Features of legal regulation of the labor of medical workers. Improving the organization of the labor of the staff of the rational organization of the activities of the medical institution personnel
"Medical Law", 2004, N 4
Features of labor regulation of medical workers
The work of the doctor at all times was honorary and respected, invaluable its importance and now, since the medical worker is responsible directly for the life and health of the patient. Therefore, it is subject to special requirements, which, in turn, are compensated by benefits and compensation. All these requirements and compensation are usually reflected in the employment contract with the employee.
In addition to the general provisions of the Labor Code of the Russian Federation, the provisions of the Fundamentals of Legislation on the Protection of Citizens of Citizens of July 22, 1993 N 5487-1 are applied on the exercise of medical activities, as well as a number of other regulatory regulatory legal documents. The main document governing the work of the physician is the employer's employer.
Conclusion of employment contract
The definition of the employment contract is given in Article 56 of the Labor Code of the Russian Federation, it states that this agreement between the employer and the employee, in accordance with which the employer undertakes to provide an employee to work on the conditioned labor function, to ensure the working conditions provided for by the Labor Code of the Russian Federation, laws and other regulatory legal legal Acts, a collective agreement, agreements, local regulatory acts containing the norms of labor law, in a timely manner and in full, to pay the employee wages, and the employee undertakes to personally fulfill the labor function defined by this Agreement, to comply with the organization of the Internal Labor Rules. The parties to the employment contract are the employer and employee.
The employment contract lies in writing, is drawn up in two copies, each of which is signed by the parties. One copy of the employment contract is transferred to the employee, another is stored with the employer. The need for a written form of the contract is due to the fact that the relationship-regulated relations are calculated for a long time, contain essential conditions for both the employee and for the employer, the change in these conditions should be agreed and mutual.
It does not rule out the possibility of labor relations in the actual assumption to work with the knowledge or on behalf of the employer or his representative, regardless of whether the employment contract was properly decorated (Article 15, 67 of the Labor Code of the Russian Federation). In the future, it is still necessary to issue labor relations in writing.
Reception for work is issued by the order (order) of the employer, published on the basis of the concluded employment contract (Art. 68 of the Labor Code of the Russian Federation). This is essentially an internal document of the Organization necessary for conducting personnel office work. Nevertheless, the order is declared an employee on a receipt for a three-day period from the date of signing the employment contract. The employee is also entitled to demand issuing it properly certified copy of the order (orders).
Essential conditions of employment contract
The considerable terms of the contract are the conditions for the subject of the contract, the conditions mentioned in the law or other legal acts as significant or necessary for the contracts of this species, as well as all those conditions regarding which an agreement should be reached on the application of one of the parties. This concept is borrowed from civil law (Art. 432 of the Civil Code of the Russian Federation).
When considering the essential conditions of the employment contract, it should be difficult at the differences of employment contracts from civil-related closers in content to labor (contract contract, compensated service, commission, agency, etc.).
The search for differences between labor contracts and civil law is relevant, because Often the employer is trying to replace the work agreement with the last work, especially when taking temporary work. The employee is also regarded by such an agreement. The consequences of the conclusion of civil law contract are somewhat different than when concluding an employment contract. For example, according to paragraph 3 of Art. 238 of the Tax Code of the Russian Federation, when calculating the amount of a single social tax to the tax base (in terms of the tax amount payable to the Social Insurance Fund), any remuneration paid to individuals under civil law agreements, including copyright and license agreements.
Participants in civil relations are equal and independent. In labor relations, the employee is subordinate to the rules of the internal regulations, but at the same time has the right to paid sick leave, vacation, various compensation and benefits.
Article 57 of the Labor Code of the Russian Federation provides a list of essential conditions of employment contract. In the contract it is necessary to indicate: last name, first name, patronymic of the employee and the name of the employer (surname, first name, patronymic of the employer - an individual), which suffered an employment contract.
The code provides for the need to indicate such conditions as:
Place of work (with an indication of the structural division);
Start date;
Name of position, specialty, profession indicating the qualifications in accordance with the staffing of the Organization or a specific labor function. Decree of the Government of the Russian Federation of 29.10.2002 N 781 approved a list of posts and institutions, working in the work experience, giving the right to the early appointment of an old-age pension to persons who carried out therapeutic and other public health activities in state and municipal health institutions, In accordance with subparagraph 11 of paragraph 1 of Article 28 of the Federal Law "On Labor Pensions in the Russian Federation". Therefore, if a destination is assigned to the position specified in the list, the name of this post must be complied with this list;
The rights and obligations of the employee;
The rights and obligations of the employer;
Characteristics of working conditions, compensation and benefits to employees for working in severe, harmful and (or) hazardous conditions;
Labor and recreation mode (if it is different from the general rules established in the organization);
Terms of remuneration (including the size of the tariff rate or an employee salary, surcharge, surcharges and incentive payments). The budget health organizations should be guided by the Order of the Ministry of Health of the Russian Federation of 15.10.1999 N 377 "On approval of the Regulation on the Whether Officers of Health Workers",
Types and conditions of social insurance directly related to labor activities. According to the changes made in Art. 63 Fundamentals of the Russian Federation on the protection of the health of citizens by Federal Law of August 22, 2004 N 122-FZ, the measures of social support for medical and pharmaceutical workers of health organizations, which are in budgetary support of various levels (federal, subject of the federation, municipal), are established by the relevant authorities (government The Russian Federation, the state authorities of the subject or local governments).
Also, according to the changes made by the specified law, medical and pharmacematic workers are deprived of the right to the priority receipt of residential premises, the installation of the phone, providing them with children in children's preschool and sanatorium-resort institutions, acquiring on preferential terms of vehicles used to perform professional duties when traveling .
Doctors, provisions, employees with secondary medical and pharmaceutical education of state and municipal health systems, working and living in rural areas and towns of urban type, as well as members of their families who live with them, are not entitled to qualify for free provision of apartments. These changes come into force on January 1, 2005.
The work agreement may provide for the testing conditions, the non-disclosure of the secrets protected by law (state, official, commercial and other), on the duties of the employee to work after training for an equally established period of the term, if the training was carried out at the expense of the employer's funds, as well as other conditions, not Worsening the position of the employee compared with the Labor Code of the Russian Federation, laws and other regulatory legal acts, collective agreement, agreements.
The conditions of employment contract can be changed only by agreement of the parties and in writing.
As a general rule, the employment contract is indefinite.
In the case of the conclusion of an urgent employment contract, it indicates its validity and circumstance (reason) that served as the basis for the conclusion of an urgent employment contract in accordance with the Labor Code and other federal laws. In the decision of the Plenum of the Supreme Court of the Russian Federation dated 17.03.2004 N 2 (paragraph 13) indicates that the conclusion of an urgent employment contract is right, and not the obligation of the employer.
Also, the Supreme Court indicated that when establishing the fact of the initiance of subsequent employment contracts for a short time for the implementation of the same labor function, the court was entitled to recognize the employment contract for an indefinite period, taking into account the circumstances of each work.
The difference between the employment contract from civil law
Contracts close to the content of labor
In contrast to the employment contract, the prerequisite for most of the compensated civil law agreements is the deadlines for the start and end of the contract.
The most common type of civil law contracts used to regulate labor relations is a contract. Article 702 of the Civil Code of the Russian Federation contract is defined as a contract for which one side (contractor) undertakes to perform a certain job on the task of the other side (Customer) and hand over its result to the customer, and the customer undertakes to take the result of work and pay it.
The subject of the contract is a certain result of the contractor's work, and not the fulfillment of a specific employment function, as is the case in the employment contract. According to Art. 703 of the Civil Code of the Russian Federation contract is to manufacture, processing or processing things or to perform other work with the transmission of its result to the customer. According to the general rule Art. 704 of the Civil Code of the Russian Federation The Contractor performs its dependent, that is, from its materials, on its own and means. The employee performs the function provided by the labor contract always personally, that is, on its own, but the provision of materials and means necessary to fulfill work is the obligation of the employer. Contractor, if the law or contract contract does not follow his duty to fulfill the work provided for in the contract personally, has the right to attract other persons to fulfill its obligations (paragraph 1 of Art. 706 of the Civil Code of the Russian Federation). The employment contract is also implied that the employee fulfills its labor duties only personally.
Unlike an employee under the general rule of Art. 705 of the Civil Code of the Russian Federation The risk of random death or accidental damage to the result of the work performed before its acceptance carries the Contractor. This contractor's risk is that in the case of the specified random events, the Contractor fully or partially loses the right to pay for the work performed. With an employee, such an employee cannot happen, since all similar property risks fall on the employer, and the employee retains its right to receive a fee for the fulfillment of the function provided by the labor contract, at least the intended result for circumstances independent of the employee and has not been reached.
The price of work in the contract does not apply to the number of its essential conditions (Art. 709 of the Civil Code of the Russian Federation), the size and conditions of remuneration are obliged to be indicated in the employment contract (Art. 57 of the Labor Code of the Russian Federation).
The contract of payment for the provision of services is greater similarity with the employment contract than the contract, since the subject of a compensated service agreement is the executive to the executor of certain actions or the exercise of other specific activities (Article 779 of the Civil Code of the Russian Federation), which is usually not accompanied by the creation of which - With a certain thing. In addition, according to Art. 780 of the Civil Code of the Russian Federation The Contractor for general rule is obliged to provide services personally. Therefore, the main criterion for the distinguishing of the employment contract and the compensated service agreement is the presence or absence of an obligation to obey when providing the service with the rules of the customer's domestic labor regulations. At the same time, it should be noted that the general provisions on the contract applies to the contract for the provision of the provision of services, if this does not contradict the norms of the Civil Code of the Russian Federation on the compensated provision of services and the peculiarities of the subject of this contract (Article 783 of the Civil Code of the Russian Federation).
It should be noted that by virtue of Part 3 of Art. 11 of the Labor Code of the Russian Federation, if a civil-legal agreement was concluded between the parties, but during the trial it will be established that the employment relationship between the employee and the employer is actually regulated by this agreement, the provisions of the Labor Code of the Russian Federation should be applied to such relations.
Admission to medical activities.
Certificate of a specialist
For work in a medical organization, a secondary or higher medical education is required, for an employee with higher education, it is also necessary to have a certificate of a specialist specialist.
In the case of admission to the work of the student, the task becomes more complicated, because To date, a clear regulatory legal framework that regulates the procedure for passing the board with young professionals, including receiving a certificate, not developed.
