Features of the legal regulation of the work of medical workers. Improving the organization of work of the personnel Rational organization of the activities of the personnel of the medical institution
"Medical Law", 2004, N 4
FEATURES OF LABOR REGULATION OF MEDICAL WORKERS
The work of a doctor at all times has been honorable and respected, its importance is invaluable even now, since a medical worker is directly responsible for the life and health of a patient. Therefore, special requirements are imposed on him, which, in turn, are compensated for by benefits and compensations. All these claims and compensations are usually reflected in the employment contract with the employee.
In addition to general provisions Labor Code RF medical workers are subject to the provisions of the Fundamentals of Legislation on the Protection of Citizens' Health of July 22, 1993 N 5487-1, devoted to the lesson medical activities, as well as a number of other subordinate normative legal documents. The main document regulating the work of a physician is an employment contract concluded with an employer.
CONCLUSION OF THE EMPLOYMENT CONTRACT
The definition of an employment contract is given in article 56 of the Labor Code of the Russian Federation, it states that this is an agreement between the employer and the employee, in accordance with which the employer undertakes to provide the employee with work according to the stipulated labor function ensure the working conditions stipulated by the Labor Code of the Russian Federation, laws and other regulatory legal acts, collective agreements, agreements, local regulations containing labor law norms, timely and in full pay wages to the employee, and the employee undertakes to personally fulfill the labor specified in this agreement function, to comply with the internal rules of the organization work schedule... The parties to the employment contract are the employer and the employee.
The employment contract is concluded in writing, is drawn up in two copies, each of which is signed by the parties. One copy of the employment contract is handed over to the employee, the other is kept by the employer. The need for a written form of the contract is due to the fact that the relations regulated by it are designed for a long period, contain essential conditions for both the employee and the employer, the change in these conditions must be agreed upon and mutually.
The possibility of occurrence labor relations with the actual admission to work with the knowledge or on behalf of the employer or his representative, regardless of whether the employment contract was properly executed (Articles 15, 67 of the Labor Code of the Russian Federation). In the future, it is still necessary to formalize the labor relationship in writing.
Hiring is formalized by the order (order) of the employer, issued on the basis of the concluded employment contract (Article 68 of the Labor Code of the Russian Federation). This is, in fact, an internal document of the organization necessary for maintaining HR administration... Nevertheless, the order is announced to the employee against receipt within three days from the date of signing the employment contract. Also, the employee has the right to demand the issuance of a duly certified copy of the order (instruction) to him.
ESSENTIAL TERMS OF THE EMPLOYMENT CONTRACT
The essential terms of the contract are the conditions on the subject of the contract, the conditions named in the law or other legal acts as essential or necessary for contracts of this type, as well as all those conditions regarding which an agreement must be reached at the request of one of the parties. This concept is borrowed from civil law (Article 432 of the Civil Code of the Russian Federation).
When considering the essential terms of an employment contract, one should dwell on the differences between employment contracts and civil law contracts, which are similar in content to labor contracts (contract for work, paid services, commission, agency services, etc.).
The search for differences between labor contracts and civil law contracts is relevant, since often the employer tries to substitute the latter for the employment contract, especially when hiring for temporary work. An employee, however, considers such a contract as a labor contract. The consequences of concluding a 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 the unified social tax to the tax base (in terms of the amount of tax payable to the Fund social insurance RF) does not include any remuneration paid to individuals under agreements of a civil nature, including copyright and license agreements.
Participants in civil law relations are equal and independent. In labor relations, the employee is subject to 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 an employment contract. The contract must indicate: the last name, first name, patronymic of the employee and the name of the employer (last name, first name, patronymic of the employer - an individual) who have entered into an employment contract.
The Code provides for the need to specify such conditions as:
Place of work (indicating the structural unit);
Start date of work;
The name of the position, specialty, profession with an indication of qualifications in accordance with the staffing table of the organization or a specific job function. Decree of the Government of the Russian Federation of October 29, 2002 N 781 approved the List of positions and institutions, work in which is counted in the length of service, which gives the right to early assignment of an old-age retirement pension to persons who carried out medical and other activities to protect the health of the population in state and municipal health care institutions, in accordance with subparagraph 11 of paragraph 1 of article 28 of the Federal Law "On labor pensions in Russian Federation". Therefore, if there is an appointment to a position indicated in the List, then the name of this position must correspond to this List;
Employee's rights and obligations;
Employer's rights and obligations;
Characteristics of working conditions, compensation and benefits to employees for work in difficult, harmful and (or) dangerous conditions;
The mode of work and rest (if it in relation to this employee differs from the general rules established in the organization);
Labor remuneration conditions (including the size tariff rate or official salary employee, additional payments, allowances and incentive payments). In budgetary healthcare organizations, one 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 remuneration of healthcare workers",
Types and conditions of social insurance directly related to work. According to the changes made to Art. 63 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens by the Federal Law of August 22, 2004 N 122-FZ, measures social support medical and pharmaceutical workers healthcare organizations that are on budgetary support at various levels (federal, constituent entity of the Federation, municipal) are established by the relevant authorities (the Government of the Russian Federation, authorities state power subject or local government).
Also, according to the changes introduced by the said law, medical and pharmaceutical workers are deprived of the right to receive priority living quarters, to install a telephone, to provide their children with places in preschool and sanatorium institutions, to purchase vehicles on preferential terms used to perform professional duties in a traveling nature of work. ...
Doctors, pharmacists, workers with secondary medical and pharmaceutical education of the state and municipal health care systems, working and living in rural areas and urban-type settlements, as well as their family members living with them, are not entitled to apply for free provision of apartments. These changes come into force on January 1, 2005.
An employment contract may provide conditions for testing, on nondisclosure of secrets protected by law (state, official, commercial and other), on the employee's obligation to work after training for at least the period established by the contract, if training was carried out at the expense of the employer, as well as other conditions not worsening the position of the employee in comparison with the Labor Code of the Russian Federation, laws and other regulatory legal acts, collective bargaining agreements, agreements.
The terms of the employment contract can be changed only by agreement of the parties and in writing.
As a general rule, an employment contract is open-ended.
If a fixed-term employment contract is concluded, it shall indicate the period of its validity and the circumstance (reason) that served as the basis for the conclusion of a fixed-term employment contract in accordance with the Labor Code and other federal laws... The Resolution of the Plenum of the Supreme Court of the Russian Federation of March 17, 2004 N 2 (clause 13) states that the conclusion of a fixed-term employment contract is a right and not an obligation of the employer.
