has the opportunity to advise from 30 to 50 people. At the same time, according to the Republic of Khakassia, consulting a specialist of an exit team is 2.5 times more expensive than consulting a specialist, but in an advisory clinic.
The practice of replacing, according to the application of the head physician, the long-term (from 7 to 35 days) absent specialists of the central hospital, mainly of a surgical profile (vacation, study, specialization), is finding wider application.
According to the plan - schedule, the employees of the Central District Hospital render assistance to the population assigned to district hospitals, medical outpatient clinics, and FAPs. The brigades are staffed by doctors of the Central District Hospital in such a way as to ensure from 6 to 12 trips to the rural area per year; they most often include a pediatrician, gynecologist, therapist, neurologist. During the visits, the CRH specialists provide, first of all, advisory assistance, primarily to pregnant women and children. The number of consultations usually ranges from 25 to 30 per trip.
Clinical monitoring of patients with peptic ulcer, diabetes mellitus, gastritis, nephritis, rheumatic heart disease, rheumatoid arthritis, etc. requires special attention. The purposeful departure of the brigade 2-3 times a year allows you to examine almost the entire dispensary group. During the visit, patients are also selected for therapeutic and surgical treatment in the Central District Hospital and in regional institutions, and in some cases practical assistance is provided on the spot. The work of rural medical workers is compulsorily analyzed, the progress of dispensary observation, the course of treatment after the previous consultation are monitored, and recommendations are given for improving medical care.
The introduction of telecommunication technologies allows the use of new principles for the transfer of medical information between clinical centers and the central district hospital, and contributes to the development of Internet technologies. The promising significance of this direction for healthcare is undoubted, although the organizational experience of its introduction and use is only accumulating.
Such a form of work as traveling medical assistant points is also possible in order to provide monitoring of patients in inpatient hospitals at home in sparsely populated areas, and to deliver the necessary medications to patients.
When assessing the nature and extent of organizational and methodological assistance, the following are taken into account:
a) information and analytical assistance in the preparation, publication and distribution of various materials: methodological recommendations, information letters, collections of health and work indicators, newsletters; preparation of reference materials at the request of higher organizations; information for health education of the population and patients through the media, including nosocomial, using special stands;
b) consultative receptions and participation in preventive examinations of the population of adults and children separately, separately for specialists, districts and the number of visits who participated in assisting; the number of examined with instrumental methods (endoscopy, ultrasound, ECG, etc.) is also taken into account.
The technical report of specialists is compiled by sections:
- inspected in total;
- from them the sick are revealed;
- including with a first-time diagnosis;
- outpatient treatment recommended at the place of residence;
- at the place of residence recommended inpatient treatment;
- sent to the regional clinics for further examination;
- sent to the regional clinics for dispensary registration;
- sent to regional hospitals.
Method Efficiency
The recommendations are a summary of the experience of organizational, methodological and field work of 42 administrative territories of the Russian Federation and the Southern District Medical Center of the Ministry of Health of the Russian Federation with 24 branches.
The analysis found that among the main problems of organizational and methodological work to protect the health of the population of the administrative territories of the Russian Federation, the problem of qualification of the personnel of organizers - methodologists is relevant. Its appearance is associated with defects in basic training and improvement, as well as with a lack of informational and methodological materials in the specialty.
Serious objective difficulties in organizing outreach assistance to municipal and district institutions are compounded by the organization’s shortcomings, in particular, insufficient succession of outreach work by specialists of regional institutions of various profiles due to imperfect coordination of their activities in the regions.
Significant reserves for increasing organizational work have been identified. So, if on average 0.48% of the institution’s financial support is spent on organizational and methodological work, then in a number of territories financing is much higher (almost double), testifying to the recognition of the significance of this activity (the republics of Buryatia, Udmurtia, Khakassia; Kamchatka, Ulyanovsk regions, Yamalo - Nenets Autonomous Okrug). The structure of expenses for organizational and methodological work, an approximate level of service for the rural population by medical aviation; proposals were made on the formation of field teams, the duration of field work.
All this allows to improve the quality, efficiency and accessibility of medical care, primarily to the rural population.
So, a team of 6 specialists of the State Health Institution of the Voronezh Regional Clinical Hospital No. 1, according to the schedule, leaves the Gazelle freight and passenger car with a frequency of 1 time per week at a distance of 50 to 300 km on average for one day. Given the remoteness of the area, the duration of the trip is determined by the time spent on the road and the amount of work ahead.
Multidisciplinary teams, on average, out of 4 employees of the Southern District Medical Center of the Ministry of Health of the Russian Federation, perform up to 7 visits per year with a range of 500 km to the subordinate medical and preventive institutions of the Azov-Volzhsky-Don water basin to provide planned advisory assistance on average for 2 days.
Appendix N 1
FOLDER OF THE MUNICIPAL INSTITUTIONS AND AREAS CURATOR
ADMINISTRATIVE TERRITORIES
The dossier for municipal and district healthcare institutions includes the following sections:
1. Assessment of the health of the population of the city, district.
The section contains information on the demographic situation in the area, performance indicators of the municipal public health management body; performance indicators of the municipal health management body according to the annual report. Materials of previous inspections, recommendations. Written appeals of citizens.
