Work plan and equipment of the methodological office of medical treatment facilities. Organizational and methodological department. Research and innovation
Organization of a sanitary asset and management of its work
Maintenance of accounting and reporting documentation
Communication with institutions:
inpatient hospital, dispensaries, sanatorium-type institutions, SES.
Tracking the health of the population of the site, analyzing morbidity and disability, developing measures to reduce them.
Dispensaries: their types, forms and methods of work. Assessment of the quality of medical examination of the population.
Prophylactic medical examination is understood as active dynamic monitoring of the health status of certain population groups (healthy and sick), registration of these population groups for the purpose of early detection of diseases, dynamic observation and comprehensive treatment of sick people, taking measures to improve their working and living conditions, prevent the development and the spread of diseases, the restoration of working capacity and the extension of the period of active life.
Clinical examination primarily provides for the preservation of health in healthy people, active identification of patients with early stages of disease and prevention of incapacity for work; its ultimate goal is to preserve and strengthen the health and working capacity of the dispensary contingent. This determines the social and hygienic essence (significance) of clinical examination. The dispensary method of observation is a function of the attending physicians of the general network of out-of-hospital institutions (polyclinics, outpatient clinics) serving the population at the place of residence and at the place of work, as well as doctors of specialized institutions - dispensaries and centers of the State Sanitary and Epidemiological Service.
Currently, there are various dispensaries (medical and physical, dermatovenerologic, anti-tuberculosis, narcological, cardiological, oncological, neuropsychiatric, etc.). Dispensaries and dispensary departments (offices) carry out mass prevention measures aimed at preventing diseases, keep records of morbidity and mortality from pathology in their profile, and also carry out therapeutic measures, consultations for patients and organizational and methodological guidance of the work of general network doctors to combat relevant diseases. The tasks of the dispensaries include: providing training for general practitioners in the relevant specialties; introduction into the practice of medical institutions of modern methods of prevention, diagnosis and treatment; promotion of healthy lifestyles.
The main documents that are issued for patients registered with dispensary are the outpatient's medical card and the dispensary observation control card, which records the timeliness of visiting a doctor and passing the next medical examination, the implementation of prescribed types of treatment, recreational activities and recommendations for employment.
Types of dispensaries: anti-tuberculosis, dermatovenerologic, cardiologic, physical therapy, oncologic, neuropsychiatric, narcological, endocrinologic, ophthalmologic, mammologic.
The structure of the polyclinic, tasks and organization of the work of the registry. The system of doctors' work.
Primary medical and social assistance to the urban population is provided by outpatient polyclinics (territorial polyclinics serving the adult population) and institutions for the protection of mothers and children (children's polyclinics and antenatal clinics).
The main organizational and methodological principles of the work of polyclinics and territorial medical associations (TMO) are precinct (assignment to a medical position of the normative number of residents) and the widespread use of the dispensary method (systematic active monitoring of the health of certain contingents). The main planning and normative indicators regulating the work of polyclinics are indicated: the standard for the district (1700 people for 1 position of the district therapist); load rate (5 visits per hour at an appointment at a polyclinic and 2 - when serving patients at home by a therapist); staff standard district therapists (5.9 per 10,000 residents over 14 years old).
The measure of the capacity of polyclinics is the number of visits per shift (more than 1200 visits - I category, less than 250 visits - V category). TMO, to a greater extent than polyclinics and antenatal clinics, meet the new principles of organization and financing of 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 dated 26.08.92). In a number of TMOs, conditions have been created for family health care, for example, joint work at the site of a therapist, pediatrician and gynecologist (obstetric-pediatric-therapeutic complex - APTK). At the same time, the indicator of work is not the dynamics of attendance, but changes in the state of health of the population (decrease in morbidity, disability, infant mortality, the number of advanced oncological diseases, the state of health 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; medical and diagnostic work (including examination of temporary disability); organizational and methodological work (management, planning, statistical accounting and reporting, analysis of activities, interaction with other health care institutions, professional development, etc.); organizational mass work.
The polyclinic is headed by the chief physician. The structure of the polyclinic includes: registration, prevention department, treatment and prophylactic departments and offices, treatment and diagnostic units, administrative part, rehabilitation treatment departments, etc. The continuity of the polyclinic and hospital work is assessed by the number of patients prepared for planned hospitalization, and the exchange of documentation before and after their treatment in a hospital.
City Polyclinic is created as an independent medical and prophylactic institution, a structural subdivision of a medical and preventive institution of an urban district or is part of an inpatient polyclinic association for the provision of primary health care to the population according to the district principle.
The main task of the city polyclinic is to reduce morbidity, disability and mortality of the population, to promote sanitary and hygienic education of the population, and to promote a healthy lifestyle.
Doctors work systems:
Alternating system
Two-link
Three-link
Brigade method
The approximate structure of the city polyclinic:
1. Management of the polyclinic, including AHCH
2.Information-analytical department:
Reception desk, information desk
Organizational and methodological room (statistics office)
3.Medical and prophylactic part:
The offices of the district therapists (department)
Specialist offices (surgical, ENT, ophthalmological, 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 health care municipal level, including the chief doctors of the Central District Hospital.
The organizational and methodological work includes:
Implementation analytical work according to the assessment of the state and dynamics of the development of the health care system of the corresponding administrative territory, the state of health of the population, the medical and demographic situation and other factors external environment influencing the level of health of the population;
Organization and improvement of the system of accounting and reporting on the activities of governing bodies and health care institutions, the results of functioning, the dynamics of the state of health of the population;
Development of promising and current plans the activities of the health care system of the administrative territory, targeted programs on priority areas of development, organization of their implementation, control and assessment of the effectiveness of implementation;
Organization and conduct of targeted inspections, expert assessment of the activities of individual services and health care institutions with expert visits to the field and the provision of organizational, methodological and advisory assistance;
Determination of the need for medical personnel in different forms lifelong learning, planning in conjunction with personnel services health authorities work to improve the qualifications of medical workers, organize and conduct conferences, seminars, visiting boards, medical councils, meetings, etc .;
Organization of outreach assistance to rural residents.
In everyday practice, the role of analytical activity increases significantly, its quality level rises based on the use of modern technologies collection and processing of statistical data, transmission of medical information, methods of analysis, justification and formation of strategies.
Recently, the requirements for the organization of planned work have been significantly increased on the basis of a more complete consideration of the influence of environmental factors, the conditions for the functioning and development of the industry, and the forecast of the most probable prospects. Are increasing strategic components planning. Plans current activities are built in accordance with the directions for the implementation of strategic goals. A system of plans is being formed that unites 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 are developed for assessing the effectiveness of the implementation of planned activities, used for their implementation of management mechanisms.