The Supreme Court also pointed out that when establishing in the course of court proceedings the fact of multiple conclusion of fixed-term employment contracts for a short period to perform the same labor function, the court has the right, taking into account the circumstances of each case, to recognize the employment contract as concluded for an indefinite period.
DIFFERENCE OF EMPLOYMENT CONTRACT FROM CIVIL LEGAL
CONTRACTS CLOSE IN LABOR CONTENT
Unlike an employment contract a prerequisite most paid civil contracts are the start and end dates of the contract.
The most common type of civil law contracts used to regulate labor relations is a work contract. Article 702 of the Civil Code of the Russian Federation defines a work contract as a contract under which one party (contractor) undertakes to perform a certain work on the instructions of the other party (customer) and hand over its result to the customer, and the customer undertakes to accept the result of the work and pay for it.
The subject of a work contract is a certain result of the contractor's work, and not his performance of a specific job function, as is the case in an employment contract. According to Art. 703 of the Civil Code of the Russian Federation, a work contract is concluded for the manufacture, processing or processing of a thing or for the performance of other work with the transfer of its result to the customer. As a general rule, Art. 704 of the Civil Code of the Russian Federation, the contractor performs the work on his own, that is, from his own materials, on his own. The employee always performs the function provided for in the employment contract personally, that is, on his own, but the provision of materials and funds necessary to perform the work is the employer's responsibility. The contractor, if the law or the work contract does not imply his obligation to perform the work provided for in the contract personally, has the right to involve other persons in the performance of his obligations (clause 1 of article 706 of the Civil Code of the Russian Federation). The employment contract implies that the employee performs his job duties only personally.
Unlike an employee, according to the general rule of Art. 705 of the Civil Code of the Russian Federation, the risk of accidental death or accidental damage to the result of the work performed before its acceptance by the customer is borne by the contractor. This risk for the contractor is that in the case of the specified random events the contractor completely or partially loses the right to payment for the work performed. This cannot happen to an employee, since all similar property risks are borne by the employer, and the employee retains his right to receive payment for the performance of the function provided for by the employment contract, even if the intended result was not achieved due to circumstances beyond the employee's control.
The price of work in a work contract is not one of its essential conditions (Article 709 of the Civil Code of the Russian Federation), the amount and conditions of labor remuneration must be indicated in the employment contract (Article 57 of the Labor Code of the Russian Federation).
A contract for the provision of services for compensation bears more resemblance to an employment contract than a work contract, since the subject of a contract for the provision of services for compensation is the performance by the performer of certain actions or the performance of another certain activities(Art. 779 of the Civil Code of the Russian Federation), which, as a rule, is not accompanied by the creation of any particular thing. In addition, according to Art. 780 of the Civil Code of the Russian Federation, the performer, as a general rule, is obliged to provide services personally. Therefore, the main criterion for distinguishing between an employment contract and a contract for the provision of services for a fee is the presence or absence of the contractor's obligation to obey the rules of the customer's internal labor regulations when providing services. At the same time, it should be noted that the general provisions on the work contract apply to the contract for the provision of services for compensation, if this does not contradict the norms of the Civil Code of the Russian Federation on the provision of paid 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 law contract is concluded between the parties, however, during the trial it will be established that this contract actually regulates labor relations between the employee and the employer, the provisions of the Labor Code of the Russian Federation should apply to such relations.
ADMISSION TO MEDICAL ACTIVITIES.
SPECIALIST CERTIFICATE
To work in a medical organization, a secondary or higher education is required medical education, for an employee with a higher education, a certificate of a specialist in a medical specialty is also required.
In the case of hiring an intern student, the task becomes more complicated, because Until now, a clear regulatory legal framework governing the procedure for passing internships for young specialists, including obtaining a certificate, has not been developed.
The main documents on this issue are: Art. 54 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens of July 22, 1993 N 5487-1, Orders of the USSR Ministry of Health of 01/20/1982 N 44 "On measures to further improve the training of medical personnel in internship" and of 08/16/1972 N 669 "On the approval of instructions on payment procedure wages doctors undergoing a one-year specialization (internship), and additional payment to the heads of departments of city (central district), regional, regional and republican hospitals that directly train doctors and fulfill instructions on the procedure for enrolling in internships and for work of graduates of medical institutes. "
In connection with the cancellation of the Order of the Ministry of Healthcare of the Russian Federation of 12/19/1994 "On the approval of the Regulations on the procedure for admission to the exercise of professional (medical and pharmaceutical) activities" (with clarifications of the Ministry of Health of the Russian Federation dated 07.08.95 N 15-00), the question of the procedure for obtaining a doctor -intern certificate of a specialist. Recall that earlier, in accordance with the above documents, a specialist certificate was issued after the end of the internship without an additional exam.
WORK TIME. WORKING BEYOND NORMAL
WORKING TIMES
The Labor Code does not specify the permissible duration of daily work for medical workers, 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 appropriate Federal Law (such a law has not yet been adopted), and Article 350 of the Labor Code of the Russian Federation for medical workers a reduced duration of working hours is established - no more than 39 hours per week. Decree of the Government of the Russian Federation of February 14, 2003 N 101, adopted in accordance with this article of the code, established an even shorter working time for some categories of medical workers - from 36 to 24 hours a week. The new edition of the Labor Code of the Russian Federation, which will enter into force on January 1, 2005, will provide for the possibility of establishing by the Government of the Russian Federation specific categories medical workers providing additional annual paid leave.
Separately, one should dwell on the issue of work outside the normal working hours. Labor legislation provides for two options: overtime work(carried out on the initiative of the employer) and part-time jobs, if the initiative comes from the employee (Article 97 of the Labor Code of the Russian Federation).
Overtime work - work performed by an employee on the initiative of the employer outside the established working hours, 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 involve the employee in overtime work in statutory cases (part 2 of article 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 work in connection with other circumstances, the employer must obtain, 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, overtime work is carried out within the framework of the existing employment contract, a new employment contract is not concluded.
Overtime work is limited to four hours on two consecutive days and 120 hours a year.
Overtime work is paid for the first two hours of work not less than one and a half amount, for the next hours - not less than double the amount. The specific amount of overtime pay may be determined by a collective agreement or an employment contract.
Unlike the Labor Code of the Russian Federation, now, at the request of the employee, overtime work instead of increased pay can be compensated by the provision of additional rest time, but not less than the time worked overtime (Article 152 of the Labor Code of the Russian Federation).