2. Material and technical base.
The structure of municipal health care. State of institutions. Prospects for medical and technical equipment. Adaptation of the provisions of the concept of healthcare development at the city, district level.
3. Compliance with the security regime of medical facilities.
The section reflects the results of inspections of the condition of buildings and its premises for the presence of suspicious foreign objects, the possibility of entry of extraneous vehicles; checking the integrity and safety of seals and seals, locks in unused rooms.
Fixed rental of buildings, structures and premises of hospitals.
The interaction with air traffic control authorities is being clarified regarding notification of unauthorized persons entering the territory or premises of medical facilities; identification of persons who are in hospital treatment, whose identity is not confirmed by documents; the treatment of persons with injuries and injuries that do not exclude criminal origin in hospitals, adjusting and instructing on-duty staff of the institution.
In case of emergencies, the round-the-clock readiness of hospitals to provide assistance to victims of injuries and burns, the availability of an irreplaceable supply of medicines and supplies; the composition, addresses and telephone numbers of the reinforcement teams on duty, the procedure for notification and staff gathering in hospitals.
Finally, the presence of an order in the hospital to limit visits by patients to relatives to 18 hours is being clarified.
4. Provision of the population with doctors and paramedical workers.
Of particular importance are questions: the staffing of the administrative apparatus; work with a reserve; the presence of job descriptions of employees (duties, rights, responsibilities); housing for health workers; monitoring the staff development plan (conferences, seminars, refresher courses).
5. The presence of organizing orders and control over their implementation.
6. Fire safety status (availability of order, plan of fire measures, instructions, briefing, availability of fire extinguishing means).
7. Compliance with safety regulations: the establishment of a certification commission for labor protection; the presence of an introductory briefing journal when applying for a job; instructions; measuring the resistance of the grounding loop and insulation of the wiring; the presence of an order for employees responsible for the electrical sector; operation of oxygen facilities under pressure.
8. Work with the administration of the city, district to protect public health. The effectiveness of interdepartmental commissions on socially determined diseases.
9. Implementation of the decisions of the collegium of the territorial health management body.
10. Organizational and methodological work.
The section provides data on the distribution of duties between officials; information support of the institution; the work of the medical council; control over the implementation of policy documents; indicators and analysis of the institution for three years; the presence of an approved plan of the main activities of the institution for the current year with applications (holding a medical council, medical conferences, introducing new technologies, work of field teams); work with recommendations of specialists of regional institutions, including on the implementation of the Healthcare Development Concept of the region; monitoring the implementation of existing orders.
11. Compliance with the sterilization - disinfection regime in the institution.
12. Medical and preventive care.
Contains materials to evaluate:
a) the quality and availability of outpatient care:
- the introduction of new technologies and forms of medical care (day hospitals, hospitals at home, day care hospital);
- the work of the departments of prevention and rehabilitation, re-profiling of the beds of local hospitals into the departments of nursing, for the treatment of patients for medical and social reasons, medical outpatient clinics with a day hospital; timeliness of transfer of patients in need of medical and social assistance to boarding houses;
- the institution's working hours; the provision of paid services to the population, enterprises, organizations;
- continuity in the examination, treatment and rehabilitation of patients between the clinic and the hospital;
- restructuring of the hospital bed fund;
- equipping the hospital with diagnostic and medical equipment;
- A system of care for emergency conditions, hospitalization and discharge of patients;
- organization of drug provision;
- organization of resuscitation care for women and children, analysis of indicators of maternal and child mortality;
b) a system for controlling the circulation of narcotic drugs: an order, an admission of the Ministry of Internal Affairs, storage, a register of narcotic drugs and psychotropic substances in accordance with the requirements of the Ministry of Health of the Russian Federation; reception and destruction of used ampoules, the work of the commission on the use of narcotic and psychotropic substances; Work with special prescription forms.
13. Organization of the quality of emergency and emergency medical care.
14. Organization of the work of the municipal health management body in the context of compulsory medical insurance and voluntary medical insurance:
- protocols of the licensing - accreditation commission, plan and implementation of recommendations;
- control of the terms and quality of treatment of the insured;
- monthly monthly use of budget funds and compulsory medical insurance.
15. Implementation of standards for the volume and quality of medical care at various stages and levels of hospitals in the city, district.
16. The work of the clinic - expert commission.
17. Work auxiliary services (laundry, communications, transport).
18. The sanitary condition of health facilities.
19. Conclusions and suggestions.
Note: When developing Appendix 1, the order of the Ministry of Health of the Saratov Region N 101-p dated 01/20/2001 "On the supervision of municipal healthcare institutions of cities and districts of the region, regional health facilities by the Ministry of Health for 2001" was used.