The need to intensify the treatment and diagnostic process requires the improvement of innovative activities in health care authorities and institutions, its organization on the basis of today's ideas about marketing, business planning of innovations, organizational forms ah and methods of implementation.
An increase in the level of medical and preventive and consultative and diagnostic assistance to the rural population in modern conditions provides for the strengthening of the material and technical base and human resources rural health care, the development of an optimal model of medical care for the rural population in health care institutions at various stages of medical care and, as an additional measure, the use of targeted forms of medical care.
Thus, one of the most important functions of a health management body is delegated to health care institutions (republican, regional, regional hospitals, central district hospitals) - the development of draft plans for the activities of the subordinate health care system, organization, control and assessment 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 methodological departments of healthcare institutions of these levels and fully corresponding to their areas of competence, are planned independently, and the procedure for adopting the plan reflects the procedure regulated for the hospital departments.
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 activities for the planned period of time, establishes specific performers and provides for resource, including financial, support for planned activities, its size and sources of investment ...
The plan consists of a main part and appendices.
The main part of the plan includes sections:
1. Development of the material and technical base of health care.
2. Training and professional development of personnel.
3. Preventive work.
4. Organization of identification of socially significant pathology.
5. Improvement of diagnostic, medical, rehabilitation assistance and the introduction of modern technologies.
6. Sanitary and hygienic education.
7. Scientific research.
8. Control over 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 health care 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 strategic development health care for the future period.
A list of the main planned indicators (benchmarks) and justification of the likelihood of their achievement in the planning period.
Draft regulatory documents required for the implementation of planned activities.
Projects of new targeted comprehensive programs to address interdepartmental problems.
1. Development of the material and technical base of health care
The section on the development of the material and technical base of health care covers measures to strengthen and maintain the fixed assets of health care institutions (buildings, vehicles, supply systems, technical and medical equipment, inventory), as well as a list of measures to implement the strategy for restructuring the health 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, premises;
Landscaping works;
Development of the vehicle fleet;
Technical re-equipment and renewal of outdated equipment, etc.
The second subsection can include activities for:
Elimination (re-profiling) of low-power hospitals that are not staffed with medical personnel, poorly equipped medical institutions;
Strengthening the outpatient-polyclinic link based on the opening of new institutions, offices, receptions, the development of new forms of service in polyclinics;
The introduction of hospital-replacing technologies (day hospitals, hospitals day stay, hospitals at home);
Differentiation of bed capacity according to the intensity of the diagnostic and treatment process, the creation of beds (departments) for nursing care, hospices, the formation of institutions or departments of a medical and social nature.
Specification of planning targets must be carried out in accordance with the strategic goals of the regional and municipal health care systems, aimed at reorienting medical care from the inpatient to the polyclinic level. Attention should be paid to the feasibility of not only strengthening, but also modernizing the diagnostic, laboratory and rehabilitation facilities of outpatient clinics, opening specialized offices for the profiles of medical specialties that correspond to the real needs of the population, and changing the nature of the activities of existing offices in accordance with the introduction of new medical technologies. services (outpatient surgery, day specialized hospitals, preventive units, etc.).
The urgency of the problem of supplying medical institutions consumables also substantiates the feasibility of reflecting the methods of its solution in planning documents.
2. Training and professional development of personnel
This section of the Plan includes a list of the main activities for the training of medical personnel and other health care professionals (economists, accountants, medical equipment maintenance technicians, etc.):
Targeted training of specialists based on targeted orders from regional and municipal authorities management;
Professional development of employees at central bases, in the system of GIDUVov, in foreign medical centers and other on-the-job educational institutions;
Continuing education on the job at cyclic, intermittent, part-time courses, seminars;
Conducting medical and nursing conferences, congresses, meetings;
Organization of competitions by profession;
Participation in the organization of the work of scientific societies.
Work on personnel training is planned by organizational and methodological departments in agreement with health personnel services in the region (municipality).
3. Preventive work
Planning preventive work provides for the formation of a list of activities for the following subsections:
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 state sanitary and epidemiological supervision authorities in accordance with the current instructions and methodological recommendations according to the established schedule.
4. Organization of identification of socially significant pathology
Measures to organize the identification and clinical examination of the population 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 dispensary observation;
Accelerated clinical examination of persons with identified pathology;
Practical assistance of regional (district) institutions in the survey of 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. Improvement of diagnostic, medical, rehabilitation assistance and the introduction of modern technologies
The main directions of organizational measures 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 (divisions), as well as during visits to subordinate institutions health care;
Regulation of taking on dispensary observation and control of contingents of dispensary patients;
Organization of centralized control over the correctness of registration of death certificates.
Planning can be carried out by objects subject to control (institutions, services, departments, specialists), by forms of control (conducting an expert assessment of medical documentation), by 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, for hospital-replacing technologies), according to the activity of medical intervention (surgical treatment), according to the results (restoration of patients' working capacity, timeliness of referral to MSEC) and in the context of other performance indicators.
The implementation section covers modern technologies for prevention, diagnosis, treatment, rehabilitation, to be introduced into the activities of healthcare institutions and the corresponding organizational measures for implementation.
6. Sanitary and hygienic education
Activities covering hygiene education may include:
Creation, distribution, control of activities, development of various organizational forms of sanitary education of the population - "Health Universities", "Health Schools" in polyclinic institutions, "Convalescent Schools" for inpatients;
Preparation of a profiled sanitary asset for caring for patients at home, primarily from among relatives;
Using various forms of mass dissemination of hygienic knowledge among the population (appearances in the media, organizing exhibitions, publishing educational materials);
Arranging meetings with health workers(lectures, talks, explanations, recommendations);
The spread of modern forms of attracting the population to healthy way life.
7. Scientific research
The planning of research topics is carried out in accordance with applied tasks practical health care, which may include certain issues of public health, the provision of medical care and the development of strategically important directions for the development of the regional (municipal) health care system.
The process of preparing the draft plan and the procedure for its adoption
The plan is developed with the participation of the main specialists of the corresponding level and, upon completion of the development, is endorsed by them. The purposefulness of plans and the effectiveness of planning tasks depend on the correct setting of goals, the choice of strategies for achieving them, and the concentration of efforts on the selected priorities.
Regional priorities for the development of medical care for the population are determined in accordance with the directions of state policy in the field of public health, taking into account regional characteristics and resource opportunities. Despite the regional differences in most constituent entities of the Russian Federation, the main directions are similar - tuberculosis; HIV AIDS; diabetes; vaccine prophylaxis; safe motherhood and childhood.