Chapter 44 of the Labor Code of Russia is devoted to part-time work. A part-time job is the performance by an employee of other regular paid work on the terms of an employment contract during his free time from the main job. Part-time work can be performed by an employee both at the place of his main work, and in other organizations.
As a general rule, part-time work cannot exceed four hours a day and 16 hours a week.
Separately, the Labor Code of the Russian Federation indicates the specifics of part-time work for certain categories of workers, including doctors.
Decree of the Ministry of Labor of the Russian Federation of June 30, 2003 N 41 "On the specifics of part-time work for pedagogical, medical, pharmaceutical workers and cultural workers" established: internal part-time jobs are allowed for medical and pharmaceutical workers in cases where a reduced working time is established.
The duration of part-time work of the specified categories of employees during 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 working time calculated from the established duration of the working week;
For medical and pharmaceutical workers who have less than 16 hours of work per week for half of the monthly standard of work for their main job - 16 hours of work per week.
For doctors and secondary medical staff cities, districts and other municipalities where there is a shortage of them - the monthly norm of working hours, calculated from the established duration of the working week. At the same time, the duration of part-time work in specific positions 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 under the jurisdiction of the subjects of the Russian Federation or local self-government bodies - in the manner determined by the bodies state authorities of the constituent entities of the Russian Federation or local governments;
For junior medical and pharmaceutical personnel - the monthly norm of working hours, calculated from the established duration of the working week.
At the same time, the duration of part-time work in specific positions 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 under the jurisdiction of the subjects of the Russian Federation or local self-government bodies - in the manner determined by the bodies state authorities of the constituent entities of the Russian Federation or local government bodies.
Also, this Resolution provides a list of types of work that are not part-time and do not require the conclusion (registration) of an employment contract, since the performance of these works is allowed in the main work time with the consent of the employer.
COMPENSATIONS AND BENEFITS FOR EMPLOYEES
UNDER SEVERE, HARMFUL AND / OR DANGEROUS ENVIRONMENTS.
OBLIGATORY INSURANCE FOR MEDICAL WORKERS
The Labor Code of the Russian Federation (Articles 92, 117) establishes shorter working hours and additional paid leave for workers employed in jobs with harmful and (or) hazardous working conditions. Lists of such industries, jobs and positions that give the right to a shorter working day and additional leave must be approved by the Government of the Russian Federation. Prior to their adoption, in accordance with Article 423 of the Labor Code of the Russian Federation, it is possible to apply regulatory legal acts issued before the adoption of the Labor Code of the Russian Federation, in the part that does not contradict it.
Resolution of the USSR State Committee for Labor and the Presidium of the All-Union Central Council of Trade Unions of 25.10.1974 N 298 / P-22 approved the List of industries, workshops, professions and positions with harmful working conditions, work in which gives the right to additional leave and a shorter working day. There is also an instruction for its use (approved by the Decree of the USSR State Committee for Labor, All-Union Central Council of Trade Unions of 11/21/1975 N 273 / P-20). This List contains section XL "Healthcare", which lists the various medical and preventive institutions and their divisions, work in which gives the right to additional leave and shorter working hours. Thus, employers are obliged to provide employees in the relevant positions with the prescribed benefits. According to Art. 126 of the Labor Code of the Russian Federation replacement of vacation monetary compensation such workers are not allowed.
It should be noted that in accordance with Art. 120 of the Labor Code of the Russian Federation, additional vacations, like the main ones, are calculated in calendar days, and in the mentioned List they are set in working days. A way out of this situation can be found if, for example, the duration additional leave in calendar days in a collective agreement or issue an order or order for the organization, in which to establish the number of calendar days of additional leave corresponding to working days.
The length of service, which gives the right to additional annual paid leave for work with harmful and (or) dangerous working conditions, includes only the time actually worked under such conditions (Article 121 of the Labor Code of the Russian Federation). Consequently, the organization needs to organize a separate accounting of working hours, which gives the right to such vacations.
Also, employers need to take measures to protect the health of workers. Order of the Ministry of Health and Social Development of the Russian Federation of August 16, 2004 N 83 approved lists of harmful and (or) hazardous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, as well as the procedure for conducting these examinations (examinations).
Harmful and (or) dangerous production factors are listed in the List of chemical, biological, physical factors, as well as factors of the labor process. If an employee is exposed to any of the listed factors, for example, ultraviolet radiation, he must undergo medical examinations in accordance with this document.
Federal Law of August 22, 2004 N 122-FZ, which concerns the monetization of benefits, amending a large number of laws, including the Fundamentals of Legislation of the Russian Federation on the Protection of Citizens' Health, among other things, clarifies the conditions for compulsory insurance of medical, pharmaceutical and other workers state and municipal health care systems, the work of which is associated with a threat to their life and health.
So, in the new edition of Article 64 of the Fundamentals, it is said about the list of positions, the occupation of which is associated with a threat to the life and health of employees, the amount and procedure for compulsory insurance, which must be approved by the Government of the Russian Federation.
The amount and procedure for compulsory insurance for medical, pharmaceutical and other employees of health care organizations under the jurisdiction of the constituent entities of the Russian Federation or under the jurisdiction of municipal health care organizations whose work is associated with a threat to their life and health are established, respectively, by the state authorities of the constituent entities of the Russian Federation or local self-government bodies. ...
Compulsory insurance also provides for the payment of a one-time cash allowance to the families of deceased employees of the state and municipal health care systems in the performance of their labor duties or professional duty during the provision of medical care or scientific research.
AMENDMENT OF THE EMPLOYMENT CONTRACT
In the course of work, organizational or technological working conditions may change at the initiative of the employer. Such changes concerning the essential terms of the contract must be agreed with the employee and drawn up in writing, or in the form supplementary agreement to the employment contract, or by renewing the contract with the employee.
The employer is notified of the introduction of such changes 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 another job available in the organization, corresponding to his qualifications and state of health, and in the absence of such work, a vacant lower position or lower-paid work that the employee can perform. taking into account his qualifications and state of health.
In the absence of the specified work, as well as in case of refusal of the employee from the proposed work, the employment contract is terminated in accordance with paragraph 7 of Art. 77 of the Labor Code of the Russian Federation.
If the employee refuses to continue working under the conditions of the relevant working hours, then the employment contract is terminated in accordance with paragraph 2 of Art. 81 of the Labor Code of the Russian Federation with the provision of appropriate guarantees and compensations to the employee.