The main documents on this issue are: art. 54 Fundamentals of the Russian Federation on the protection of the health of citizens of July 22, 1993 N 5487-1, the orders of the Ministry of Health of the USSR of 20.01.1982 N 44 "On measures to further improve the training of medical personnel in the internship" and from 08/16/1972 N 669 "On Approval of Instructions on The procedure for paying wages to doctors passing one-year specialization (internship), and additional payment by the heads of the branches of urban (central district), regional, regional and republican hospitals engaged in direct training for doctors and the implementation of instructions on the procedure for enrolling in the internship and on the work of graduates of medical institutions .
In connection with the abolition of the order of the Ministry of Health of the Russian Federation of 12/19/1994, "On approval of the Regulation on the procedure for admission to the implementation of professional (medical and pharmaceutical) activities" (with clarification of the Ministry of Health of the Russian Federation of 07.08.95 N 15-00), it remains an uncertain question about the procedure for obtaining a doctor - The informous certificate of a specialist. Recall that earlier in accordance with the specified documents, the specialist certificate was issued after the end of the internship without an additional exam.
WORKING TIME. Work outside normal
Duration of working time
The permissible duration of the daily work of medical professionals in the Labor Code does not indicate, but part 3 of Article 92 of the Labor Code of the Russian Federation provides for the possibility of establishing a reduced working time for medical workers by adopting the relevant federal law (such a law has not yet been adopted), and Article 350 of the Labor Code of Medical Workers There is an abbreviated duration of working time - no more than 39 hours per week. Decree of the Government of the Russian Federation dated February 14, 2003 N 101, adopted in accordance with the specified article of the Code, has established an even shorter duration of working time for some categories of medical workers - from 36 to 24 hours a week. In the new edition of the Labor Code of the Russian Federation, which enters into force on January 1, 2005, the possibility of establishing the Government of the Russian Federation to certain categories of medical professionals for the provision of annual additional paid leave.
Separately, it is necessary to dwell on the question of work outside the normal duration of working time. Labor legislation provides for two options: overtime work (carried out at the initiative of the employer) and combination, in case the initiative comes from the employee (Art. 97 of the Labor Code of the Russian Federation).
Overtime work - work produced by an employee at the initiative of the employer outside the established duration of working time, daily work (shift), as well as work in excess of the normal number of working hours for the accounting period.
The employer has the right to attract an employee to overtime work in legislative cases (Part 2 of Art. 99 of the Labor Code of the Russian Federation), while the written consent of the employee is required. If the employee is involved in such works in connection with other circumstances, the employer must be obtained in addition to the written consent of the employee, the approval of the elected trade union body of this organization (part 3 of Article 99 of the Labor Code of the Russian Federation). That is, the performance of overtime works under the existing employment contract, the new employment contract is not.
Exterior operation is limited to four hours for two days in a row and 120 hours per year.
The payment of overtime is carried out in the first two hours of operation at least as one-hour size, for the next hours - not less than double. The specific amounts of payment for overtime work can be determined by a collective agreement or employment contract.
Unlike the KZOT RF, at the request of the employee, overtime work instead of elevated payment can be compensated by the provision of additional rest time, but no less time worked out overtime (Art. 152 of the Labor Code of the Russian Federation).
Participation work is devoted to chapter 44 of the Labor Code of Russia. Commonwealth is the fulfillment by the employee of another regular paid work on the terms of the employment contract in its free time. Work part-time can be performed by the employee both at the place of its main work and in other organizations.
Part-time work as a general rule may not exceed four hours a day and 16 hours a week.
Separately, the Labor Code of the Russian Federation indicates the peculiarities of the work on the part-time of certain categories of workers, including physicians.
Decision of the Ministry of Labor of the Russian Federation of 30.06.2003 No. 41 "On the peculiarities of work on the part-time of pedagogical, medical, pharmaceutical workers and cultural workers" established: for medical, pharmaceutical workers, an internal combination is allowed in cases where the abbreviated duration of working time is established.
The duration of the work on the part-time of the specified categories of workers within a month is established by agreement between the employee and the employer, and for each employment contract it cannot exceed:
For medical and pharmaceutical workers - half of the monthly rate of working time, calculated from the required duration of the working week;
For medical and pharmaceutical workers who have half a monthly working time rate for the main work is less than 16 hours a week, - 16 hours of work per week.
For doctors and medium medical personnel of cities, districts and other municipalities, where their disadvantage is there - a monthly rate of working time, calculated from the undertaken duration of the working week. At the same time, the duration of part-time work on specific posts in institutions and other organizations of federal subordination is established in the manner determined by the federal executive bodies, and in institutions and other organizations that are under the jurisdiction of the constituent entities of the Russian Federation or local governments - in the manner determined by the authorities state power of the constituent entities of the Russian Federation or local governments;
For junior medical and pharmaceutical personnel - a monthly rate of working time, calculated from the established duration of the working week.
At the same time, the duration of part-time work on specific posts in institutions and other organizations of federal subordination is established in the manner determined by the federal executive bodies, and in institutions and other organizations that are under the jurisdiction of the constituent entities of the Russian Federation or local governments - in the manner determined by the authorities State power of the constituent entities of the Russian Federation or local governments.
Also, this resolution provides a list of types of works that are not part-time and not requiring the conclusion (design) of an employment contract, since the execution of these works is permitted for the main working time with the consent of the employer.
Compensation and benefits to employees for work
In severe, harmful and (or) dangerous conditions.
Mandatory Insurance of Medical Workers
The Labor Code of the Russian Federation (Art. 92, 117) by employees engaged in the work with harmful and (or) hazardous working conditions has been established by the convex work time, as well as additional paid leave. Lists of such industries, works and positions giving the right to a shortened working day and for additional leave should be approved by the Government of the Russian Federation. Prior to their adoption, according to Article 423 of the Labor Code of the Russian Federation, it is possible to apply regulatory legal acts published before the adoption of the Labor Code of the Russian Federation, in part, not contradictory.
Decision of the USSR State Protection Protection and the Presidium of the WCSPS of 10/25/1974 N 298 / P-22 approved a list of industries, workshops, professions and positions with harmful working conditions, work in which it gives the right to additional leave and a shorter working day. There is also an instruction on its use (approved by the decision of the USSR State District Committee, the Central Bank Center of 21.11.1975 N 273 / P-20). In this list, there is a section of XL Healthcare, which lists various therapeutic and prophylactic institutions and their units, working in which it gives the right to additional leave and a shorter working day. Thus, employers are obliged to provide employees who occupy the relevant posts perfected benefits. According to Art. 126 TK RF, replacement of issuance of cash compensation to such employees is not allowed.
It should be noted that in accordance with Art. 120 Tk RF Additional leave, as well as basic, are calculated in calendar days, and in the list of the list they are installed in working days. The way out of this situation can be found if, for example, to indicate the duration of additional vacation in calendar days in a collective agreement or publish an order or an order for an organization in which the number of additional vacation calendar days appropriate for working days.
In the work experience, giving the right to annual additional charged holidays for working with harmful and (or) hazardous working conditions, is included only by the time-actual time (Article 121 of the Labor Code of the Russian Federation). Therefore, in an organization, it is necessary to organize separate accounting of working time giving the right to such vacation.
Employers also need to take measures to protect the health of employees. Order of the Ministry of Health and Social Development of the Russian Federation of 16.08.2004 N 83 approved lists of harmful and (or) hazardous production factors and works, when performing preliminary and periodic medical examinations (surveys), as well as the procedure for these inspections (surveys).
Harmful and (or) hazardous production factors are the chemical, biological, physical factors listed in the list, as well as the labor process factors. In the event that the employee is exposed to any of the listed factors, such as ultraviolet, it needs to undergo medical examinations in accordance with this document.
Federal Law of August 22, 2004 N 122-FZ, which concerns the monetization of benefits, which makes changes to a large number of laws, including the basis of the legislation of the Russian Federation on the protection of citizens' health, among other things, clarify the conditions for compulsory insurance of medical, pharmaceutical and other employees. State and municipal health systems whose work is associated with the threat of their lives and health.
Thus, in the new edition of Article 64, the foundations referred to the list of posts whose occupation is associated with the threat of life and health of employees, the amount and procedure for compulsory insurance, which should approve the Government of the Russian Federation.
The size and procedure for compulsory insurance for medical, pharmaceutical and other employees of health organizations that are under the jurisdiction of the constituent entities of the Russian Federation or in jurisdiction of municipal health organizations, the work of which is associated with the threat of their lives and health, are established by the state authorities of the constituent entities of the Russian Federation or local government agencies .
Compulsory insurance also provides for the payment of a one-time cash benefit to the families of the dead workers of state and municipal health systems in the performance of labor duties or professional debt during the provision of medical care or conducting scientific research.
Changing the employment contract
In the process of work, organizational or technological conditions of work may vary on the initiative of the employer. Such changes relating to the essential conditions of the contract must be coordinated with the employee and draw in writing or in the form of an additional agreement to the employment contract, or renewing the contract with the employee.
On the introduction of such changes, the employee is notified by the employer in writing no later than two months before their introduction.
If the employee does not agree to continue working in the new conditions, the employer is obliged in writing to offer him a different work available in the organization corresponding to his qualifications and health status, and in the absence of such a job - a vacant position or lower job that the worker can perform Taking into account his qualifications and health status.
In the absence of the specified work, as well as in the event of a refusal of an employee from the proposed work, the employment contract is terminated in accordance with paragraph 7 of Art. 77 TK RF.
If the employee refuses to continue working on the conditions of the appropriate modes of working time, the employment contract is terminated in accordance with paragraph 2 of Art. 81 TK RF with the provision of employee relevant guarantees and compensation.
Cancellation of the regime of incomplete working time is carried out by the employer, taking into account the opinion of the representative body of employees of the organization.
Changes to the significant conditions of the employment contract cannot be introduced, worsening the position of the employee compared with the terms of the collective agreement, the agreement.
The code describes a number of cases when there is no need to make changes to the employment contract, we are talking about the initiative emanating from the employer (Article 72, 74-76):
1. Transfer to another permanent job in the same organization at the initiative of the employer, that is, a change in the labor function or a change in the essential conditions of employment contract, as well as the transfer to a permanent job to another organization or to another locality together with the organization is allowed only with the written consent of the employee ( Art. 72 TK RF).