The plan of organizational and methodological work of the republican, regional, regional hospital, CRH is a structural component of a unified plan for the development of regional (municipal) health care, which defines a hierarchical system of long-term and current planning of the activities of governing bodies and health care institutions of the region (municipality).
The procedure for adopting 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's work, progress in the implementation of target programs over the past period. The regulations of the procedure for adopting the plan provide for the obligatory participation in the discussion of representatives of the apparatus of the health management body of the corresponding level, and for the CRH - representatives of the district administration. The optimal level of hearing for regional institutions is the board of the health authority if the plan concerns only medical activities, and the regional government if the plan is comprehensive.
After discussion, the comprehensive plan is approved by the head (deputy) of the administration of the corresponding level, and if the plan is intradepartmental, then by the head of the relevant health management body. The approved plan is a binding document.
Monitoring the implementation of the plan
The current control by quantitative and qualitative criteria for the implementation of the plan is carried out by the organizational and methodological department (office) of the organization that made it.
The sections of the plan, which provide a list of activities, the levels of their execution, terms, responsible persons, the dates of the planned execution, it is advisable to supplement the columns for, dates of actual execution and the costs of their implementation. For control, use the data of the state statistical reporting... It is verified on the spot by the district curators during planned trips.
The transparency of the activity is ensured by the simultaneous public hearing of the curator and the persons responsible for carrying out the planned events.
It is methodologically more effective to hear not one district on the maximum possible number of questions, but several districts on one question. This allows you to diversify the problem and choose the optimal approaches to its solution, arising from the accumulated practical experience.
An important control tool is a six-month (depending on the importance of the issue) interim hearing of the implementation of the plan in the health administration apparatus of the region and the administration of the territory.
Examples of particular questions of the hearing are the following:
Organization and effectiveness of examinations of the population and medical examination;
Treatment of patients with chronic diseases;
Anti-epidemic measures;
On the role of regional institutions as organizational and methodological centers;
Information about teaching aids;
Analysis of the work of institutions, etc.
Final report on the implementation of the plan
The final report on the implementation of the plan is drawn up either in a tabular or in a descriptive form according to its sections and includes the following headings:
Planned tasks to be solved;
Baseline indicators at the beginning of the planning period;
Activities carried out (a, b, c, etc.);
Results of the current year;
Efficiency mark.
According to the report, an explanatory note is drawn up with an analysis of the results achieved, and in the absence or insufficient effectiveness measures taken with an analysis of the causes, a critical assessment of defects in the conduct of activities and possible measures to improve their quality.
A report on the implementation of measures according to the plan of organizational measures by the departments of the institution that supervise the subordinate medical and preventive institutions is provided at the request of the organizational and methodological department (office) on time according to the profile of the department, indicating the performers in the following aspects:
Preparation of questions for hearing at meetings, collegiums of the management apparatus (planned / unscheduled, level);
Writing business surveys on the profile of departments;
Issue of teaching materials on the supervision area (which ones);
Pedagogical work (courses, seminars, lectures, individual training of specialists);
Business trips to supervised territories (where, purpose, duration, planned / unscheduled, brigade / individual, what assistance was provided);
Participation in meetings, conferences, conventions, etc. (what, the topic of the speech, the level of regional, interregional, international).
When analyzing the progress of the plan, they strive not so much to formulate new tasks as to determine the effectiveness of already known approaches to solving the set ones.
The publication has been prepared on the basis of guidelines"Planning of organizational and methodological work and organization of field assistance to medical and preventive institutions" dated 15.10.2002 N 2002/107.
MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
CENTRAL RESEARCH INSTITUTE
ORGANIZATIONS AND INFORMATIZATION OF HEALTH CARE
APPROVED
First Deputy Minister
A.I. VYALKOV
15.10.2002 N 2002/107
GUIDELINES
PLANNING OF ORGANIZATIONAL - METHODOLOGICAL WORK
AND ORGANIZATION OF OUTCOMING ASSISTANCE THERAPEUTIC -
PREVENTIVE INSTITUTIONS
These guidelines present methodological approaches to the planning of organizational and methodological work in the main areas of public health protection and the organization of outbound medical care that have been tested in the administrative territories of Russia.
The proposed approaches can be used by employees of regional institutions providing organizational and methodological assistance to medical and preventive institutions of administrative territories, as well as by heads of public health services at the municipal level, including chief doctors of the Central District Hospital.
The recommendations can be used in the organization of the pedagogical process in the preparation of health care organizers and in the advanced training of management personnel, primarily specialists in organizational and methodological work.
Organization - developer:
Central Research Institute for Organization and Informatization of Health Care of the Ministry of Health of the Russian Federation.
Authors:
Doctor of Medical Sciences, Prof., Corresponding Member RAMS V.I. Starodubov, Doctor of Medical Sciences, Prof. Yu.V. Mikhailova, Doctor of Medical Sciences, Prof. R. A. Khalfin, Ph.D. T. A. Siburina, MD Yu.A. Korotkov, D.Med.Sc., prof. A.A. Kalininskaya, Ph.D. T. I. Eremicheva, Ph.D. V. A. Magnitsky, Ph.D. S. I. Shlyafer, Ph.D. V.K. Popovich, MD 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 healthcare has changed significantly over the past decade. The reforms have expanded the economic independence of the heads of medical and preventive institutions. The importance of organizational and methodological work in organizing and improving the quality of the treatment and diagnostic process is growing. Reorganization of the management of organizational and methodological activities in accordance with the main strategic directions of the industry development becomes extremely urgent.
In accordance with the Concept for the development of healthcare and medical science in the Russian Federation, further improvement of organizational and methodological work in healthcare is aimed at:
- improving the quality of medical care for the population, strengthening the preventive component in the activities of health care institutions;
- ensuring state guarantees in the provision of qualified medical care to the rural population on the basis of strengthening primary health care and the development of mobile forms of medical care;
- increasing the efficiency of resource use, the formation of rational systems of phased medical care and the introduction of resource-saving technologies;
- expanding the influence of health care on the formation and implementation of state policy in the field of public health protection at all levels of government;
- coordination of interaction of various services and departments in solving complex medical and social problems.
The implementation of the goals set will require significant changes in the organizational and methodological work, which is an integral part of the management activities of the regional and municipal health care management system.