The abolition of part-time work is carried out by the employer, taking into account the opinion of the representative body of the employees of the organization.
Changes to the essential terms of the employment contract that worsen the employee's position in comparison with the terms of the collective agreement or agreement cannot be introduced.
The Code describes a number of cases when no changes are required in the employment contract, we are talking about an initiative coming from the employer (Articles 72, 74-76):
1. Transfer to another permanent job in the same organization on the initiative of the employer, that is, changing the job function or changing the essential conditions of the employment contract, as well as transferring to permanent work in another organization or in another locality together with the organization is allowed only with the written consent of the employee (Article 72 of the Labor Code of the Russian Federation).
A transfer to another permanent job in the same organization, as well as a transfer to a permanent job in another locality together with the organization is drawn up by an order (order) of the employer. The corresponding record of the transfer is entered in the work book.
When transferring to work in another locality, employees are paid appropriate compensations: the cost of travel for the employee himself and his family members, the cost of baggage, the cost of settling in a new place, etc. (Article 169 of the Labor Code).
"Other" means the area outside the administrative-territorial boundaries of the corresponding settlement... Transfer to work from one locality to another, even within one administrative region, is considered as transfer to another locality, regardless of the presence of a bus or other regular service between these points.
The employer who, in accordance with the medical opinion, needs to provide another job, the employer is obliged, with his consent, to transfer to another existing job that is not contraindicated for him for health reasons. If the employee refuses to transfer or if there is no corresponding work in the organization, the employment contract is terminated in accordance with clause 8 of Art. 77 of the Labor Code of the Russian Federation.
The Code establishes that it is not a transfer to another permanent job and does not require the consent of the employee to move him in the same organization to another workplace, to another structural unit of this organization in the same locality, assigning work on another mechanism or unit, if this does not entail changes in the labor function and changes in the essential conditions of the employment contract. Although information about the structural unit is one of the essential conditions of the employment contract.
2. Also, it is not required to amend the employment contract when temporary transfer for another job, in case of production necessity (Article 74 of the Labor Code of the Russian Federation). The employer has the right to transfer the employee for a period of up to one month to work not stipulated by the employment contract in the same organization with wages for the work performed, but not lower than the average earnings for the previous job. Such translation is allowed to prevent a catastrophe, industrial accident or eliminate the consequences of a catastrophe, accident or natural disaster; to prevent accidents, downtime (temporary suspension of work for reasons of an economic, technological, technical or organizational nature), destruction or damage to property, as well as to replace an absent employee. At the same time, the employee cannot be transferred to work that is contraindicated for him for health reasons.
The duration of a transfer to another job to replace an absent employee cannot exceed one month during a calendar year (from January 1 to December 31).
With written consent, an employee can be transferred to a job requiring lower qualifications.
3. The Labor Code of the Russian Federation (Art. 76) obliges the employer to remove from work (not allow to work) an employee: who appears at work in a state of alcoholic, narcotic or toxic intoxication; who has not undergone training and testing of knowledge and skills in the field of labor protection in the prescribed manner; not passed in the prescribed manner mandatory preliminary or periodic medical checkup; as well as if contraindications for the employee to perform work stipulated by the employment contract are identified in accordance with the medical report; according to the requirements of the authorities 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 suspends (does not admit to work) the employee for the entire period of time until the elimination of the circumstances that were the basis for the suspension from work or non-admission to work.
During the period of suspension from work (non-admission to work), the employee's wages are not charged, with the exception of cases provided for by federal laws. In cases of suspension from work of an employee who has not undergone training and testing of knowledge and skills in the field of labor protection or a mandatory preliminary or periodic medical examination through no fault of his own, he is paid for the entire period of suspension from work as for idle time.
In the event of a change in the owner of the organization's property new owner no later than three months from the date of the emergence of the right of ownership, he has the right to terminate the employment contract with the head of the organization, his deputies and the chief accountant. With other employees of the organization, the new owner does not have the right to terminate employment contracts only on the basis of a change in the owner of the organization's property. At the same time after state registration the transfer of ownership, a reasonable reduction in the number or staff of employees is allowed, which is not directly related to the change in the owner of the organization.
An employee may refuse to continue working in connection with a change in the owner of the organization's property. In this case, the employment contract is terminated in accordance with paragraph 6 of Art. 77 of the Labor Code of the Russian Federation.
When the jurisdiction (subordination) of the organization changes, as well as when it is reorganized (merger, accession, division, separation, transformation), labor relations continue with the consent of the employee.
TERMINATION OF THE EMPLOYMENT CONTRACT
The grounds for terminating the employment contract are listed in Art. 77 of the Labor Code of the Russian Federation, it is precisely the paragraphs of this article that must be referred to when making a record of dismissal in the employee's work book in accordance with the Rules for maintaining and storing work books, making work book forms and providing employers with them, approved by Decree of the Government of the Russian Federation of 04.16.2003 N 225, with the exception of cases of termination of an employment contract at the initiative of the employer and due to circumstances beyond the control of the parties.
Upon termination of an employment contract on the initiative of the employer, a record of dismissal (termination of the employment contract) is made in the work book with reference to the relevant paragraph of Article 81 of the Labor Code of the Russian Federation.
When the employment contract is terminated due to circumstances beyond the control of the parties, an entry is made in the work book about the grounds for terminating the employment contract with reference to the relevant paragraph of Article 83 of the Labor Code of the Russian Federation.
In all cases, the day of dismissal of an employee is the last day of his work.
Legal advisor to a law firm
"Uniko-94"
N.I. STRELKINA
The Association assists in the provision of services in the sale of timber: at competitive prices on an ongoing basis. Timber products are of excellent quality.
One of the most important tasks of communist construction is the creation of the material base of communism, under which a steady increase in labor productivity and its scientific organization are noted. In modern conditions, NOT is a labor organization based on the achievements of science and advanced experience, systematically introduced into production.
Mechanization and automation of labor contribute to the continuous increase in its productivity, the preservation of human health and the gradual transformation of labor into the first vital necessity. NOT stands for consistent and steady improvement in the organization of work.
Further improvement of the health care system is unthinkable without the introduction of the elements of NOT in all its links. The purpose of NOT is to improve medical care for the population, to further improve its quality, to ensure optimal sanitary and hygienic working conditions for medical personnel, maximum labor productivity and effective cost working time, prevention of occupational diseases, the use of the labor process as a therapeutic and prophylactic factor. Labor should give medical workers moral satisfaction.