Transfer to another permanent job in the same organization, as well as the transfer to a permanent job to another locality together with the organization is issued by the order (order) of the employer. The corresponding translation record is made to the employment record.
When transferring to the other terrain, employees are paid to the appropriate compensation: the cost of the fare of the employee itself and his family members, the cost of luggage transport, the cost of the device in a new place, etc. (Article 169 of the TC).
Under the "Other" means the locality outside the administrative and territorial borders of the relevant settlement. Transfer to work from one settlement to another, even within one administrative area, is considered as a translation into another area, regardless of the availability of a bus or other regular message between these points.
The employer must be transferred to the other work in accordance with the medical conclusion in the provision of another work of the employee to another existing work that is not contraindicated for health. If the employee fails to refuse or the absence of an appropriate work in the organization, the employment contract is terminated in accordance with paragraph 8 of Art. 77 TK RF.
The code has been established that it is not a translation to another constant work and does not require the consent of the employee to move it in the same organization to another workplace, to another structural unit of this organization in the same locality, the commissioning of the work on another mechanism or unit, if it does not entail Because of the changes in the labor function and the changes of the essential conditions of the employment contract. Although information on the structural unit is one of the essential conditions of employment contract.
2. It is also not necessary to make changes to the employment contract with a temporary translation to another work, in the case of industrial necessity (Art. 74 of the Labor Code of the Russian Federation). The employer has the right to translate the employee for a period of up to one month to the work not due to the employment contract in the same organization with the work of labor at the work performed, but not lower than the average earnings for the same work. Such a translation is allowed to prevent disasters, a production accident or eliminate the consequences of a catastrophe, an accident or natural disaster; To prevent accidents, downtime (temporary suspension of work for the reasons of economic, technological, technical or organizational nature), destruction or damage to property, as well as for replacing the missing employee. At the same time, the employee cannot be transferred to work contraindicated by him for health.
The duration of transfer to another job to replace the missing employee cannot exceed one month during the calendar year (from January 1 to December 31).
With written consent, the employee can be transferred to work requiring lower qualifications.
3. The Labor Code of the Russian Federation (Art. 76) at the employer assigns the obligation to remove from work (not allowed to work) an employee: who appeared at work in a state of alcoholic, narcotic or toxic intoxication; not held in the prescribed manner training and verification of knowledge and skills in the field of labor protection; Mandatory preliminary or periodic medical examination in the prescribed manner; as well as when identifying in accordance with the medical conclusion of contraindications to fulfill the employee of the work due to the employment contract; According to the requirements of bodies and officials authorized by federal laws and other regulatory legal acts, and in other cases provided for by federal laws and other regulatory legal acts.
The employer removes from work (does not allow for work) an employee for the entire period of time before eliminating circumstances that have been the basis for removing or preventing work.
In the period of suspension from work (preventing operation), wages of the employee are not charged, except in cases provided for by federal laws. In cases of removal from the work of the employee who did not follow the training and testing of knowledge and skills in the field of labor protection or a mandatory preliminary or periodic medical examination is not in its fault, it is paid for all the time of removal from work as simple.
In the event of a change in the owner of the property of the organization, a new owner no later than three months from the date of his own property rights has the right to terminate the employment contract with the head of the organization, his deputies and chief accountant. With other employees of the organization, the new owner is not entitled to terminate labor contracts only on the basis of a change in the owner of the organization's property. At the same time, after state registration of the transfer of ownership, a reasonable reduction in the number or staff of employees is allowed, which is not directly related to the change of the owner of the organization.
The worker may refuse to continue working in connection with the change of ownership of the property of the organization. In this case, the employment contract is terminated in accordance with paragraph 6 of Art. 77 TK RF.
With the change in the jurisdiction (subordination) of the organization, as well as to its reorganization (merger, accession, separation, allocation, transformation), labor relations with the consent of the employee continue.
Termination of employment contract
The grounds for termination of the employment contract are listed in Art. 77 of the Labor Code of the Russian Federation, it is for the items of this article that it is necessary to refer to a record of dismissal to the employment record of the employee according to the rules for the management and storage of labor books, making the forms of labor book and provide employers approved by the Decree of the Government of the Russian Federation of 16.04.2003 No. 225, except Cases of termination of the employment contract on the initiative of the employer and in circumstances that do not depend on the will of the parties.
When terminating the employment contract on the initiative of the employer, an entry on the dismissal (termination of the employment contract) is made with reference to the appropriate paragraph of Article 81 of the Labor Code of the Russian Federation.
Upon termination of the employment contract in circumstances that do not depend on the will of the Parties, an entry on the basis of the termination of the employment contract with reference to the corresponding paragraph of Article 83 of the Labor Code of the Russian Federation is made to the employment record.
In all cases, the day of the dismissal of the employee is the last day of his work.
Legal legal adviser
"Yuniko 94"
N.I. Strelet
The Association assists in the provision of services for timber: at competitive prices on an ongoing basis. Forest products of excellent quality.
One of the most important tasks of communist construction is to create a material base of communism, in which the steady increase in labor productivity and its scientific organization are noted. In modern conditions, notes is an organization based on the achievements of science and best practices systematically implemented in production.
Mechanization and automation of labor contribute to a continuous increase in its performance, preserve human health and gradual conversion of labor in the first vital necessity. Notes means consistent and steady improvement in the organization of work.
Further improvement of the health care system is unthinkable without implementing the notes elements in all its links. The purpose of notes is to improve medical care to the population, further improving its quality, ensuring optimal sanitary and hygienic working conditions of medical personnel, maximum labor productivity and efficient working hours, prevention of occupational diseases, the use of the labor process as arapeutic and preventive factor. Labor must give medical professionally to moral satisfaction.
Labor physiology solves the main problem - the fatigue of the body, while at the same time determining those activities that will help reduce it. Fatigue may arise due to the employment process, as well as as a result of any deficiencies in the organization of labor in production. The labor productivity of a tired person is much lower than a well-rested. If the fatigue developed during the working shift is so much significantly that it cannot be liquidated during the daily and weekly rest, overcomes is an overwork - which is a painful process, to eliminate which medical care is necessary. Therefore, the notes provides for the fight against increased fatigue.
The scientific organization of labor in medical institutions has a large population importance. As an incentive to improve the quality of medical care to the population, it helps to reduce morbidity, disability, increases the ability to work and productivity.
The subject of notes are the most rational design of personnel, the appropriate separation and cooperation of labor, equipment and equipment of the workplace, excluding the unproductive times of time and labor, the introduction of methods and techniques that facilitate the work of medical personnel. Centralized supply of linen, food, drugs, etc. allows medium and younger medical personnel to significantly reduce the time to visit the pharmacy, germination and to pay more attention to the direct maintenance of patients in the departments.
Studying the actual time of time on various elements of therapeutic process can establish and reduce the unproductive spending time and labor of medical personnel.
Rafic work of secondary medical personnel is compiled depending on the separation profile, the number of patients in it and others. Care for patients should be as close as possible to the individual, which can be achieved by attaching each medical sister and younger medical sister to certain chambers.
When organizing its workplace, a medical sister must comply with sanitary and hygienic requirements, norms and rules that allow you to create maximum amenities for both sick and personnel.
In the workplace of the medical sister should be everything you need. It should be equipped so as to eliminate the excessive time of time to search for the necessary medicines, tools, documentation, etc. In all offices, it should be equipped with light and sound alarms according to the "patient - duty nurse" scheme, which ensures a quick medical sister reaction to the challenge. The organization of telephone or selector communication between all hospital branches significantly reduces the non-production time. Nursing medical posts should be provided with the tools necessary for each branch, a special stand, which lists mandatory in various disease diseases, the rules for the preparation of patients and taking material for analyzes.
The dual-beed system of maintenance of patients significantly improves the care of them and the work of medium and younger medical personnel. The mechanization of the labor of younger nurses is much easier for their work. To reduce overvaluation, the labor costs of district medical care gradually need to be released from the implementation of unqualified preparatory work before entering the site. Medical sisters receive normalized tasks, finished styling with the necessary number of sterile syringes and other materials, written on special standard appointments and the address of patients,
Preparatory work is centralized in one place, laying it on specially dedicated persons. The central sterilization laboratory of the polyclinic should be supplied with sterile material and toolbook of nurses. Plot medical sisters should be provided by the Polyclinic vehicles and provide them with certain benefits for travel on urban transport during the performance of official duties. It has been established that medical sisters of therapeutic and pediatric departments spend 38.8% of working time to maintain patients at home and the same on movement on the site. Since the work on the site is more responsible and is associated with an increased emotional stress, the need for greater qualifications, is currently resolved by the issue of material and moral stimulation of precinct medical sisters working in more complex conditions.
The rationalization of the work of senior medical sisters should be carried out by reducing the costs of time on writing through the introduction of various finished standard forms, table chest, schedules, applications for materials, simplifying the accounting system, centralization of obtaining and issuing medicines, inventory, materials.
Many polyclinics organized posts of the Feldscher, medical sister, dispatching points, etc. This makes it possible to reduce the time spent by patients to visit the polyclinic, as well as to free the district doctor from performing 5-10% of visits per day that do not require the mandatory competence of the therapist.
In the process of becoming notes, it turned out that medical sisters in the hospital are very downloaded by the management of medical records, purely economic activities that do not require medical knowledge, which reduces the effectiveness of their labor with a significant cost of physical forces. Nursing the labor of medical sisters can not be carried out in the separation from medical work. All practical activities of doctors and nurses, all types and forms of notes can lose their value and do not give effect if the staff violates the principles of deontology. Notes and care for the culture of medical personnel, about properly conducting and handling of patients - this is a single process, links of one chain.
Forms of separation and cooperation of labor, if they are chosen correctly and meet the specific conditions of this medical facility, should certainly contribute to saving time, reduce material costs, improving labor efficiency. Practice shows that the rational separation and cooperation of labor contribute to increasing its meaningful, qualifications and creative activity of medical workers; Estimated monotony, monotony of labor, reduced fatigue. The most important points in the field of notes are the improvement of working conditions and the rational organization of the workplace of the medical personnel. The work on the introduction of notes convincingly demonstrates its great efficacy.