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 development of the health care system of the corresponding administrative territory, the state of health of the population, the medical and demographic situation and other environmental factors that affect the level of health of the population;
- organization and improvement of the system of accounting and reporting on the activities of governing bodies and health care institutions, the results of functioning, the dynamics of the state of health of the population;
- development of long-term and current plans for the activity of the health care system of the administrative territory, target programs in priority areas of development, organization of their implementation, control and assessment of the effectiveness of implementation;
- organization and conduct of targeted inspections, expert assessment of the activities of individual services and health institutions with on-site visits by experts and the provision of organizational, methodological and advisory assistance;
- determination of the need for medical personnel in various forms of continuous training, planning, together with the personnel services of health authorities, work to improve the qualifications of medical workers, organizing and holding conferences, seminars, visiting boards, medical councils, meetings, etc.;
- organization of outreach assistance to rural residents.
In everyday practice, the role of analytical activity is significantly increasing, its quality level is increasing through the use of modern technologies for collecting and processing statistical data, transferring medical information, methods of analysis, justification and formation of strategies.
Recently, the requirements for the organization of planned work have been significantly increased on the basis of a more complete consideration of the influence of environmental factors, the conditions for the functioning and development of the industry, and the forecast of the most probable prospects. The strategic components of planning are being strengthened. The 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 unites 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 are developed for assessing the effectiveness of the implementation of planned activities, used for their implementation of management mechanisms.
The need to intensify the treatment and diagnostic process requires the improvement of innovative activities in health care authorities and institutions, its organization on the basis of today's ideas about marketing, business planning of innovations, organizational forms and methods of implementation.
The increase in the level of medical and preventive and consultative and diagnostic assistance to the rural population in modern conditions provides for the strengthening of the material and technical base and human resources of rural health care, the development of an optimal model of medical care for the rural population in health care institutions at various stages of medical care and, as an additional measure, the use of special-purpose mobile forms of medical care.
Thus, one of the most important functions of a health management body is delegated to health care institutions (republican, regional, regional hospitals, central district hospitals) - the development of draft plans for the activities of the subordinate health care system, organization, control and assessment 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 methodological departments of healthcare institutions of the indicated levels and fully corresponding to their areas of competence, are planned independently, and the procedure for adopting the plan reflects the procedure regulated for the hospital departments.
Description (formula) of the method: an improved planning system is proposed for the organizational and methodological work of the regional health care facilities and the central district hospital, 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 control over implementation.
CONTENT AND STRUCTURE
PLAN FOR ORGANIZATIONAL - METHODOLOGICAL WORK
The plan of organizational and methodological work (hereinafter PLAN) is a list of specific tasks, determines the order, timing, sequence of activities for the planned period of time, establishes specific performers and provides for resource, including financial, support for planned activities, its size and sources of investment.
The plan consists of a main part and appendices.
The main part of the plan includes sections:
1. Development of the material and technical base of health care.
2. Training and professional development of personnel.
3. Preventive work.
4. Organization of identification of socially significant pathology.
5. Improvement of diagnostic, medical, rehabilitation assistance and the introduction of modern technologies.
6. Sanitary and hygienic education.
7. Scientific research.
8. Control over 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 health care 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 health care for the long term.
- A list of the main planned indicators (benchmarks) and justification of the likelihood of their achievement in the planning period.
- Draft regulatory documents required for the implementation of planned activities.
- Projects of new targeted comprehensive programs to address interdepartmental problems.
1. Development
material and technical base of health care
The section for the development of the material and technical base of health care covers measures to strengthen and maintain the fixed assets of health care institutions (buildings, vehicles, supply systems, technical and medical equipment, inventory), as well as a list of measures to implement the strategy for restructuring the health care system.
As the main activities for the first subsection, the following can be planned:
- construction of new institutions, buildings;
- carrying out major and current repairs of buildings, premises;
- work on the improvement of the territory;
- development of the vehicle fleet;
- technical re-equipment and renewal of outdated equipment, etc.
The second subsection can include activities for:
- liquidation (re-profiling) of low-power hospitals that are not staffed with medical personnel, poorly equipped, medical institutions;
- strengthening the outpatient-polyclinic link based on the opening of new institutions, offices, receptions, the development of new forms of service in polyclinics;
- introduction of hospital-replacing technologies (day hospitals, day 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.
Specification of planning targets must be carried out in accordance with the strategic goals of the regional and municipal health care systems, aimed at reorienting medical care from the inpatient to the polyclinic level. Attention should be paid to the feasibility of not only strengthening, but also modernizing the diagnostic, laboratory and rehabilitation facilities of outpatient clinics, opening specialized offices for the profiles of medical specialties that correspond to the real needs of the population, and changing the nature of the activities of existing offices in accordance with the introduction of new medical technologies. services (outpatient surgery, day specialized hospitals, preventive units, etc.).
The urgency of the problem of supplying medical and prophylactic institutions with consumables also justifies the feasibility of reflecting the ways to solve it in planning documents.
2. Training and professional development of personnel
This section of the Plan includes a list of the main activities for the training of medical personnel and other health care professionals (economists, accountants, medical equipment maintenance technicians, etc.):
- targeted training of specialists based on targeted orders from regional and municipal authorities;
- advanced training of employees at central bases, in the GIDUV system, in foreign medical centers and other educational institutions with a break from production;
- advanced training on the job at cyclic, intermittent, full-time - correspondence courses, seminars;
- holding medical and nursing conferences, congresses, meetings;
- organization of competitions by profession;
- participation in the organization of the work of scientific societies.
Work on personnel training is planned by organizational and methodological departments in agreement with health personnel services in the region (municipality).
3. Preventive work
Planning of preventive work provides for the formation of a list of measures for the following subsections:
- 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 state sanitary and epidemiological supervision authorities in accordance with the current instructions and methodological recommendations according to the established schedule.
4. Organization of identification of socially significant pathology
Measures to organize the identification and clinical examination of the population with socially significant diseases (tuberculosis; HIV / AIDS; sexually transmitted diseases (STDs); various forms of drug addiction; mental disorders) include:
- an annual survey of the contingents subject to periodic examinations and dispensary observation;
- accelerated clinical examination of persons with identified pathology;
- practical assistance of regional (district) institutions in the survey of 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. Improvement of diagnostic, therapeutic,
rehabilitation assistance and the introduction of modern
technologies
The main directions of organizational measures 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 (divisions), as well as during visits to subordinate healthcare institutions;
- regulation of taking on dispensary observation and control of contingents of dispensary patients;
- organization of centralized control over the correctness of execution of death certificates.
Planning can be carried out by objects subject to control (institutions, services, departments, specialists), by forms of control (conducting an expert assessment of medical documentation), by 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, for hospital-replacing technologies), according to the activity of medical intervention (surgical treatment), according to the results (restoration of patients' working capacity, timeliness of referral to MSEC) and in the context of other performance indicators.