Physiology of labor solves the main problem - about fatigue of the body, at the same time identifying those measures that will help reduce it. Fatigue can occur as a result of the labor process, as well as as a result of any shortcomings in the organization of labor in production. The productivity of a tired person is much lower than that of a well-rested person. If the fatigue that develops during the work shift is so significant that it cannot be eliminated during the daily and weekly rest, overwork occurs - which is a painful process, for the elimination of which medical assistance is needed. Therefore, NOT provides for the fight against increased fatigue.
The scientific organization of labor in medical institutions is of great national economic importance. As an incentive to improve the quality of medical care for the population, it helps to reduce morbidity, disability, and increases work capacity and labor productivity.
The subject of NOT is the most rational distribution of personnel, reasonable division and cooperation of labor, equipping and equipping a workplace that excludes unproductive waste of time and labor, the introduction of methods and techniques that facilitate the work of medical personnel. The centralized supply of linen, foodstuffs, medicines, etc. allows the middle and junior medical personnel to significantly reduce the time spent visiting the pharmacy, catering facility and to pay more attention to the direct service of patients in the departments.
Examining the actual time spent on various elements of the treatment process can identify and reduce the wasted time and labor of medical personnel.
The work schedule of nursing staff is drawn up depending on the profile of the department, the number of patients in it, etc. Patient care should be as close as possible to the individual, which can be achieved by attaching each nurse and junior nurse to certain wards.
When organizing her workplace, a nurse must comply with sanitary and hygienic requirements, norms and rules that make it possible to create maximum comfort for both patients and staff.
A nurse's workplace should have everything you need. It should be equipped in such a way as to eliminate the unnecessary waste of time looking for the necessary medicines, instruments, documentation, etc. All departments should be equipped with light and sound alarms according to the "patient - nurse on duty" scheme, which ensures a quick response of the nurse to the call. The organization of telephone or intercom communication between all departments of the hospital significantly reduces wasted time. Nursing medical posts should be provided with the tools necessary for each department, a special stand, which lists the studies required for various diseases, the rules for preparing patients for them and taking material for analyzes.
A two-stage system of patient care significantly improves their care and the work of nursing and junior medical personnel. Mechanization of the work of junior nurses makes their work much easier. To reduce the unproductiveness of the labor costs of district nurses, it is necessary to gradually release them from performing unskilled preparatory work before going to the site. Nurses receive standardized assignments, ready-made styling with the required amount sterile syringes and other materials written out on special standard prescription forms and patient addresses,
The preparatory work is centralized in one place, entrusting it to specially designated persons. The central sterilization laboratory of the polyclinic should supply sterile material and equipment for nurses. It is necessary to provide district nurses with the polyclinic's vehicles and provide them with certain benefits for travel on public transport during the execution official duties... It was found that nurses of the therapeutic and pediatric departments spend 38.8% of their working time to serve patients at home and the same amount on moving around the site. Since work on the site is more responsible and associated with increased emotional stress, the need for more qualifications, the issue of material and moral stimulation district nurses working in more difficult conditions.
Rationalization of the work of senior nurses should be carried out by reducing the time spent on writing by introducing various ready-made standard forms, timesheets, schedules, applications for materials, simplifying the accounting system, centralizing the receipt and issuance of medicines, inventory, materials.
In many polyclinics, posts of a paramedic on duty, a nurse, dispatch centers, etc. have been organized. This reduces the time patients spend visiting the polyclinic, as well as 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 the formation of the NOT, it became clear that the nurses in the hospital are very busy with the maintenance of medical records, purely economic activities that do not require medical knowledge, which reduces the efficiency of their work with a significant expenditure of physical strength. The rationalization of the work of nurses cannot be carried out in isolation from medical work. All practical activities of doctors and nurses, all types and forms of NOT may lose their significance and do not give an effect if the staff violates the principles of deontology. NOT and care for the culture of medical personnel, for its proper conduct and treatment of patients is a single process, links in one chain.
Forms of division and cooperation of labor, if they are chosen correctly and meet the specific conditions of a given medical institution, must certainly contribute to saving time, reducing material costs, increasing labor efficiency. Practice shows that rational division and cooperation of labor contribute to an increase in its content, qualifications and creative activity of medical workers; the monotony and monotony of labor are eliminated, and fatigue is reduced. The most important points in the field of health care are the improvement of working conditions and the rational organization of the workplace of medical personnel. The ongoing work on the introduction of NOT convincingly testifies to its great efficiency.
More on the topic SCIENTIFIC LABOR ORGANIZATION (NOT) IN THE WORK OF A MEDICAL NURSE:
- The main organizational and methodological principles of the scientific organization of labor in health care institutions
- 13. Regulations on the nurse of the organizational and methodological department for social and medical work
- The Law “On Health Insurance of Citizens in the Russian Federation”. Stages of its implementation. Organization of work and licensing of medical institutions
Introduction
The current stage of health care development raises in a new way the issues of the quality of medical care provided to the population. The proper level of medical care can only be achieved with the appropriate staffing healthcare institutions. The formation of the number of medical personnel, the establishment of labor standards, the rational placement and use of personnel are the most significant components of the labor rationing system in health care, which are based on sectoral labor regulations. Currently, the regulatory framework developed by the USSR Ministry of Health at the end of the 80s is used. Normative documents on labor are not focused on the organizational and technical conditions for the operation of medical and preventive healthcare institutions, as well as the incidence of the population and the demographic situation that are currently taking place in Russia. The need to update the existing regulatory framework and develop modern labor regulations is quite obvious. First, the crisis phenomena in the economy and the deterioration of the ecological situation in recent years have significantly changed the nature of the pathology and the severity of the disease in the population served, as well as the frequency of referrals, the duration and intensity of treatment. In this regard, it became necessary to develop new modern norms and standards for labor and improve the existing ones. Secondly, the standard standards for most of the main types of institutions (regional, city hospitals, adult and children's city polyclinics, etc.), developed 25-30 years ago and corresponding to the technology of the diagnostic and treatment process adopted at that time, do not meet modern requirements and need revision. Thirdly, the rapid development of medical science, the introduction of new technologies and modern technology in the treatment and diagnostic process, the improvement of instrumental research methods have significantly changed the nature and content of a doctor's work 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 labor rationing methods, methods for studying the costs of working time and approximate calculations of labor rationing for middle and junior medical personnel.
The work uses various sources, publications, educational literature.