More on the topic Scientific Organization of Labor (notes) in the work of a medical sister:
- The main organizational and methodological principles of the scientific organization of labor in health facilities
- 13. Regulations on the medical sister of the Organizational and Methodological Department for Social and Medical
- Law "On Medical Insurance of Citizens in the Russian Federation". Stages of its introduction. Organization of work and licensing of medical institutions
Introduction
The modern stage of health development puts in a new quality of the quality of medical care produced by the population. The proper level of medical care can be achieved only with the appropriate staff provision of healthcare institutions. The formation of the number of medical personnel, the establishment of labor standards, the rational arrangement and the use of personnel is the most significant components of labor organization of health in health care, which are based on industry regulatory documents on labor. Currently, a regulatory framework developed by the Ministry of Health of the USSR is used in the late 80s. Regulatory documents on labor are not focused on organizational and technical conditions for the activities of therapeutic and preventive health care facilities, as well as the incidence of the population and the demographic situation that take place in Russia at the present time. The need to update the existing regulatory framework and the development of modern regulatory documents on labor is completely obvious. First, crisis phenomena in the economy and the deterioration of the environmental situation in recent years have significantly changed the nature of the pathology and the severity of diseases of the diseases of the population, as well as the frequency of treatment, duration and intensity of treatment. In this regard, it was necessary to develop new modern standards and labor standards and improving existing ones. Secondly, regular standards of most of the main types of institutions (regional, city hospitals, adults and children's urban polyclinics, etc.), developed 25-30 years ago and corresponding to the treatment-and-diagnostic process adopted at the time, do not meet modern Requirements and need revision. Third, the rapid development of medical science, the introduction of new technologies and modern technology into the medical and diagnostic process, the improvement of instrumental research methods has significantly changed the nature and content of the work of the doctor and also require a serious revision and updating of the regulatory framework in health care.
The purpose of this work is to consider the types of laboring methods, methods for studying the costs of working time and exemplary calculations of the laboring of the labor of medium and junior medical personnel.
The paper uses various sources, publications, educational literature.
The work consists of several sections. The first section finds the concepts of labor norms, its types, defines the functions, tasks and principles of laboring, as well as the order of introduction, replacement and revision of labor norms. The second section discusses the types of laboring, methods for studying the cost of working time. The third section presents calculations for the standardization of the labor of the middle and junior medical personnel of various units of the medical institution.
The conclusion contains conclusions about the work done and the list of references.
Theoretical aspects of labor rationing in health care
Essence of labor standards and its types
The norm of labor is called the work set for the employee per hour, the day (shift), a week, month, the year he is obliged to fulfill under normal conditions. The employer is obliged to provide normal working conditions: a good condition of the mechanisms, equipment, devices, timely provision of technical documentation, appropriate quality materials and tools for work, their timely submission, safe and healthy working conditions. Labor standards - the norms of development, time, service - are established in accordance with the achieved level of technology, technology, labor and production, and if they are changed, it is necessary to systematically revise. Mandatory replacement is subject to labor standards, as far as the workplaces are certified, the introduction of new technology, technology, technical re-equipment of production, ensuring an increase in labor productivity. Introduction, revision and replacement of labor standards is carried out by the employer, taking into account the opinion of the trade union, local regulatory acts. On the introduction of new standards, employees are notified at least two months.
Distinguish the following types of labor standards: developmental standards; time standards; service standards; Normal norms; normalized tasks; Enlarged and integrated norms used in collective forms of organization and remuneration (in the production team). In the sphere of their action, the labor standards are distinguished by uniform, type, inter-sectoral, industry (departmental) and local. In practice, local, which are developed on the basis of typical, sectoral and other centralized standards of a recommendation character.
The production rate is set in units of products, the work operations of the work that the employee must perform per hour, day (shift), month, working year.
The rate of time is the amount of working time (in hours, minutes) for the production of a unit of products or a working operation, serves to calculate, determine the rules of development and other labor standards.
Service standards are the volume of service mechanisms, machine tools, squares installed on one employee. Their variation is the rate of controllability - the number of employees in this production, which should be managed by one leader (brigadier, head of the plot, master, etc.). This is also a calculated norm for determining the state of managers managers.
The rate of the number of employees is the established number of working personnel of a particular profession, qualifications for work in this section of production, such as repair workers for maintenance of machines or all workers of the workshop, department, enterprises, institutions, organizations.
The rate of number and service rate is interconnected, since the service rate is determined by the norm, and vice versa.
Enlarged and integrated norms applied in the collective work of the production team in a single along, are calculated on the entire team of the brigade, i.e. it is the amount of work that the brigade should be executed a day, week, month.
With a piece of salary system, a piece of charge is applied - this is a payment for the unit made of products (operating operation) of proper quality (without marriage). A piece of charge with a simple piece system is always the same, no matter how much the employee has produced; When a piece-progressive system is the same within the development, and for products made above the norm, it increases progressively (but this system is rarely applied, as it is reflected in the cost of production). Complete rates are established by the administration and the revision of labor standards is also revised.
The normalized task is the total work per working day (shift) for an employee or brigade, installed on a time-based wage system based on time standards and production standards, is used to increase the labor efficiency of workers with time-based payment. Depending on what time the task is set, the daily (replaceable) and the monthly normalized task differ. Essentially, this is a special production rate used for volunteers.
Functions, tasks, value and principles of laboring
The main functions of laboring are the distribution of labor, the scientific organization of labor and production, production planning, the assessment of the work of individual workers and teams, which serves as the basis for the moral and material promotion and dissemination of best practices.
Labor rationing includes:
¾ learning and analysis of working conditions and production capabilities at every workplace;
¾ study and analysis of production experience to eliminate the shortcomings, identifying reserves and reflecting best practices in labor standards;
¾ design of rational composition, method and sequence of the elements of the labor process, taking into account technical, organizational, economic, physiological and social factors;
¾ establishment and implementation of labor norms;
¾ systematic analysis of the performance of labor standards and revising outdated norms.
The main tasks of labor rationing are::
¾ justify the necessary and sufficient value of the cost of working time per unit of products under concrete conditions;
¾ design rational working methods;
¾ systematically analyze the performance of labor standards to open production reserves;
¾ constantly analyze the performance of labor standards for opening production reserves;
¾ Constantly study, summarize and distribute production experience, revise labor costs as far as possible conditions.
The solution of these tasks will make it easier for the work of workers, improve labor productivity and increase production.
Labor rationing is the basis of the scientific organization of labor. Using the methods used in the standardization of labor, losses and non-production costs of working time are distinguished. By studying labor movements, the most economical, productive and least fatigue techniques are produced. This contributes to the growth of labor productivity. Further improvement of the organization of labor is impossible without improving its rationing.
Labor rationing is also the basis of the wage organization. Establishment of labor standards The goal is to guarantee society a certain productivity, and the employee has a certain level of wages. For the fulfillment of labor norms, the labor activity of each employee is estimated and his work is paid. Without laboring, labor is impossible to implement the economic law of labor distribution.
Labor rationing is an important means of organizing production. The organization of production is to control the process of manufacturing material goods, i.e. Establishing the interaction between labor and production facilities to achieve the maximum economic effect in specific conditions. Through the organization of labor, the influence of labor organization on the organization of production is manifested.
Scientific sound labor standards allow us to assess the results of the work of each employee, each brigade and compare their results. Only when compared the fronts and laggards are detected.
Scientifies of labor norms, correctly reflecting specific conditions, ensure an increase in labor productivity. If the norms of labor are underestimated, they can give rise to grateful or pessimism, which negatively affects performance results, if the norms are overestimated, they are impracticable. In both cases, the growth of labor productivity will be braked. Thus, all changes in the organization of labor and production, technology and work technologies are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor in the enterprise.
Labor rationing is the basis of labor planning. For promising, current and operational planning, a whole system of norms is applied: the rate of consumption of materials, fuel energy, machine performance norms, working time costs. Thus, labor standards play an important role in the system of norms used in planning in the enterprise.
The preparation of the work plan and the establishment of labor costs in accordance with the volume of production is impossible without scientifically based norms of labor. The great independence of enterprises in labor planning is strengthened by the interests of the teams in the introduction of scientifically based labor standards.
The following principles should be based on the normization of labor:
¾ scientific validity of labor standards;
¾ equal intensity of labor standards in the same work in identical conditions;
¾ preservation of the main productive force of society - workers;
¾ Participation of workers in establishing labor standards.
The norm of labor is not only as the magnitude of the required costs of working time, but also as an expression of the employment duties of each participant in production.
Order of the introduction, replacement and revision of labor standards
According to Art. 160 Labor Code of the Russian Federation, labor standards should be established in accordance with the achieved level of technology, technology, organization of production and labor.
Introduction, as well as replacement and revision of the norms of labor, are issued by local regulatory acts of the organization (by order, order, regulations on normalization, etc.) and taking into account the opinion of the representative body of workers (trade union body, the Council of the Labor Group, etc.).
The most rational and preferred method of designing regulatory materials is an analytical and estimated method, since it is most perfect and economically effective.
The following activities are organized for the development of labor standards:
1. Preparatory and organizational and methodological works.
During the work, the objectives and objectives of the development of regulatory materials for laboring of labor are determined, the types of norms are specified, the technical task is drawn up.
The technical assignment is developed by the organization-performer of regulatory work and is approved by the Customer Organization.
The current technology, instructions, provisions, organizational and technical conditions and methods of performing work in the workplace are studied, the equipment passports, characteristics of the applied tools, devices, raw materials, materials, equipment modes, the maintenance of technological and labor processes; The possibility of developing regulatory materials using time standards, including microelement, the use of electronic computing machines for the design of rational labor processes and the calculation of labor standards is established.
A methodological program for working on the development of a regulatory document is being developed, reflecting the following questions:
¾ The choice of enterprises (institutions, organizations), their structural divisions, on the basis of the organization of production and labor of which will be developed by progressive technological (labor) processes and rational organizational and technical conditions of their implementation, provided for in the design of labor costs;
¾ use of existing regulatory materials for labor rationing, including microelement standards;
¾ Definition of factors affecting the costs of time when performing individual works and ensuring the greatest accuracy of standards and norms with the smallest complexity and labor intensity of their development;
¾ Instructing workers carrying out observations and analysis of working time costs and designing standards and standards, the use of instruments, video equipment, computer equipment for this operation, data statistical, operational and other reporting;
¾ verification of the draft regulatory materials under production conditions;
¾ Registration of the collection of regulatory materials as a whole.