The implementation section covers modern technologies for prevention, diagnosis, treatment, rehabilitation, to be introduced into the activities of healthcare institutions and the corresponding organizational measures for implementation.
6. Sanitary and hygienic education
Activities covering hygiene education may include:
- creation, distribution, control of activities, development of various organizational forms of public health education - "Health Universities", "Health Schools" in polyclinic institutions, "Schools for convalescents" for inpatients;
- preparation of a profiled sanitary asset for caring for patients at home, primarily from among relatives;
- the use of various forms of mass dissemination of hygienic knowledge among the population (appearances in the media, organizing exhibitions, publishing educational materials);
- organization of meetings with medical professionals (lectures, conversations, explanations, recommendations);
- the spread of modern forms of attracting the population to a healthy lifestyle.
7. Scientific 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, the provision of medical care and the development of strategically important directions for the development of the regional (municipal) health care system.
The process of preparing the draft Plan and its procedure
adoption
The plan is developed with the participation of the main specialists of the corresponding level and, upon completion of the development, is endorsed by them. The purposefulness of plans and the effectiveness of planning tasks depend on the correct setting of goals, the choice of strategies for achieving them, and the concentration of efforts on the selected priorities.
Regional priorities for the development of medical care for the population are determined in accordance with the directions of state policy in the field of public health, taking into account regional characteristics and resource opportunities. Despite the regional differences in most constituent entities of the Russian Federation, the main directions are similar - tuberculosis; HIV AIDS; diabetes; vaccine prophylaxis; safe motherhood and childhood.
The plan of organizational and methodological work of the republican, regional, regional hospitals, CRH is a structural component of a unified plan for the development of regional (municipal) health care, which defines a hierarchical system of long-term and current planning of the activities of governing bodies and health care institutions of the region (municipality).
The procedure for adopting 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's work, progress in the implementation of target programs over the past period. The regulations of the procedure for adopting the plan provide for the obligatory participation in the discussion of representatives of the apparatus of the health management body of the corresponding level, and for the CRH - representatives of the district administration. The optimal level of hearing for regional institutions is the board of the health authority if the plan concerns only medical activities, and the regional government if the plan is comprehensive.
After discussion, the comprehensive plan is approved by the head (deputy) of the administration of the corresponding level, and if the plan is intradepartmental, then by the head of the relevant health management body. The approved plan is a binding document.
8. Control over the implementation of the plan
The current control by quantitative and qualitative criteria for the implementation of the plan is carried out by the organizational and methodological department (office) of the organization that made it.
The sections of the plan, which provide a list of activities, the levels of their execution, terms, responsible persons, the dates of the planned execution, it is advisable to supplement the columns for, dates of actual execution and the costs of their implementation. For control, data from state statistical reporting are used. It is verified on the spot by the district curators during planned trips.
The transparency of the activity is ensured by the simultaneous public hearing of the curator and the persons responsible for carrying out the planned events.
It is methodologically more effective to hear not one district on the maximum possible number of questions, but several districts on one question. This allows you to diversify the problem and choose the optimal approaches to its solution, arising from the accumulated practical experience.
An important control tool is a six-month (depending on the importance of the issue) interim hearing of the implementation of the plan in the health administration apparatus of the region and the administration of the territory.
Examples of particular questions of the hearing are the following:
- organization and effectiveness of examinations of the population and medical examination;
- treatment of patients with chronic diseases;
- carrying out anti-epidemic measures;
- about the role of regional institutions as organizational and methodological centers;
- information about teaching aids;
- analysis of the work of institutions, etc.
Final report on the implementation of the plan
The final report on the implementation of the plan is drawn up either in a tabular or in a descriptive form according to its sections and includes the following headings:
- planned tasks to be solved;
- initial indicators at the beginning of the planning period;
- the activities carried out (a, b, c, etc.);
- the results of the current year;
- efficiency mark.
According to the report, an explanatory note is drawn up 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 implementation of measures and possible measures to improve their quality.
A report on the implementation of measures according to the plan of organizational measures by the departments of the institution that supervise the subordinate medical and preventive institutions is provided at the request of the organizational and methodological department (office) on time according to the profile of the department, indicating the performers in the following aspects:
- preparation of questions for hearing at meetings, collegiums of the management apparatus (planned / unscheduled, level);
- writing business surveys on the profile of divisions;
- Issue of teaching materials on the supervision area (which ones);
- pedagogical work (courses, seminars, lectures, individual training of specialists);
- business trips to supervised territories (where, purpose, duration, planned / unscheduled, brigade / individual, what assistance was provided);
- participation in meetings, conferences, congresses, etc. (what, the topic of the speech, the level of regional, interregional, international).
When analyzing the progress of the plan, they strive not so much to formulate new tasks as to determine the effectiveness of already known approaches to solving the set ones.
Organizational and methodological assistance to institutions
health care
Organizational and methodological activities are carried out by the leading (head) institutions of the federal, regional and district levels of health care and it consists in providing practical assistance to supervised services and health care institutions in a wide range of issues related to the organization and improvement of the quality of the treatment and diagnostic process, improvement of prevention, technological improvement of activities , optimization of management, including increasing the level of planning.
Institutions of federal subordination provide planned assistance primarily to institutions of the regional level, but, if necessary, at the district level. Leading institutions of the regional level provide organizational and methodological assistance to municipal institutions, practically help both the Central District Hospital (inter-district centers) and primary health care institutions.
Diagnostic, therapeutic and rehabilitative medical care for patients who apply to institutions are regulated by the job descriptions of the relevant departments and the internal regulations of the institution. The organizational action plan coordinates organizational, methodological and practical assistance provided by employees of all departments of the institution to supervised institutions both directly at the institution and during field visits. It outlines the range of responsibilities for the performance of the department's own work (cabinet).
The organizational and methodological department (office) of the leading (head) health care facility is designed to solve mainly three large blocks of tasks:
1. Formation of commissions and mobile teams from the staff of the institution. Organization of planned trips of curators and teams of curators to areas of territories, inter-district centers for organizational, methodological, advisory and practical assistance; listening to their reports, taking into account the work done, creating and maintaining a regional card index of recommendations in working order.
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 control the progress of 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 (together 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. Drawing up a summary annual report, its analysis, execution of conclusions based on the results of work, market surveys, collections of the main indicators of the work of medical institutions and public health (with the participation of leading experts).
Organization of outbound medical care for residents
rural areas
The low density of the rural population, employment with personal subsidiary plots, the seasonality and urgency of the main agricultural work, the remoteness of medical (especially specialized) care from the places of residence of patients, the weak development of transport communications at significant distances, the high cost of travel - all this reduces the level of appeal and hospitalization of the rural population ...