The work consists of several sections. The first section characterizes the concept of labor standards, its types, defines the functions, tasks and principles of labor rationing, as well as the procedure for introducing, replacing and revising labor standards. The second section examines the types of labor rationing, methods of studying the cost of working time. In the third section, the calculations of the rate setting for the work of middle and junior medical personnel of various departments of a medical institution are given.
The conclusion contains conclusions about the work done and a list of references.
Theoretical aspects of labor rationing in health care
The essence of labor standards and its types
The standard of work is the amount of work established for an employee per hour, day (shift), week, month, year, which he is obliged to perform under normal working conditions. The employer is obliged to ensure normal working conditions: good condition of mechanisms, equipment, devices, timely provision of technical documentation, proper quality materials and tools for work, their timely submission, safe and healthy working conditions. Labor standards - production, time, service rates - are established in accordance with the achieved level of technology, technology, labor and production organization, and should be systematically revised if they change. Labor standards are subject to mandatory replacement as well as certification of workplaces, implementation new technology, technologies, technical re-equipment of production, ensuring an increase in labor productivity. The introduction, revision and replacement of labor standards is made by the employer, taking into account the opinion of the trade union committee, local regulations. Employees are notified of the introduction of new standards at least two months in advance.
There are the following types of labor standards: production rates; time norms; service standards; population norms; standardized tasks; consolidated and complex norms used in collective forms of organization and remuneration (in the production team). According to their sphere of action, labor standards are distinguished: uniform, standard, intersectoral, sectoral (departmental) and local. In practice, there are always local ones, which are developed on the basis of standard, industry and other centralized norms of a recommendatory nature.
The production rate is the amount of work established in units of production, work operations, which 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 output or a work operation; it is used to calculate, determine production rates and other labor rates.
Service standards are the volume of servicing of production mechanisms, machine tools, and areas established for one employee. A variety of them is the control rate - the number of workers in a given production, who must be managed by one manager (foreman, site manager, foreman, etc.). This is also a calculated standard for determining the staff of managers who manage labor.
The number of workers is the established number of working personnel of a certain profession, qualifications for performing work in a given production area, for example, repair workers for servicing machines or all workers in a shop, department, enterprise, institution, organization.
The headcount rate and the service rate are interrelated, since the number of employees is determined by the service rate, and vice versa.
The enlarged and comprehensive norms used in the collective work of the production team in a single outfit are calculated for the entire team of the team, that is, this is the amount of work that the team must perform per day, week, month.
With a piece-rate wage system, a piece rate is applied - this is payment for a unit of product made (work operation) of proper quality (without marriage). The piece rate under a simple piece rate system is always the same, no matter how much the worker produces; under a piece-rate progressive system, it is the same within the limits of production, and for products made in excess of the norm, it progressively rises (but this system is rarely used, since it affects the cost of production). Piece rates are set by the administration and are also revised with a revision of labor standards.
The normalized task is the total amount of work per working day (shift) for an employee or a team, established under a time-based wage system based on time rates and production rates, and is used to improve the efficiency of workers with time-wages. Depending on the time for which the task is set, the daily (shift) and monthly standardized tasks are distinguished. In essence, this is a special production rate applied to time workers.
Functions, tasks, meaning and principles of labor rationing
The main functions of labor rationing are distribution according to work, scientific organization of labor and production, production planning, assessment of the labor activity of individual workers and collectives, which serves as the basis for moral and material encouragement and dissemination of advanced experience.
Labor rationing includes:
¾ study and analysis of working conditions and production possibilities at each workplace;
¾ study and analysis of production experience to eliminate deficiencies, identify reserves and reflect best practices in labor standards;
¾ designing a rational composition, method and sequence for performing the elements of the labor process, taking into account technical, organizational, economic, physiological and social factors;
¾ establishment and implementation of labor standards;
¾ systematic analysis of the implementation of labor standards and revision of outdated standards.
The main tasks of labor rationing are to:
¾ substantiate the necessary and sufficient amount of labor time spent on a unit of production in specific conditions;
¾ design rational labor methods;
¾ systematically analyze the fulfillment of labor standards to reveal production reserves;
¾ constantly analyze the fulfillment of labor standards to reveal production reserves;
¾ constantly study, generalize and disseminate production experience, revise labor costs as working conditions change.
The solution of these tasks will make it possible to facilitate the work of workers, increase labor productivity and increase the volume of production.
Labor rationing is the basis scientific organization labor. With the help of the methods used in the regulation of labor, losses and unproductive expenditures of working time are distinguished. By studying labor movements the most economical, productive and least tiring methods of work are developed. This contributes to the growth of labor productivity. Further improvement of the organization of labor is impossible without improving its regulation.
Also, labor rationing is the basis for organizing wages. The establishment of labor standards pursues the goal of guaranteeing a certain labor productivity to the society, and a certain level of wages to the employee. According to the fulfillment of labor standards, the labor activity of each employee is assessed and his labor is paid. Without labor rationing, it is impossible to implement the economic law of distribution according to labor.
Labor rationing is an important means of organizing production. The organization of production is the management of the production process material wealth, i.e. networking between labor force and means of production to achieve maximum economic effect in specific conditions. Through the organization of labor, the influence of labor rationing on the organization of production is manifested.
Scientifically based labor standards allow us to evaluate the results of the labor activity of each employee, each team and compare their results. Only by comparison are the leaders and the laggards revealed.
Scientifically based labor standards, correctly reflecting specific conditions, ensure an increase in labor productivity. If labor standards are understated, they can generate complacency or pessimism, which negatively affects productivity results, if the norms are overestimated, they are impracticable. In both cases, the growth of labor productivity will be inhibited. Thus, all changes in the organization of labor and production, technology and work technology are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise.
Labor rationing is the basis of labor planning. For perspective, current and operational planning a whole system of norms is applied: norms of consumption of materials, energy of fuel, norms of productivity of machines, norms of expenditure of working time. Thus, labor standards play important role in the system of norms used in planning in the enterprise.
Drawing up a work plan and establishing labor costs in accordance with the volume of production is impossible without scientifically based labor standards. The greater independence of enterprises in matters of labor planning increases the interest of collectives in the implementation of scientifically based labor standards.
Labor rationing should be based on the following principles:
¾ scientific validity of labor standards;
¾ equal intensity of labor standards for identical jobs in identical conditions;
¾ preservation of the main productive force of society - the working people;
¾ participation of workers in the establishment of labor standards.
The labor rate acts not only as a quantity necessary costs working time, but also as an expression of the work responsibilities of each participant in the production.