2. Study of the cost of working time at workplaces.
These works include:
¾ Preparation for observations: performers are selected, the work of which will be monitored, the correspondence of technology, the organization of the workplace and its maintenance is designed;
¾ Conducting direct measurements of working time (timing, photos of working time, video shooting of labor processes, etc.) or torque observations; At the same time, materials related to the establishment of labor costs at selected enterprises are maximally used;
¾ Conduct technical calculations, experimental and other research works, processing of collected materials.
3. Processing of collected materials.
These works include:
¾ analysis and summarization of the results of studying the cost of working time, the development of standards (norms) of labor costs;
¾ clarification of the main factors affecting the amount of labor costs; the derivation of empirical (based on experience) formulas of dependencies between the values \u200b\u200bof influencing factors and the values \u200b\u200bof labor costs;
¾ Preparation of the draft regulatory document in the first edition, as well as instructive guidelines on the procedure for conducting its inspection directly at the enterprise;
¾ determination of specific enterprises (institutions, organizations), their structural units to conduct regulatory materials on them;
¾ Direction of the draft regulatory document with guidance on the procedure for conducting its verification to selected enterprises (institutions, organizations), in their structural units.
4. Check regulatory materials under production conditions.
The purpose of verification is to identify the nature of the clarifications and additions to be submitted to the project.
5. Preparation of the final version of regulatory materials.
An analysis is carried out and studying the results of the verification of the draft regulatory document under production conditions, a summary of the received reviews, comments and proposals.
Established labor standards according to Art. 160 of the Labor Code of the Russian Federation can be reviewed as the improvement of new techniques, technology and conducting organizational or other activities that ensure the increase in labor productivity, as well as in the case of using physically and morally obsolete equipment.
It should be noted that it cannot be the basis for the revision of previously established norms to achieve a high level of production of products (provision of services) by individual employees through the application of new workshop techniques and improving jobs (that is, advanced methods and forms of labor organization).
Replacement and revision of uniform and standard standards is carried out by the authorities approved by the authorities. The revised norms are issued by the local regulatory act of the organization and bring to workers no later than two months before the introduction.
The inspection of the enterprise operating at the enterprise (in the institution, organization) of labor standards is carried out by certification commissions approved by the leaders of enterprises (institutions, organizations).
According to the results of the inspection for each norm, a decision is made: certified or not certified. Certified recognized technically sound norms corresponding to the achieved level of technology and technology, organization of production and labor.
Outdated and mistakenly established norms are recognized as not certified and subject to revision. Outdated, in particular, the norms acting on the work, the complexity of which decreased as a result of the overall improvement in the organization of production and labor, growth of professional skills and improving the production skills of workers and employees. The norms may be considered erroneous, when determining which the organizational and technical conditions were incorrectly taken into account or inaccuracies in the application of regulatory materials or in carrying out calculations.
When checking the cost of labor costs, the administration is obliged to provide a thorough check of the implementation by the provisions by the norms by the norms of the technology on all operations of the employment process, the correspondence of the actually performed volume of work in volumes laid down when calculating the norms. At the same time, the administration based on specific production conditions is obliged to rationalize the technological processes of operations, the conditions of the implementation of which provided for by the norms do not correspond to the achieved level of organization and labor, best practices.
The revision of obsolete norms is carried out on time and in the sizes established by the management of the enterprise in coordination with the trade union committee. The revision of erroneous norms is carried out as they are detected as agreed with the trade union committee.
The basis for applying correction coefficients to standards and regulations can serve the development of production facilities, new technology, technology, new types of products or inconsistency of the actual organizational and technical conditions of production provided for in newly introduced norms and standards.
Methods of labor rationing
Types of labor rationing methods
Improving medical care to the population requires not only building a material and personnel base of health care, but also further improvement of style and working methods, organizational activities at all levels, taking into account the economic efficiency of the events. One of the important tasks of further improving health care is the rational use of all resources. Determining the volume of activity of a group of medical personnel, the establishment of a direct link between indicators and wages, calculations of the cost of medical care to the population as a whole and its individual species is especially important during the implementation of economic management methods in health care and transition to insurance medicine.
Significant tools for solving these tasks is the rationing of labor. To date, there are insufficiently studied population needs in certain types of medical care, and scientifically based proposals are not developed on a number of health care institutions, their structural units and positions of medical personnel, as well as recommendations on the rational forms of labor organization.
The laboring method is a set of techniques for the study and analysis of labor processes, determining the costs of working time, identifying and accounting for the normative factors, designing a rational organization of labor and development of standards.
The regulation of the labor of medical workers is the most difficult question that reflects the specifics of the industry and requiring a thorough approach and a scientific justification in its decision. In health care, as in other sectors of the national economy, there are two types of laboring methods: analytical and total (Fig. 1).
Figure 1- Labor rationing methods
Analytical method provides for the dismemberment of the employment process into individual components. Depending on the methods of developing labor standards, this method is divided into analytical and research and analytical.
An analytical and research method is a method in which the labor rate is established on the basis of studying the cost of working time using photochronimetry observations directly at workplaces. It implies a detailed study of the production process and labor costs according to component elements. Based on these data, the most rational technological regimes of the equipment and the organization of the workplace and labor are design.
An analytical and estimated method provides for the cost of time costs for predetermined time standards, the operational modes of the equipment, as well as the formulas of the time dependence on the factors affecting the duration of the operation. This method establishes the normalized number of auxiliary workers, managers, specialists and technical performers.
The total method of laboring of labor establishes the costs of working time as a whole per unit of product of a particular workflow without analyzing the latter. The method of performing the work is determined by the employee. The varieties of the total method are an experienced, statistical and comparative methods.
Experienced method. The expert gets acquainted with the workplace, means and working conditions and intuitively, based on its subjective impressions and prior experience, determines the norm of labor. The established norm of labor is not an average value, but only the private value of possible costs of working time. Its validity, compliance with the conditions of the workplace entirely depend on the experience of the expert. This method is not able to provide the same tension of the norms. In addition, he reflects only past experience. Practice shows that labor standards established by an experienced intuitive method are usually low quality. This is evidenced by a significant overfulfilling of such rules by most workers.
Statistical method. Labor standards are installed mainly based on statistical reporting data on the amount of work. This method can be used only in confidence that the doctor, on the one hand, there is no undetegration of working time, and on the other hand, the technology of the medical and diagnostic process is observed, and the patient is proper medical care in full.
A comparative method for establishing labor standards is used in the case when the technology of staff work is similar to that which there are already regulatory indicators. For example, the activities of medical recorders, statisticians, etc. Uniform in all types of institutions.
The total method that does not take into account the fully content and organization of the employment process, the rational use of working time cannot be recommended for widespread use in the development of labor standards. At the same time, its simplicity and economy in some cases makes it preferring exactly this method.
Thus, currently for centralized development of standards for labor, it is advisable to apply mainly an analytical research method. In healthcare facilities to determine the number of personnel, which requires one or another work, the establishment of a number of regulatory indicators must be widely used by the calculating and analytical method. In cases where there are no staff load standards, for example, in the introduction of new types of instrumental research, with the organization of a new service, we can apply total rationing methods to establish temporary norms so that in the next 2-3 years on the basis of the existing work experience their scientific justification.
Methods for studying the cost of working time
There are 4 methods for studying the cost of working time (Fig. 2).
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Figure 2 - Methods for studying the cost of working time
Consider each of them.
Timber, methodology.
The timing is the method of studying the cost of working time by measuring the repeated elements of the operation.
The main goal is to identify the most optimal methods of work and the definition of the corresponding norms of time. The timing allows you to assess the organization of the workplace, to differentiate the structure of a separate operation and the conditions for its execution. The process of timekeeping includes three stages.
On the first (preparatory) stage, the operation is made for individual items using fixtures. The fixture point is a distinct external sign, perceived by the eye or on a hearing, signaling about the beginning and end of a particular element of the operation. At the same stage, work in the workplace and the study of the workplace are carried out. This is documented in the front of the timing and observation card, where the data on the operation is entered, the amount of products produced at certain times, the types and condition of the work of labor, the nature of the process, the qualification and experience of the artist's work, the wage system used.
At the second stage, observation and time fixation is carried out. Time measurements are made collective and accumulative methods using a two-stroke stopwatch. The observer must measure time on fixture points and make the stopwatch readings into the supervisory sheet of a timekeeping card, follow the procedure for performing the operation.
In the third stage, data processing and determination of the duration of the operation element are performed. The resulting values \u200b\u200bof the duration of the operation element are written to a historical variation range, where the upper line of the option is measurements in ascending order (decrease) of the measurement duration (t), and the lower line of the frequency (P) shows how often this option is found in the timing row. The total frequency amount should be equal to the number of measurements. Increactive (defective) measurements are pre-excluded and then the quality of the timing series is estimated.
Photo of working time, species and methods
Working time photography is observation, measurement and consistent recording of all time without exception throughout the work shift or another period.
If the observation period coincides with the duration of the working day, it will be a photo of the working day.
The working time photography is used to identify the loss of working time and the reasons that they cause them, as well as to establish the relationship between certain types of time. The data obtained are used as source when normalized.
The object of photography can be workers, cars or production process as a whole. If an object of observation is one worker, then the working time photo is individual, and if the group of workers - group. When the working time costs are recorded by the workers themselves, there is self-photograph of working time in order to study the loss of working time and their reasons.
The working time photography is carried out in three stages.
At the first stage, a preliminary study of work is carried out, the choice of observation object. The object is selected depending on the purpose of the observation. If you need to get sustainable performance of exemplary work, then the best working work is selected, and if it is necessary to study the reasons for non-compliance with norms, then the lagging workers.
The second stage includes direct observation and studying all time spending with accuracy to one minute. The results are fixed in special observation sheets. At the same time, the types of work and breaks as they are recorded in the Count "Name of Time Costs", and the moment of their completion is in the Count "Current Time".
At the third stage, based on the observational sheet data, the table of the same name and the actual balance of working time are drawn up. In conclusion, it is analyzed by the results of the observations carried out, irrational costs and direct losses of working time are established, which are excluded in the preparation of the designed balance, and the coefficient of possible increase in labor productivity by eliminating losses and irrational costs of working time is determined.
Photo chronic
Photochronometer - view of the observation, at which simultaneously with the photograph of working time conducted during the change in its separate periods, a timing is carried out. It is advisable to apply it when studying the cost of time on separate elements of work, not repeated cyclically during the working day.