Unsatisfactory working conditions in the agricultural sector, in most industries not meeting sanitary hygiene requirements due to non-observance of sanitary norms and rules, they contribute to the occurrence of diseases, which, with low detection and insufficient treatment, leads to the development of neglected cases, chronicity of pathology, high mortality of the population. More often than in cities, brucellosis, intestinal infections, diseases of the musculoskeletal system, respiratory diseases (dust bronchitis), vibration disease are encountered in the countryside. Hence follows the need to activate field forms of organizational, advisory and practical assistance from regional and inter-district institutions. At the same time, 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 when leaving, and irregular working hours.
Emergency and urgent care for patients with complex pathologies, in particular, requiring surgical interventions, is provided year-round by the emergency and planned consultative department of regional (regional, republican, district) hospitals or the Center for Disaster Medicine by means of medical aviation (plane, helicopter) or fixed vehicles. 27% of rural residents in the population account for more than 67% of patients served by air ambulances. The average republican indicator is 1.7 departures per 1000 rural population, the maximum level reaches 4.4.
Routine assistance is provided to specialists from the Central Regional Hospital, physicians - curators, specialists from hospitals and consultative polyclinics of the constituent entities of the Russian Federation.
To provide assistance to rural health care facilities, by order of the regional health care governing body, both full-time and freelance specialists of regional (regional, republican) institutions - hospitals (adults and children), maternity hospitals, dispensaries, centers for the fight against AIDS and medical prevention are assigned to district and city health care facilities , State Sanitary and Epidemiological Supervision, as well as interdistrict diagnostic and treatment centers.
The volume and nature of planned assistance to health care institutions 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 departments of emergency and planned - advisory assistance 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 posts, nursing hospitals, and district ambulance stations.
The content of the assistance provided by regional institutions to district ones is:
- coordination of health care management;
- implementation of strategic decisions of the health management apparatus;
- systematization of the organizational and methodological work of municipal health care systems;
- practical assistance to the management and specialists of the Central Regional Hospital, other institutions of the municipal level;
- strengthening of intradepartmental quality control of medical care;
- strengthening of expert work at all levels;
- holding seminars, etc.
The main tasks of the curators when traveling to the districts are to determine how the agreements between the administration of the municipality and the regional health authority in the field of public health are being implemented; decisions of the collegiums and orders; how the security regime is observed in the district health care facility. The curator provides organizational and methodological assistance and implements standards of medical care, organizes control over their observance.
The chief specialists of the regional institutions should introduce modern technologies and disseminate best practices. In addition to the visits of chief specialists, the supervision of rural health care facilities is carried out by specialists from 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 used by institutions of regional subordination to medical and preventive institutions of districts. The division of the assistance provided by type is conditional. We can only talk about the prevalence of one or another component: expert - consultative, organizational - methodological, or directly practical participation in the treatment - diagnostic process.
Advisory assistance on diagnostics, treatment and rehabilitation of patients is provided in the outpatient clinics of the Central District Hospital, in local hospitals, at home, in a 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 consulting work in all districts of the region and part of local hospitals. In the Stavropol Territory, on the basis of interdistrict surdocabinets and in large CRHs, mobile teams of specialists from the centers of audiology, hearing aids and phoniatrics of the clinical hospital work.
Organizational and methodological assistance is provided by the main full-time and freelance specialists of the regional (regional, republican, district) level. The most experienced, highly qualified specialists are involved in field work.
On the instructions of the administrative apparatus of the region (region, republic, district), in the course of preparing medical councils, visiting boards, meetings, conferences, the quality of medical care for the rural population is monitored. municipal institutions(CRH, UB, FAPah); the material - technical and personnel potential, the possibility of licensing the services of the Central District Hospital is being studied; the results of responding to complaints from the population are monitored. In parallel, methodological assistance is also provided.
Mobile hospital medical councils with the participation of the heads of administrations and the medical community of the districts justify themselves, at which the results of an expert assessment of the activities of the district services according to a unified method are discussed, as well as consultative reception of patients by specialists of regional institutions is organized.
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, offsite conferences are held, incl. scientific - practical, seminars, meetings.
In the course of providing mainly practical assistance, comprehensive, targeted, preventive examinations and medical examinations of the population are organized, expeditionary trips are carried out. CRH specialists monthly examine the population served by local 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 the period of field work in the countryside, field camps are assigned mobile teams for preventive examinations of machine operators, field growers, sanitary and educational work to prevent injuries, poisoning, and infectious diseases.
Teams of doctors from the Perinatal
center of Lipetsk region for examination of women of fertile age with
risk factors and pregnant women.
Elective surgical operations, incl. outpatient, selection of patients for further examination and treatment in adult and children's regional institutions.
Possible forms of field work:
- individual visits of specialists are often unscheduled - at the request of the municipal health care facility; the practice of urgently calling the necessary specialists at the request of the head physician of the institution is expanding at the expense of the receiving party;
- departures of teams of 2-5 specialists (adults and children), who are preferred when planned work as they are more cost-effective compared to individual trips; in the structure of departures - brigade 77% versus 23% - individual;
- mobile (field) outpatient clinics (polyclinics): the teams formed in their structure serve adult patients and children in accordance with the plan approved by the chief physician and agreed with the territorial health authorities.
This form of service to the population has become firmly established. A team of 5-7 specialists is recruited taking into account the wishes of the districts and works on average for four days (the first and fourth - in the Central Regional Hospital, one each - in the 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 outbound assistance; participation in interdistrict conferences, seminars, meetings - 6%; educational and methodological assistance - 4%; on the instructions of the main department of health care - 2.2%; complex inspections - 1.75%; licensing of health care facilities - 1.3%. Single trips - 33.8%. The share of visits by chief freelance specialists was 6.2%.
On average, the number of field teams consists of 5-6 people: specialists in therapeutic, surgical, pediatric, obstetric - gynecological, paraclinical profiles, organizational and methodological work, neurologist, ophthalmologist. The composition of the brigade of specialists is staffed taking into account the interests of the region, if necessary, it is expanded at the expense of other specialists, in particular phthisiatricians, dermatovenerologists, etc.
In preparation for the 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 - polyclinic care, in particular to the rural population, by levels (regional institutions, CRH, rural medical outpatient clinics); assessment of the staffing of doctors and nursing staff, their qualifications.
In the regions of the region, before the arrival of the brigade, a flow of patients is formed, mainly of the dispensary group, as well as groups for receiving operational assistance from an ophthalmologist, traumatologist, oncologist at the rate of 2-3 - operations for departure. It is necessary to equip leaving teams with equipment for examining and treating adults and children.