Appendix N 2
REPORT
ABOUT THE PLANNED (EXTRAORDINARY) DEPARTURE OF THE CURATOR (SPECIALIST)
FOR PROVIDING METHODOLOGICAL AND PRACTICAL ASSISTANCE
MUNICIPAL, REGIONAL HEALTH CARE INSTITUTIONS
1. Name, position, place of work.
2. Date of departure.
3. Settlement, institution assisted.
4. Purpose of departure: the introduction of new techniques, technologies; training; practical help; conducting inspections.
5. Results: Filled in accordance with the rubrics of the Curator's Folders within the competence of the specialist.
The nature of the help in the section:
- organizational and methodological work includes the results of inspections of outpatient and inpatient facilities, emergency medical care according to statistical indicators, according to the current documentation, standards of patient care, etc .;
- medical advisory work - indicates the number of consulted by age groups, industry, operations, manipulations, benefits;
- pedagogical work - its type is noted: lecture, conference, seminars, practical exercises; topic, number of participants.
6. Recommendations.
The report is prepared in duplicate and is certified by the signatures of the seconded specialist and the heads of the institution, which was assisted. One copy remains in the health facility for the implementation of the recommendations, the other is transferred to the organizational and method department of the institution that sent the employee on a business trip.
from 11-06-13 to 14-06-13
Format: Seminar
Town: St. Petersburg
Location: St. Petersburg, Educational complex CSTI "Progress", Vasilyevsky Island, Sredny prospekt, 36/40
1. Organizational and methodological work - an integral link to improve the effectiveness of health care facilities.
Tasks, contents and methods of organizational and methodological work of medical facilities.
The methodology for the interaction of medical units in a multidisciplinary hospital in solving organizational and methodological problems.
Compilation of a comprehensive plan for organizational and methodological work of hospitals: analytical, statistical, operational, tactical.
Organizational and methodological department (office) of the medical institution as the headquarters of the chief physician and chief specialists.
Regulatory documents on the work of the organizational and methodological departments (OMO) of medical facilities.
Content and scope of OMO work.
Job descriptions of managers, doctors and other OMO staff.
The activities of the city organizational and methodological department for the coordination of work and information support of hospitals to provide high-tech medical care (VMP).
2. The current legislative framework in the field of healthcare. Federal Law of November 21, 2012 No. 323 "On the Basics of Protecting the Health of Citizens of the Russian Federation" and its implementation in healthcare facilities.
New in licensing medical activities.
The program of state guarantees for the provision of free medical care to citizens.
Changes in the CHI system - theory and practice.
3. Organization of paperwork and workflow in a medical institution.
Organization of work with documents: requirements and recommendations. Organizational and administrative documentation. Work with regulations, instructions; preparation of analytical reviews, references, materials, etc. Work with regulatory documents (orders, directives, etc.); work with methodological and normative literature. Bringing working information to all structural units of the medical institution. Work with letters, appeals.
Organization and control of the correct collection of documents for healthcare systems archives, ensuring the standard shelf life.
4. The role of organizational and methodological departments in the system of accounting and reporting of medical organizations. Accounting for documentation used to generate reporting forms on health care activities for federal statistics and industry statistics.
5. Standardization as one of the areas of methodological work.
The principle of formation of the Federal Standard.
The principle of the formation of the territorial standard.
Organization of a quality control system for the provision of medical care at all stages of the diagnostic process. Assessment of defects in the provision of medical care. Analysis of the quality of care. Organizational and managerial issues on the construction of a quality management system.
from 27-02-12 to 02-03-12
Format: Seminar
Town: St. Petersburg
Location: Educational complex TSNTI
The program contains the following questions:
1. Changes in the legislation governing the activities of medical organizations. The impact of the changes introduced on management activities. Responsibility of the head, deputy, employee. Legal protection of a medical institution: organizational and methodological work.
2. Organizational and methodological work in a medical institution: goals and objectives; participation in strategic planning; planning strategy and tactics; organizational planning of health care facilities; planning techniques; development of regulations and internal standards; participation in the planning of health care facilities; coordination of plans, events.
3. Organization of work of the deputy chief physician for organizational and methodological work. What is changing in the status and position of deputy head? Regulations on the deputy chief physician for organizational and methodological work. Job and functional duties. Regulations on the organizational and methodological department, office. Organization of work of the organizational department.
4. Organization of workflow of a medical institution. Organization of work with documents: requirements and recommendations. Organizational and administrative documentation. Work with regulations, instructions; preparation of analytical reviews, references, materials, etc. Work with regulatory documents (orders, directives, etc.); work with methodological and normative literature; work with letters, appeals.
It might be useful to read:
- Legal form of enterprise, organization;
- What is a quote request?;
- Actual changes in the contract system for procurement participants;
- Guide to filling out the declaration of ownership of SMP for LLC and IP;
- Electronic Auction: Protocol Issues (Pratura O;
- Retrospective bonus program for wholesale customers. New explanatory and derivational dictionary of the Russian language, T;
- EDS for the electronic ots-tender platform From the procurement platform;
- Entry into the procurement plan of the start date of the procurement. Dates. Frequency of the planned procurement. How to fill in.;