Procedure for the introduction, replacement and revision of labor standards
According to Art. 160 of the 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.
The introduction, as well as the replacement and revision of labor standards are formalized by the organization's local regulations (order, order, regulation on rationing, etc.) and taking into account the opinion of the representative body of workers (trade union body, council labor collective etc.).
The most rational and preferable method of designing regulatory materials is the analytical-calculation method, since it is the most perfect and cost-effective.
To develop labor standards, the following activities are organized and carried out:
1. Preparatory and organizational-methodical work.
In the course of the work, the goals and objectives of the development of normative materials for the regulation of labor are determined, the types of norms are specified, a technical task is drawn up.
The terms of reference are developed by the organization executing the normative research work and approved by the customer organization.
The current technology, instructions, regulations, organizational and technical conditions and methods of performing work at workplaces are studied, equipment passports are selected, the characteristics of the tools, devices, raw materials, materials, equipment operating modes, the content of technological and labor processes are selected; the possibility of developing normative materials with the use of time standards, including microelement ones, the use of electronic computers for the design of rational work processes and the calculation of labor standards is established.
A methodological program of work on the development of a regulatory document is being developed, reflecting the following issues:
¾ selection of enterprises (institutions, organizations), their structural divisions, on the basis of the organization of production and labor of which progressive technological (labor) processes and rational organizational and technical conditions for their implementation will be developed, provided for in the design of labor costs;
¾ use of existing normative materials for labor rationing, including microelement standards;
¾ determination of factors affecting the time spent in performing individual works and ensuring the highest accuracy of standards and norms with the least complexity and laboriousness of their development;
¾ instructing workers who observe and analyze the costs of working time and design norms and standards, the use of devices, video equipment for this work, computer technology, data of statistical, operational and other reporting;
¾ checking the draft of normative materials in production conditions;
¾ preparation of the collection of normative materials as a whole.
2. Studying the cost of working time at workplaces.
These works include:
¾ preparation for observations: performers are selected, whose work will be monitored, the compliance of the technology, organization of the workplace and its maintenance with the designed ones is specified;
¾ Carrying out direct measurements of working time (timing, photographs of working time, video filming of work processes, etc.) or instant observations; at the same time, the materials associated with the establishment of labor costs at the selected enterprises are used to the maximum;
¾ carrying out technical calculations, experimental and other research works processing the collected materials.
3. Processing of collected materials.
These works include:
¾ analysis and generalization of the results of studying the costs of working time, the development of standards (norms) of labor costs;
¾ clarification of the main factors affecting the amount of labor costs; derivation of empirical (based on experience) formulas of dependencies between the values of influencing factors and the values of labor costs;
¾ preparation of a draft normative document in the first edition, as well as instructions on the procedure for its verification directly at the enterprise;
¾ determination of specific enterprises (institutions, organizations), their structural subdivisions for conducting inspections of regulatory materials on them;
¾ sending the draft normative document with instructions on the procedure for conducting its verification to the selected enterprises (institutions, organizations), to their structural divisions.
4. Verification of normative materials in a production environment.
The purpose of the check is to identify the nature of the clarifications and additions to be made to the project.
5. Preparation of the final version of regulatory materials.
The analysis and study of the results of checking the draft normative document in production conditions, generalization of the received reviews, comments and suggestions are carried out.
The established labor standards in accordance with Art. 160 of the Labor Code of the Russian Federation may be revised as the improvement or implementation of new equipment, technology and organizational or other measures are taken to ensure an increase in labor productivity, as well as in the case of the use of physically and morally obsolete equipment.
It should be noted that there cannot be a reason for revising the previously established norms, the achievement of a high level of production (provision of services) by individual workers through the use, on their initiative, of new methods of work and improvement of workplaces (that is, advanced methods and forms of labor organization).
Replacement and revision of uniform and model norms carried out by the bodies that approved them. The revised norms are formalized by the local regulation organizations and are communicated to employees no later than two months before the introduction.
Checking the labor standards in force at the enterprise (institution, organization) is carried out certification commissions, approved by the heads of enterprises (institutions, organizations).
Based on the results of the check for each standard, a decision is made: to certify or not to certify. Technically justified norms are recognized as certified, corresponding to the achieved level of technology and technology, organization of production and labor.
Outdated and erroneously established norms are recognized as not attested and are subject to revision. Outdated, in particular, should be considered the norms in force at work, the labor intensity of which has decreased as a result of a general improvement in the organization of production and labor, growth professional excellence and improving the production skills of workers and employees. Norms can be considered erroneous if the organizational and technical conditions were incorrectly taken into account or inaccuracies were made in the application of normative materials or in the calculations.
When checking the norms of labor costs, the administration is obliged to ensure a thorough check of the implementation of the technology provided for by the norms in all operations of the labor process, the compliance of the actually performed volume of work with the volumes laid down in the calculation of the norms. At the same time, the administration, based on specific production conditions, is obliged to rationalize technological processes those operations, the conditions for the performance of which, stipulated by the norms, do not correspond to the achieved level of organization of production and labor, advanced experience.
The revision of outdated norms is carried out within the time frame and in the amount established by the management of the enterprise in agreement with the trade union committee. Revision erroneous norms carried out as soon as they are identified in agreement with the trade union committee.
The basis for the application of correction factors to the norms and standards may be the development of production capacities, new equipment, technology, new types of products or the discrepancy between the actual organizational and technical conditions of production provided for in the newly introduced norms and standards.
Labor rationing methods
Types of labor rationing methods
Improving medical care to the population requires not only building up the material and personnel base of health care, but also further improving the style and methods of work, organizational activities at all levels, taking into account the economic efficiency of the activities. One of the important tasks for the further improvement of health care is the rational use of all resources. Determining the scope of activities of a particular group of medical personnel, establishing a direct relationship between indicators and wages, calculating the cost of providing medical care to the population as a whole and its individual types is especially important during the period of introduction of economic management methods in health care and the transition to insurance medicine.
Labor rationing is an important tool for solving these problems. To date, the needs of the population in certain types of medical care remain insufficiently studied, scientifically grounded proposals on a number of health care institutions, their structural divisions and positions of medical personnel, as well as recommendations on rational forms of labor organization, have not been developed.
The method of labor rationing is a set of techniques for studying and analyzing labor processes, determining the cost of working time, identifying and accounting for norm-forming factors, designing a rational organization of labor and developing standards.