During the trip, patients are examined in the central regional hospital, and, if necessary, at FAPs, in rural medical outpatient clinics and district hospitals.
The duration of a business trip varies from several hours to 10 days, averaging 2.4 days. According to the data of the Samara region, each specialist in two days of work has the opportunity to consult from 30 to 50 people. At the same time, according to the data of the Republic of Khakassia, a consultation with an on-site team specialist costs 2.5 times more than a consultation with the same specialist, but in an advisory clinic.
The practice of replacing for a long time (from 7 to 35 days) absent CRH specialists, mainly of a surgical profile (vacation, study, specialization), is finding more and more widespread use.
Workers of the Central District Hospital, according to the plan and schedule, provide assistance to the population assigned to district hospitals, medical outpatient clinics, and FAPs. The teams are staffed with doctors from the Central District Hospital in such a way as to provide from 6 to 12 visits to the rural area per year; most often they include a pediatrician, gynecologist, therapist, and neurologist. During the visits, the specialists of the Central Regional Hospital provide, first of all, consultative assistance, first of all, to pregnant women and children. The number of consultations usually ranges from 25 to 30 per visit.
Special attention is required for dispensary observation of patients with peptic ulcer, diabetes mellitus, gastritis, nephritis, rheumatic heart diseases, rheumatoid arthritis, etc. The purposeful departure of the team 2-3 times a year allows you to inspect almost the entire dispensary group. During the trip, patients are also selected for therapeutic and surgical treatment in the Central Regional Hospital and in regional institutions, and in some cases, practical assistance is provided directly on the spot. The work of rural medical workers is analyzed without fail, the course of dispensary observation, the course of treatment after the previous consultation is 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 CRH, contributes to the development of "Internet" technologies. The promising importance of this area for health care is undoubtedly, although the organizational experience of its implementation and use is only accumulating.
It is also possible such a form of work as field feldsher posts, in order to ensure that in sparsely populated areas, patients are monitored in hospitals at home, and to deliver the necessary medicines to patients.
When assessing the nature and volume 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: guidelines, information letters, collections of health and performance indicators, bulletins; preparation of reference materials at the request of higher organizations; information for health education of the population and patients through the media, incl. nosocomial, using special stands;
b) consultative receptions and participation in preventive examinations of the population separately for adults and children, separately according to the specialists involved in providing assistance, regions and the number of visits; the number of those examined with instrumental methods (endoscopy, ultrasound, ECG, etc.) is also taken into account.
The technical report of specialists is drawn up in sections:
- viewed everything;
- of them, the sick were identified;
- incl. with a diagnosis established for the first time in his life;
- outpatient treatment is recommended at the place of residence;
- inpatient treatment is recommended at the place of residence;
- sent to regional polyclinics for additional examination;
- sent to regional polyclinics for dispensary registration;
- sent to regional hospitals.
Effectiveness of using the method
The recommendations are a generalization of the experience of organizational, methodological and field work in 42 administrative territories of the Russian Federation and the Southern Regional Medical Center of the Ministry of Health of the Russian Federation with 24 branches.
In the course of the analysis, it was 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 qualifying the staff of organizers - methodologists is urgent. Its appearance is associated both with defects in basic training and improvement, and with a lack of information and methodological materials in the specialty.
Serious objective difficulties in organizing field assistance to municipal and regional institutions are aggravated by the organization's shortcomings, in particular, insufficient continuity of field work by specialists from regional institutions of various profiles due to imperfect coordination of their activities in the regions.
Revealed significant reserves for improving organizational work. So, if on average 0.48% of the financial support of the institution is spent on organizational and methodological work, then in a number of territories the funding is much higher (almost twice), indicating the recognition of the importance 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 indicative level of service to the rural population by air ambulance has been established; suggestions were made on the formation of field teams, the duration of field work.
All this makes it possible to improve the quality, efficiency and availability of medical care, primarily for the rural population.
Thus, a team of 6 specialists from the State Healthcare Institution of the Voronezh Regional Clinical Hospital No. 1 is scheduled to travel once a week in a Gazel truck for a distance of 50 to 300 km on average for one day. With the remoteness of the area, the duration of a business trip is determined by the time spent on the road and the amount of work to be done.
Multidisciplinary teams of an average 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 distance of 500 km to the subordinate medical and preventive institutions of the Azov - Volga - Don water basin to provide planned consultations for an average of 2 days.
Appendix N 1
FOLDER OF THE CURATOR OF MUNICIPAL INSTITUTIONS AND AREAS
ADMINISTRATIVE TERRITORIES
The dossier for municipal and regional health care institutions includes sections:
1. Assessment of the health of the population of the city, district.
The section contains information on the demographic situation in the region, indicators of the activities of the municipal health management body; indicators of the activities of the municipal health management body according to the data of the annual report. Materials of previous checks, recommendations. Written appeals from citizens.
2. Material and technical base.
Municipal health care structure. The state of institutions. Prospects for medical and technical equipment. Adaptation of the provisions of the concept of health care development at the level of the city, district.
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 foreign vehicles; checking the integrity and safety of seals and seals, locks in unused rooms.
The leasing of buildings, structures and premises of medical facilities is recorded.
Clarifies the interaction with the ATC authorities in terms of notification of cases of penetration of unauthorized persons into the territory or premises of a medical facility; identification of persons undergoing inpatient treatment, whose identity is not confirmed by documents; treatment of persons with injuries and wounds, not excluding criminal origin, to health care facilities, adjustment and briefing of the institution's duty personnel.
In case of emergencies, the round-the-clock readiness of the healthcare facility to provide assistance to victims with injuries and burns is checked, the availability of an irreducible supply of medicines and consumables; the composition, addresses and telephones of the brigades to strengthen the duty service, the procedure for alerting and collecting employees in health care facilities.
Finally, it clarifies the existence of a hospital order to limit visits of patients with relatives until 6 pm.
4. Provision of the population with doctors and nurses.
Of particular importance are the following issues: staffing of the administrative apparatus; work with a reserve; availability of job descriptions of employees (duties, rights, responsibilities); provision of housing for health workers; control of the personnel development plan (conferences, seminars, refresher courses).
5. Availability of organizing orders and control over their execution.
6. The state of fire safety (the presence of an order, a plan of fire-prevention measures, instructions, briefing, the availability of fire extinguishing means).
7. Compliance with safety measures: creation of an attestation commission for labor protection; availability of an introductory briefing journal upon hiring; instructions; measuring the resistance of the grounding loop and insulation of electrical wiring; the presence of an order for employees responsible for the electrical system; operation of the oxygen facility under pressure.