In practice, work on work is used by individual and group photochronism. Thus, the group photochronet is recommended to be carried out when setting the composition of the brigade and the distribution of functions between its members, the individual elements of which do not have cyclic repeatability.
Observations and measurements are carried out by the procedures for processing observation results, the analysis of the data obtained and the design of rational labor processes under photochronism is carried out separately according to the historical observations and photographs in the prescribed manner.
Method of torque observations
Method of torque observations allows you to register and take into account during the observation period the same name of the working time of the group of performers or work time and breaks in the operation of a different number of equipment and on this basis to determine the specific weights and absolute value costs. For the method, a minor complexity and simplicity of observations and processing obtained results obtained, the operationalization of the study, wide coverage of the observation of various objects, as well as attracting personnel research with the simultaneous performance of their main work, etc. To the disadvantages of the method include: obtaining only average working hours and time use of equipment; Lack of data on the sequence of studied processes, as well as possible changes, etc.
When conducting research, it is recommended to use arrowheads (hours, single and two-time stopwalls), special equipment that allows you to automatically fix both the time and content, structure and method of performing normalized processes (oscillography, photo-video and film equipment).
Filming provides objectivity and high accuracy of registration of all elements of the employment process in time and space, as well as determining its conditions, the completeness of the characteristics of the process being studied (trajectory and speed of movements, displacement distances of labor objects, sequence and degree of combination of receptions, actions and movements, etc. .)
Labor rationing of middle and junior medical personnel
The rationing of the labor of middle and junior medical personnel of outpatient polyclinic institutions
The posts of medium and younger medical personnel in the outpatient clinical institutions are set by the number of posts of outpatient receptions of a particular specialty (to calculate the number of medical sisters and the relevant categories of the corresponding cabinets). The posts of outpatient reception doctors include all positions of the doctors of outpatient polyclinic institutions. In addition to the posts of physicians of clinical laboratory diagnosis, bacteriologists, radiologists, radiologists, physiotherapists, reflexotherapists, manual therapy, endoscopists, anesthesiologists-resuscitators, statisticals, doctors of items (offices) of medical care at home , on therapeutic physical education, sports medicine, functional or ultrasound diagnostics, healthy and healthy and district pediatricians, as well as leaders of all ranks.
The need to allocate medical posts on the outpatient reception is due to the fact that, depending on their number, according to regular regulations, the number of posts of doctors and the average medical personnel of auxiliary and some other medical and diagnostic units are determined:
· The total number of posts of outpatient reception doctors: Medical sisters of a procedural office, medical recorders (to calculate the number of medical sisters of the procedural office, medical recorders);
· Total number of posts of doctors (to calculate the number of medical statistics);
· Changing the work of the unit or institution (to calculate the number of manifolds of procedural, vaccination cabinets, registry);
· Number of population and its individual contingents (to calculate the number of nurses of vaccination cabinets, medical sisters to collect breast milk, etc.);
· Mixed procedure for establishing posts: to calculate the number of paramedics or medical seisters of the filter in the children's urban clinic (change of work and number of children).
Most of the current standards of outpatient polyclinic institutions currently approved more than 25 years ago: regular standards of urban and children's urban clinics located in cities with a population of over 25 thousand people, identified by the Order of the USSR Ministry of Health from 11.10.1982 No. 999, in cities and towns of urban type with population up to 25 thousand people. Order of the USSR Ministry of Health from 09/26/1978 No. 900. In 2001, an order was approved on staff regulations for children's clinics, which are part of urban and children's city hospitals, health patients with hospitals (Order of the Ministry of Health of Russia of October 16, 2001 No. 371), However, the lack of validity of the main provisions of this order makes it unacceptable for health care practice.
By the nature and volume of the activities of the average medical personnel established for the doctors of outpatient reception in different specialties, these posts can be divided into the following groups:
· Medical sisters are carried out with a doctor outpatient reception of patients;
· Along with an outpatient admission, together with a doctor, medical sisters of precious doctors-therapeutors, pediatrician doctors, general practitioners (family medicine) also perform the appointment of a doctor for providing relevant medical and diagnostic and preventive care to the house of the population.
Medical sisters of surgeon doctors, orthopedic traumatologists carry out dressings, overlay and removal of plaster, etc.
The first group includes most of the posts of nurses of the doctors of outpatient reception. The regulatory ratio of medium and medical personnel in this group is usually 1: 1, i.e., one position of the doctor is planned one position of a medical sister. At the same time, according to the specialties of doctors as neurology, endocrinology and dentistry, this ratio is violated and in accordance with the current regular standards for one position of the doctor of these specialties, 0.5 of the medical sister is set. It is difficult to find a logical explanation to such regulations, and in the absence of relevant recommendations on the sectoral level, heads of health care facilities on the basis of the rights to form the number of personnel of the LPU, it is advisable to set the number of medium-sized medical personnel on these specialties corresponding to the medical personnel. Order of the Ministry of Health and Social Development of Russia dated 04/14/2006 No. 289 This provision for a children's dental clinic is corrected, and the posts of medical examinations of medical sites are established at the rate of 1 Position for each Position of the dentist's children's doctor, a dental surgeon and orthodontist. Such a standard is fully consistent with the modern technologies of the medical and diagnostic process in dentistry when using modern composite materials, the work of "four hands" and the ethically legal standards for receiving the patient in a separate office.
In recent years, in connection with the introduction of compulsory health insurance in the territories, where payment is carried out for individual medical services, the classifiers of medical services are developed and approved, in which the corresponding time norms are established for a doctor and a medical sister. The expediency of such a separate settlement of the time of time for the specialties, where the regulations identified an equal number of doctors and medium medical personnel, causes greater doubts. For example, in one of the classifiers on otolaryngology, where according to regular standards, one position of the medical sister was established for one position of the doctor, the time spent on the front tamponade of the nose (including after bleeding) were determined in the amount of 2.0 coats for a doctor and 1.5 coats for a medical sister, i.e. 20 and 15 minutes, respectively. It is unlikely that a medical sister, having completed the procedure earlier a doctor, will assist another patient without an appropriate medical examination and appointments. The situation is complicated when the specified cost of working time is less than a medical sister. For example, to replace the cystostomomic drainage, the urologist has been installed 3.0 hours, that is, 30 minutes, and the medical sister is 4.0 even, that is, 40 min. After completing this operation, the doctor will take the following patient without a medical sister, which can lead to a violation of the technology of the medical and diagnostic process, which provides for the joint work of a doctor and a medical sister, or expect within 10 minutes the completion of the medical sister of this employment operation.
Thus, the establishment of different standards of time on separate labor operations for a doctor and a medical sister is confirmed with the industry standards for labor, which determine the relationship between the number of medical sisters and outpatient reception doctors for a particular specialty.
Moreover, as noted in the recommendations, determining the cost of time for individual labor operations, as well as simple and complex medical services can be considered only as an intermediate stage for the formation of regulatory costs to a more enlarged indicator, fixed in the reporting and accounting documentation of the LPU, i.e. . at visit.
The regulatory number of junior medical personnel posts also differentiate in the specialties of outpatient reception doctors. Thus, in urban clinics located in the cities with a population of over 25 thousand people, the posts of the Sanitarks are established at the rate of 1 Position for each post of a surgeon doctor, traumatologortopeda, infectious examiner; For every 2 posts of doctors on therapeutic physical education, allergologists-immunologists; For every 3 posts of other doctors leading outpatient reception.
Normation of labor of middle and junior medical personnel of hospital institutions
The rationing of the labor of middle and junior medical personnel of hospital institutions has certain features that are listed further:
· The need to ensure round-the-clock maintenance of patients in the hospital;
· An indicator that serves as the basis for calculating the number of posts is the number of beds;
· Setting the load standards (maintenance) on the patient's stay in hospital or shift.
The regulations of the number of middle and younger medical personnel of hospital institutions are among the number of beds for one position, or one round-the-clock post. Depending on this, the time rate is set either on the day of the position, or for a day.
Stage I. The normative costs of working time medical personnel of hospital institutions are determined by 1 patient per day or per day. The patient's stay in the hospital for calculating the normative indicators on the work is differentiated as follows:
· Day of receipt;
· Treatment day;
· Extract day.
Time costs are typically based on timekeeping.
The calculation of the weighted average performance of the working time of the medical sister or nurse, working daily, on the patient's stay in the hospital (Tent) is carried out by the formula:
Tent \u003d (tp + t l x 0,825 (m - 2) + tv) / (m x 0,825), (1)
where TP is the cost of a medical sister's time or a doctor on a patient on arrival day;
tL - the time spent on the patient during the treatment period per day;
tB - time spent on the patient for his discharge day;
m- average duration of inpatient treatment (in days).
The formula introduced a coefficient of 0.825, showing the reduction of the number of days of work of the medical sister or agencies during the entire period of stay at the expense of festive and weekend days. When calculating the coefficient, 12 festive and 52 weekends are taken into account when working at the Six Day Working Week: (365-52-12) / 365 ≈ 0.825.
At the specified mode, i.e., medical sisters are working every day, carrying out individual care for seriously ill, dressing, procedural, buffetic and sanitaries.
Example of calculation
The length of the medical sister's time for organizing individual care for seriously ills per 1 day of the patient's stay is 100 minutes per day of receipt, 80 min daily during the treatment period and 70 minutes per day of discharge. The weighted average indicator at the average duration of the patient's stay, equal to 13 days, calculated by formula 1, is 83.5 minutes.
(100 + 80 × 0.825 × (13 2) + 70) / (13 × 0,825) ≈ 8.4.
In the separation of about 10% seriously ill, therefore, this indicator per hospitalized is 8.4 minutes (83.5: 10).
Most of the middle and younger medical personnel of hospital institutions work around the clock. This introduces 2 or 3 power system.
The use of a 2-power system provides for the maintenance of patients with a doctor and a medical sister. At the same time, the steamed medical sister completely and directly serves the patient, and the sanitary card performs only sanitary and hygienic functions in the wards and utility rooms. Forced fulfillment of the functions of the younger medical personnel with celative medical sisters, for example, on the cleaning of premises in the absence of a proper number of senios, certainly worsens the quality of medical care and contradicts sanitary and hygienic requirements.
With a 3-power system, a doctor, a nurse and a nurse participate in the maintenance of patients.