8. Work with the administration of the city, district to protect the health of the population. The effectiveness of interdepartmental commissions on socially conditioned diseases.
9. Fulfillment of decisions of the collegium of the territorial health management body.
10. Organizational and methodical work.
The section provides data on the distribution of responsibilities between officials; information support of the institution; work of the medical council; control over the execution of directive documents; indicators and analysis of the institution's activities for three years; the presence of an approved plan of the main activities of the institution for the current year with annexes (holding a medical council, medical conferences, the introduction of new technologies, the work of mobile teams); work with the recommendations of specialists from regional institutions, incl. on the implementation of the Concept for the development of healthcare in the region; control over the implementation of existing orders.
11. Compliance with the sterilization and disinfection regime in the institution.
12. Medical and preventive care.
Contains materials to evaluate:
a) the quality and availability of outpatient - polyclinic care:
- introduction of new technologies and forms of medical care (day hospitals, home hospitals, day hospital);
- work of prevention and rehabilitation departments, re-profiling of beds in district hospitals into nursing departments, for the treatment of patients for medical and social reasons, medical outpatient clinics with a day hospital; the timeliness of the transfer of patients in need of medical and social assistance to boarding houses;
- working hours of the institution; 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 treatment equipment;
- system of assistance in case of emergency conditions, hospitalization and discharge of patients;
- organization of drug supply;
- organization of intensive care for women and children, analysis of indicators of maternal and child mortality;
b) the system of control over the circulation of narcotic drugs: order, permission of the Ministry of Internal Affairs, storage, register of narcotic drugs and psychotropic substances in accordance with the requirements of the Ministry of Health of the Russian Federation; acceptance and destruction of used ampoules, work of the commission on the use of narcotic and psychotropic substances; work with special prescription forms.
13. Organization of the quality of work of ambulance and emergency medical care.
14. Organization of the work of the municipal health management body in the conditions of compulsory medical insurance and voluntary medical insurance:
- minutes of the licensing and accreditation commission, plan and implementation of recommendations;
- control of the terms and quality of treatment of the insured;
- item-by-item 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 health care facilities in the city and district.
16. The work of the clinical expert commission.
17. Work of auxiliary services (laundry, communications, transport).
18. Sanitary condition of health care institutions.
19. Conclusions and suggestions.
Note: When developing Appendix 1, the order of the Ministry of Health of the Saratov Region N 101-p dated January 20, 2001 "On the supervision of municipal health care institutions in cities and districts of the region, regional health care facilities by the Ministry of Health for 2001" was used.
Appendix N 2
REPORT
ABOUT THE PLANNED (UNSCHEDULED) DEPARTURE OF THE CURATOR (SPECIALIST)
FOR PROVIDING METHODOLOGICAL AND PRACTICAL ASSISTANCE
MUNICIPAL, DISTRICT HEALTHCARE INSTITUTIONS
1. Full name, position, place of work.
2. Date of departure.
3. Locality, institution that received assistance.
4. The purpose of the visit: the introduction of new techniques, technologies; education; practical help; conducting inspections.
5. Results: filled in in accordance with the headings of the Curator's folders within the competence of the specialist.
The nature of the help by section:
- organizational and methodological work includes the results of inspections of outpatient, inpatient institutions, emergency medical care according to statistical indicators, according to ongoing documentation, patient management standards, etc .;
- medical and consulting work - the number of consultants by age groups, industry, operations performed, manipulations, benefits is indicated;
- pedagogical work - the type of it is noted: lecture, conference, seminars, practical exercises; topic, number of participants.
6. Recommendations.
The report is drawn up in two copies and certified by the signatures of the seconded specialist and the heads of the institution that was assisted. One copy remains in the healthcare facility to implement the recommendations, the other is transferred to the organizational and methodological 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", Vasilievsky Island, Sredny prospect, 36/40
1. Organizational and methodological work is an integral part of improving the efficiency of health care facilities.
Tasks, content and methods of organizational and methodological work of health care facilities.
Methods of interaction of medical units in a multidisciplinary hospital in solving organizational and methodological problems.
Drafting comprehensive plan organizational methods of medical treatment facilities: analytical and statistical, operational, tactical.
Organizational and methodological department (office) of the healthcare facility as the headquarters of the chief physician and chief specialists.
Regulatory documents on the work of organizational and methodological departments (OMO) of health care facilities.
The content and scope of work of OMO.
Job descriptions for managers, doctors and other personnel of the medical and medical organization.
The activities of the city organizational and methodological department for the coordination of work and information support of medical institutions for the provision of high-tech medical care (HMP).
2. Modern the legislative framework in the field of health care. Federal Law of November 21, 2012 No. 323 "On the Basics of Health Protection of Citizens of the Russian Federation" and its implementation in health care facilities.
New in medical licensing.
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 office work and workflow in a medical institution.
Organization of work with documents: requirements and recommendations. Organizational and administrative documentation. Working with regulations, instructions; preparation of analytical reviews, references, materials, etc. Working with regulatory documents(orders, instructions, etc.); work with methodological and normative literature. Communicating working information to everyone structural units medical institution. Working with letters, appeals.
Organization and control over the correct completing of the archives of healthcare systems with documents, ensuring the normative terms of their storage.
4. The role of organizational and methodological departments in the accounting and reporting system 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 directions of methodological work.
The principle of the formation of the Federal standard.
The principle of forming a territorial standard.
Organization of a quality control system for the provision of medical care at all stages of the treatment and diagnostic process. Assessment of defects in the provision of medical care. Analysis of the state of the quality of medical care. Organizational and managerial issues for building a quality management system.
from 27-02-12 to 02-03-12
Format: Seminar
Town: St. Petersburg
Location: CSTI educational complex
The program contains the following questions:
1. Changes in the legislation governing the activities of medical organizations. Impact of the introduced changes on management activities... The responsibility of the manager, 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 in-house standards; participation in the planning of departments of health care facilities; coordination of plans, activities.
3. Organization of the work of the deputy chief physician for organizational and methodological work. What changes in the status and position of the deputy head? Regulations on the deputy chief physician for organizational and methodological work. Official and functional responsibilities... Regulations on the organizational and methodological department, cabinet. Organization of the work of the organizational and methodological department.
4. Organization of document circulation of a medical institution. Organization of work with documents: requirements and recommendations. Organizational and administrative documentation. Working with regulations, instructions; preparation of analytical reviews, certificates, materials, etc. Work with regulatory documents (orders, instructions, etc.); work with methodological and normative literature; work with letters, appeals.
It might be helpful to read:
- Listening in Russian lessons Reasons for the language barrier;
- International relations theory;
- Organization and regulation of labor at the enterprise;
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