The calculation of the weighted average cost of the working time of the medical sister or agencies per day of the patient's stay in the hospital (TSUT) is calculated by the formula, similar to formula 1, but excluding the coefficient of 0.825:
Touch \u003d (tp + t l x (m - 2) + tv) / m, (2)
All designations correspond to Formula 1 with the calculation not on the day, but for the day of staying patient in the hospital.
Weighted average time costs are calculated separately on patients who received in a planned manner and for emergency testimony, and for the separation of the surgical profile, in addition, on the operated and non-operated patients. Then, taking into account the specific gravity of emergency hospitalization and operational activity, the indicator of the average cost of the time of the medical sister or nitrate per patient is determined. This method of calculation allows you to simulate the effective indicator of the average time spent per patient according to the separation profile, depending on the change in the main working conditions: increase or decrease the amount of emergency hospitalization, the number of operational interventions, changes in the average duration of the patient's stay in the hospital, etc.
Example of calculation.
The costs of the working time of the medical sister per patient per day at the duration of stay in the hospital, who received emergency testimony and in a planned manner.
Calculations of the time spent per patient per day, conducted according to Formula 2, show that they received in a planned manner with an average length of stay equal to 12 days, they will be 40.8 minutes:
(73.8 + 34.6 (12 2) + 70.2) x 12 ≈ 40.8.
The costs of working time on patients who were erected, with an average length of stay in the hospital, equal to 8 days, will be 107.4 minutes: (396.6 + 60.8 (8 2) + 97.8) / 8 ≈ 107, four.
The average time spent at 10 percent emergency hospitalization is 47.5 minutes: (107.4 × 10 + 40.8 × 90) / 100 ≈ 47.5.
The average time spent at 30 percent emergency hospitalization will be 61.8 minutes: (107.4 × 30 + 40.8 × 70) / 100 ≈ 61.8.
Thus, an increase in the specific gravity of hospitalization for emergency testimony from 10 to 30% leads to an increase in the cost of the working time of the medical sister per patient per day from 47.5 to 61.8 min, i.e. by 30%.
Stage II. Estimated load standards (maintenance) for medical personnel of hospital institutions expressed among those serviced patients per day or per day by the formula:
NB \u003d (in x k) / t, (3)
where NB is the load standards on the medical staff hospitals;
In the daily working hours of medical personnel (at the six-day working week) or daily working time;
k - the coefficient of use of the working time of the middle medical personnel on the main and auxiliary activities;
T - average time spent per patient per day (from Formula 2).
The main activity of medical personnel is, as a rule, work carried out directly with the patient, i.e., the time of direct contact of the personnel with the patient, namely the fulfillment of various kinds of procedures and manipulations. However, some categories of medical personnel are not completely in contact with patients, such as a nurse-cleaner with a two-way service system, so the main activity for them is the implementation of the direct production task.
All preparatory work, produced to fulfill the main activity and carried out both in the presence and in the absence of a patient, is auxiliary activity: preparation and cleaning of the workplace, preparation for manipulation, procedure, transition to another compartment, etc.
During the working day, personnel need a short-term rest, food reception, sanitary and hygienic events. These costs belong to the personal need.
Inter-sectoral Methodological materials recommend to remove approximately 10% of working time to the personal need. Experience in standardization of labor in health care shows that the coefficient of working time for basic and auxiliary activities for most positions of medical personnel (except for auxiliary medical diagnostic service) is 0.923, i.e. from 6.5 hours of working day about 30 minutes, about 30 minutes are given to other types of work : (6.5 - 0.5) / 6.5 \u003d 0.923.
For further calculations, the coefficient of 0.9 can be taken.
Example of calculation.
The settlement standards of the medical sister's load for the organization of individual care for severely ill with the cost of working time per hospitalized amount to 8.4 mins of the load (maintenance) calculated by formula 3 are 42 hospitalized:
(6.5 × 60 × 0.9) / 8.4 ≈ 42.
Example of calculation.
Estimated load standards for a medical sister at the cost of working time per patient per day, equal to 47.5 min, determined by formula 3, are 27 hospitalized: (24 × 60 × 0.9) / 47.5 ≈ 27,
and with costs equal to 61.8 min, 21 patients: (24 × 60 × 0.9) / 61.8 ≈ 21.
III stage. The standing of the post of medical personnel of a hospital institution, expressed among the number of beds for one position, is calculated by the formula:
NK \u003d (NB x 365) / R, (4)
where Nk is the number of beds, incidental for one position;
NB - load among patients per day (from formula 3);
R is a planned number of beds of Koyki in the year.
The value of R in formula 4 is:
· For urban, regional hospitals - 330-340 days;
· For hospitals located in the countryside, 320 days;
· For infectious hospitals - 310 days;
· For maternity hospitals - 300 days.
Example of calculation.
The standing of a medical sister's position for organizing individual care for seriously ill patients of the branch of a city hospital, calculated according to formula 4, at the cost of time per patient per day equal to 8.4 min and the number of patients serviced equal to 42, is 45 beds (42 x 365 ) / 340) for one position.
Example of calculation.
To ensure the activities of the ward nurse department in the conditions of the city hospital at the cost of working time per patient per day, equal to 47.5 min, and the calculated load standards of 27 patients, a 24-hour post-in-house post is required ((27 x 365) / 340), and With costs equal to 61.8 min and load standards, 21 patients are a 24-hour post at 23 beds ((21 x 365) / 340).
The calculation of the number of positions to ensure the work of the round-the-clock post is carried out by the formula:
DPost \u003d (24 × 60 × 365) / b, (5)
where the referee is the number of posts to ensure the work of the round-the-clock post;
B - the annual budget of the work time position.
The annual working time budget (B in Formula 5) is calculated by the formula submitted in the methodological recommendations "Development of labor rationing technology in health care":
B \u003d m × d - n - z,
where b - annual working time budget;
m - the number of hours of work per day at the five-day work week;
d - the number of working days a year in a five-day work week;
n is the number of hours of cutting the duration of the working day or shift in pre-holiday days (during the year);
z - The number of working hours per vacation period of time, which is determined by multiplying the weekly duration of the working time for the number of vacation weeks.
In accordance with Art. The 350 Labor Code of the Russian Federation for medical workers has been established by the abbreviated duration of the working week - not more than 39 hours. Decree of the Government of the Russian Federation of February 14, 2003 No. 101 due to the special working conditions for a number of categories of medical personnel, an abbreviated duration of the working week, component of 24, 30, 33 and 36 hours, was established.
In accordance with the clarification of the Ministry of Labor of Russia dated December 29, 1992 No. 5, approved by the decision of 29.12.1992 No. 65, the daily period of working time is calculated on the calculated schedule of the five-day working week with two weekends on Saturday and Sunday. The duration of the working day is determined by dividing the weekly duration of working time for 5 days.
In accordance with Art. 95 TK RF Duration of the working day or shift, directly preceding the non-working holiday day, decreases by 1 hour.
At the coincidence of the weekend and non-working day, the day off is transferred to the next day after the holiday. In order to rational use by workers of the weekend and non-working days, the Government of the Russian Federation has the right to transfer the weekend to other days. As a rule, as a result of such transfers, there are 7 or 8 pre-holiday days during the year. Currently, the number of non-working holidays in the Russian Federation is determined by the Law of the Russian Federation of December 29, 2004 No. 201 "On Amendments to Article 112 of the Labor Code of the Russian Federation":
When calculating the number of workers, festive non-working and pre-holiday days a year, it is advisable to use the production calendar.
In 2009 - 250 working days on the five-day work week, 7 pre-holiday days.
In connection with the adoption of the Labor Code of the Russian Federation, a transition was carried out on the calculation of labor leave in calendar days (Art. 115 of the Labor Code of the Russian Federation), but the duration of leave remained the same. In the calculations of the annual budget, vacation time is advisable to determine as a product of the weekly duration of working time for the number of weeks.
Example of calculation.
Annual Budget of the Working Position of the Medical Sister of the City Hospital at a 39-hour week of week, a 28-day vacation (among the calendar days), designed for 2009, is 1787 h: (39/5) × 250 - 7 - 4 × 39 \u003d 1787 h, or 107 220 min (60.0 × 1787).
Example of calculation.
The number of medical sisters posts to ensure the work of a round-the-clock post at the annual working time budget, equal to 1787 hours, calculated according to Formula 5 is 4,916 positions ((24 x 366) / 1787)
The calculation of the number of posts in a particular department is carried out by the formula:
Dotod \u003d (DP × K) / n, (6)
where dotd is the number of posts in the department;
DP is the number of posts per 1 post;
K - the number of beds in the department;
P - number of beds for 1 post (according to the standard).
Example of calculation.
In the compartment for 30 beds with a regulatory indicator, which constitutes 20 beds per 1 post, and the number of the posts of a medical sister (ward) to ensure the work of one round-the-clock post, equal to 4,916 positions (at the 39-hour week and 28 days of vacation), 7,374 The posts of the ward medical sister: (4,916 × 30) / 20 \u003d 7,374.
The calculation was carried out according to formula 6.
Features of the standardization of middle and younger medical personnel in day hospitals
In recent years, random-intensive types of care are obtained. The regular standards of the medical staff of day hospitals establishes the post of senior medical sister (regardless of the total number of beds). Positions of nurses are introduced at the rate of 1 Position for 15 beds, the posts of ceiling agencies or junior medical care sisters are established according to the posts of nurses (order of the Ministry of Health of Russia of 09.12.1999 No. 438).
The amount of work of secondary and junior medical personnel is associated with the need to organize the care and implementation of medical purposes during the daytime, and in different institutions, the opening hours of the day hospital are determined depending on the specific local conditions and range from 5 to 9 h daily. In some cases, a two-chaired work of the day hospital is practiced. When calculating, it is necessary to take into account the number of days of the day hospital per year: in a five-day or six-day working week, without weekends and holidays, etc.
The calculation of the number of medium and junior medical personnel in day hospitals can be performed on the basis of these photochricultural observations. However, given the complexity of photographic surveillance observations to determine the norms of time in health facilities, it can be recommended to use the existing regulatory framework for these personnel groups through hospital institutions, but taking into account the time of the day hospital.
Planning the number of ward nurses, junior nurses for patient care, ceiling agencies, celestial sanitary-cleaners of hospital institutions are carried out by establishing round-the-clock posts on a specific number of beds. When organizing the work of this personnel, the load rate (maintenance) during the daytime, as a rule, increase, in the night - decrease. For example, when planning a single post on 20 beds in the daytime, you can set the load of 15 beds, and in the night - 40-50 beds.
However, differences in the composition of patients in the day hospital compared to a conventional hospital department, the mobility of patients and self-service ability allow us to be taken as the basis for planning the number of medium and younger medical personnel in the day hospital. The total value of the number of bed numbers for one post.
The calculation of the number of posts of the elegant nurses, ceiling agencies in day hospital are carried out by the formula:
Dmitne \u003d X (T / W) X (K / N), (7)
where ddvnun is the number of posts of ward nurses and emergency sites in day hospital;
The referee is the number of medical sisters or senses to ensure the work of the round-the-clock post;
T - the number of hours of day hospital over the year;
W is the number of hours of work around the clock post per year;
K - the number of beds in day hospital;
N is a regulatory number of beds in a hospital with a 24-hour stay at 1 post.
Example of calculation.
The hospital of the daytime stay of the therapeutic profile on 25 beds is open from 10 to 18 hours, i.e. 8 hours daily within 303 days (at the six-day working week).
Therefore, T \u003d 2424 h (8 × 303). The round-the-clock post of the Klative Medical Sister in the Therapeutic Office of the City Hospital is installed on 20 beds, manifold-cleaners - for 30 beds (with a two-beared service system). To ensure the work of the round-the-clock post, 4,916 posts are required (at the 39-hour working week and 28 days of vacation). Calculations according to Formula 7 show that in this day hospital in 2009 it is necessary to 1,696 posts of nurses and 1,131 sentences.
In accordance with the procedure for rounding posts to the staffing schedule, 1,75 posts of the Balant Medical Sister and 1.25 post-cleaner retirement were introduced.
Conclusion
The formation of a socially oriented market economy and its development is impossible without developed labor relations. The material basis of any society is the labor activity of people. Labor is independent of any public forms the condition of human existence and makes it an eternal natural necessity. All areas of employment need regulation. In this regard, labor regulation in health care becomes even greater relevance.
Currently, for therapeutic and preventive institutions there is no unified land regulatation base, which affects the quality of the medical services provided. All developed materials in the field of labor regulatory, which are used in the organization of labor in health facilities, were either developed in the late 1980s., Or were published several years ago without a serious revision, taking into account the current situation in the modern health system of the Russian Federation. The modern organization of labor rationing in health care requires improvement in part of the definition and use in further calculations of the work time utilization coefficients for basic and other activities, as well as for the operational and auxiliary time.
As can be seen from the work done, scientifically based norms of labor, correctly reflecting specific conditions, ensure an increase in labor productivity. If the norms of labor are underestimated, they can give rise to pessimism, which adversely affects performance results, if the norms are overestimated, they are impracticable. In both cases, the growth of labor productivity will be braked. Thus, all changes in the organization of labor and production, technology and work technologies are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor in the enterprise. Labor rationing is the basis of labor planning.
In health organizations, work on labor organization should be carried out in a timely manner in order to further reduce the cost of the provision of medical services to the population, taking into account the use of new work techniques, best practices, as well as improving jobs and equipment used. The result of the use of proposed guidelines will be developed by the developed rational norms of the load for medical personnel of therapeutic and preventive institutions.
Bibliography
one . Valchuk E.A. Socio-economic norms and regulations. Their use in health management // Medicine. - 1998. - № 2.
2. Kadyrov F.N. Stimulating wage systems in health care. M.: Grant, 2000.
3. Organization and standardization of labor / Ed. V.V. Adamchuk. - M.: Finstatinform CJSC, 1999.
four . Shipova V.M. Organization of labor organization in healthcare / ed. Acad. Ramne O.P. Screech. M.: Grant, 2002.
five . Adamchuk V.V., Romanov O.V., Sorokina M.E. Economy and Sociology of Labor: Textbook for universities. - M.: Uniti, 1999.
6. Economy Course: Textbook / Ed. B.A. Rezberg. - Infra-M, 1997.
7. Meeting recommendations "Development of labor standardizing technology in health care", approved by the Ministry of Health and Social Development of Russia 20.12.2007 No. 250-PD / 704. Developers' authors - employees of the GU National Research Institute of Public Health Ramna: O.P. Schepin, A.L. Lindenbrene, V.M. Schipova, V.V. Kovaleva, N.K. Grishina, V.I. Filippova, S.M. Golovin, O.A. Kozachenko, N.B. Solovyov.
8.Shipova V.M. Planning the number of medical personnel of hospital institutions. M.: Grant. 1999.
9. Maglis A. L., Shilova V.M., Gavrilov V. A. The number of posts of the LPU // Methodical and regulatory materials on the calculation of the number of positions and the preparation of staff schedules of medical and prophylactic institutions. - M.: Agar, 1997.
For medical workers, there is a shortened duration of working time not more than 39 hours per week. Depending on the post and (or) specialty, the length of working time of medical workers is determined by the Government of the Russian Federation.
In accordance with the Decree of the Government of the Russian Federation of February 14, 2003, N 101 "On the duration of the working time of medical workers, depending on their position and (or) specialty," the following abbreviated duration of working time is established for medical professionals, depending on their position and ( or) specialty:
36 hours a week - on the list according to Appendix N 1; For example, medical professionals working in infectious hospitals, departments, wards, as well as in the cabinets; Skin-venereological dispensaries, offices, medical workers working with HIV-infected, etc.
33 hours a week - on the list according to Appendix N 2; (an outpatient reception doctor, exercising exclusively an outpatient reception of patients in preventive organizations, institutions (clinics, ambulance, dispensary, medical items, stations, branches, cabinets)
30 hours a week - on the list according to Appendix N 3; (doctors, as well as medium medical staff working intuberculous (anti-tuberculosis) organizations of health and their structural divisions;
24 hours a week - for medical professionals directly carrying out gamma therapy and experimental gamma irradiation with gamma-drugs in radio announcement rooms and laboratories.
Individual categories of health workers can be provided annual additional paid vacation. The duration of additional vacation is established by the Government of the Russian Federation.
According to Article 222 of the Federal Law "On the prevention of the dissemination of the disease in the Russian Federation caused by the human immunodeficiency virus (HIV infection)" employees of enterprises, institutions and organizations of state and municipal health systems, carrying out diagnosis and treatment of HIV-infected people, as well as persons, work which are associated with the materials containing the human immunodeficiency virus, the allowance for the official salary is paid, a shorter working day is established and an additional vacation for work in particularly dangerous working conditions. The procedure for granting these benefits is determined by the Government of the Russian Federation. In particular, according to the Decree of the Government of the Russian Federation of April 3, 1996 N 391 "On the procedure for providing benefits to employees who are subjected to the risk of infection with the human immunodeficiency virus in the performance of their official duties," employees of health organizations, carrying out diagnosis and treatment of HIV-infected people, as well as employees of organizations whose work is associated with the materials containing the human immunodeficiency virus, the working hours of 36 hours per week and the annual paid leave of 36 working days (taking into account the annual additional leave for working in the health of working conditions for health).
Resolution of the Ministry of Labor of Russia dated August 08 of August 1996 N 50 "On approval of the procedure for providing an abbreviated duration of working time (36 hours per week) and annual paid leave with a duration of 36 working days (taking into account the annual additional holidays for working in hazardous labor conditions) employees Health organizations carrying out diagnosis and treatment of HIV-infected people, as well as employees of organizations whose work is related to the materials containing human immunodeficiency virus "approved the procedure for providing the reduced duration of working time and annual paid leave to employees of health organizations, the category of which are provided in the annex to this resolution .
Thus, the Resolution identifies the categories of workers who are established by the abbreviated duration of working time (36 hours per week) and an annual paid leave with a duration of 36 working days (taking into account the annual additional leave for work in dangerous labor conditions). It is also provided that the abbreviated duration of the working day (shift) on the basis of the 36-hour working week is approved for the categories of workers listed in the ruling, only in those days when they were actually occupied on the work in the health of labor conditions.
TK RF. Article 350. Some features of labor regulation of medical workers
For medical workers, there is a shortened duration of working time not more than 39 hours per week. Depending on the post and (or) specialty, the length of working time of medical workers is determined by the Government of the Russian Federation.
Health care organizations living and working in rural areas and in urban-type settlements, the duration of work on part-time may increase by decision of the Government of the Russian Federation, adopted taking into account the opinion of the relevant All-Russian Professional Union and the All-Russian Employers Association.
(see text in the previous edition)
In order to implement the program of state guarantees of free provision of medical care to citizens in emergency or urgent form of medical professionals with their consent, duty may be established at home.
Home duty is a medical professional medical staff at home in anticipation of a challenge to work (to provide medical care in emergency or urgent form).
When taking into account the time actually spent a medical worker of a medical organization, the time of duty at home is taken into account in the amount of one second hour of working time for every hour of duty at home. The total duration of the working time of the medical worker of a medical organization, taking into account the time of duty at home, should not exceed the norm of the working time of the medical worker of a medical organization for the corresponding period.
The positions of managers, deputy heads of medical organizations subordinate to the federal executive bodies, the executive authorities of the constituent entities of the Russian Federation or local governments, heads of branches of medical organizations, jumped by federal executive authorities, are replaced by persons under the age of sixty-five, regardless of the labor period contracts. Persons who occupy the specified posts and reached the age of sixty five years are translated from their written consent to other positions corresponding to their qualifications.
The founder has the right to extend the period as an employee who occupies the position of head of the medical organization, subordinated by the federal executive authority, the executive authority of the subject of the Russian Federation or the local government body, until the age of seventy years old on the submission of the General Meeting (Conference) of the employees of this Medical Organization .
The head of the medical organization, subordinated by the federal executive body, the executive authority of the constituent entity of the Russian Federation or local government, has the right to extend the period of stay as an employee who holds the position of deputy head of the specified medical organization or the position of head of the branch of a medical organization, subordinated by the federal executive authority, Until they reach the age of seventy years in the manner established by the Charter of the Medical Organization.
Art. 350 TC RF. Some features of labor regulation of medical workers
Perhaps it will be useful to read:
- Performance analysis and efficiency of labor use;
- Improving the organization of the labor of the staff of the rational organization of the activities of the medical institution personnel;
- Characteristics of the process and main stages of strategic management of the organization The initial stage of the strategic management process;
- Asymmetric information in the economy;
- Methods of mentoring staff;
- Mentoring as an element of personnel development system in the company;
- Labor rationing in health care you are tired;
- Changing the volume and cost of production in the short term;