The regulation of the work of medical workers is the most difficult issue, reflecting the specifics of the industry and requiring a careful approach and scientific justification when solving it. In health care, as in other sectors of the national economy, there are two types of labor rationing methods: analytical and summary (Fig. 1).
Figure 1- Methods of labor rationing
The analytical method provides for the division of the labor process into separate components. Depending on the methods of developing labor standards, this method is divided into analytical-research and analytical-calculation.
The analytical research method is a method in which the labor rate is established on the basis of studying the cost of working time using photo-timing observations directly at the workplace. It involves a detailed study of the production process and labor costs by its constituent elements. On the basis of these data, the most rational technological modes of equipment operation and the organization of the workplace and labor are designed.
The analytical and computational method provides for the calculation of time consumption according to predetermined time standards, equipment operation modes, as well as formulas for the dependence of time on factors affecting the duration of the operation. This method sets the standardized number of auxiliary workers, managers, specialists and technical executors.
The total method of labor rationing establishes the expenditure of working time as a whole per unit of production of a specific work process without analyzing the latter. The way the work is done is determined by the employee. The types of the summary method are experimental, statistical and comparative methods.
Experienced method. The expert gets acquainted with the workplace, means and working conditions and intuitively, on the basis of his subjective impressions and previous experience, determines the labor standard. The established labor rate is not an average value, but only a partial value of the possible expenditure of working time. Its validity, compliance with the conditions of the workplace depends entirely on the experience of the expert. This method is not able to provide the same intensity of norms. Moreover, it only reflects past experiences. Practice shows that labor standards established by an experienced intuitive method, as a rule, are of low quality. This is evidenced by the significant overfulfillment of such norms by the majority of workers.
Statistical method. Labor standards are established primarily on the basis of statistical reporting data on the volume of work. This method can be used only if the doctor is confident that, on the one hand, there is no shortage of working time, and on the other hand, the technology of the treatment and diagnostic process is observed, and the patient is provided with proper medical care in full.
The comparative method for establishing labor standards is used when the technology of personnel work is similar to that for which there are already standard indicators. For example, activities medical registrars, statisticians, etc. is homogeneous in all types of institutions.
The total method, which does not fully take into account the content and organization of the labor 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 cost-effectiveness in some cases makes one give preference to this particular method.
Thus, at present, for the centralized development of labor standards, it is advisable to apply mainly the analytical and research method. In health care institutions, in order to determine the number of personnel required for a particular volume of work, the establishment of a number of standard indicators, the calculation and analytical method should be widely used. In cases where there are no developed standards for the workload of personnel, for example, when introducing new types of instrumental studies, when organizing a new service, it is possible to apply summary methods of standardization to establish temporary standards in order to carry out their scientific basis.
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
Let's consider each of them.
Timing, methodology.
Timing is a method of studying the cost of working time by measuring the recurring elements of an operation.
Its main purpose is to identify the most optimal methods of work and determine the corresponding norms of time. Timing allows you to assess the organization of the workplace, differentiate to study the structure of an individual operation and the conditions for its implementation. The timing process includes three stages.
At the first (preparatory) stage, the operation is divided into separate elements using fixing points. The fixation point is a distinct external sign, perceived by the eye or by ear, signaling the beginning and end of one or another element of the operation. At the same stage, the worker is instructed and the workplace is studied. This is documented in the front side of the timekeeping-observational card, where the data on the operation are entered, the amount of products produced at a certain time, the types and condition of the means of labor, the nature of the process, the qualifications and length of service of the performer, the applied wage system are indicated.
At the second stage, observation and time recording is carried out. Time measurements are made collectively and cumulatively using a two-hand stopwatch. The observer must record the time by fixing points and enter the stopwatch readings in the observation sheet of the time-keeping chart, monitor the order of the operation.
At the third stage, the data are processed and the duration of the operation element is determined. The obtained values of the duration of the operation element are recorded in the timing variation series, where the upper line is a variant - these are measurements in ascending (decreasing) order of the duration of measurements (t), and the lower line of frequencies (p) - shows how often this variant occurs in the time series. The total sum of frequencies should be equal to the number of measurements. Inaccurate (defective) measurements are preliminarily excluded and then the quality of the time series is assessed.
Photography of working hours, types and methods of carrying out
A photograph of working time is the observation, measurement and sequential recording of all, without exception, the time spent during a work shift or other period.
If the observation period coincides with the duration of the working day, it will be a photograph of the working day.
A photograph of working time is used to identify losses of working time and the reasons that cause them, as well as to establish the relationship between separate types time consuming. The obtained data are used as input for standardization.
The subject of the photograph can be workers, machines or manufacturing process generally. If the object of observation is one worker, then the photograph of the working time is an individual one, and if a group of workers is a group one. When the costs of working time are recorded by the worker himself, a self-photograph of working time takes place in order to study the losses of working time and their causes.
The photograph of the working time is carried out in three stages.
At the first stage, a preliminary study of the work is carried out, the choice of an object of observation. The object is selected depending on the purpose of observation. If it is necessary to obtain stable indicators of exemplary work, then the best worker is selected, and if it is necessary to study the reasons for non-fulfillment of norms, then the lagging workers are selected.
The second stage includes direct observation and study of all time costs with an accuracy of up to one minute. The results are recorded in special observation sheets. In this case, the types of work and breaks, as they are registered, are entered in the column "Name of time expenditures", and the moment of their completion - in the column "Current time".
At the third stage, based on the data from the observation sheet, a table of costs of the same name and the actual balance of working time are compiled. In conclusion, the analysis of the results of the observations is carried out, irrational costs and direct losses of working time are established, which are excluded when drawing up the projected balance, and the coefficient is determined possible increase labor productivity by eliminating losses and waste of working time.
Photo timing
Photo timing is a type of observation in which simultaneously with the photograph of working hours taken during the shift, timing is carried out in its individual periods. It is advisable to use it when studying the time spent on individual elements of work that do not repeat cyclically during the working day.
In the practice of work on labor, individual and group photo-timing are used. Thus, it is recommended to carry out group photo-timing when establishing the composition of the brigade and distributing functions among its members, the individual elements of which do not have cyclical repetition.
Observations and measurements are carried out accepted methods processing of the observation results, analysis of the data obtained and the design of rational work processes during photochronometry are carried out separately according to the data of time observations and photographs in the prescribed manner.
Momentary observation method
The method of instant observations allows you to register and take into account during the observation period the costs of the same working time of a group of performers or the time of work and breaks in the work of various numbers of equipment and, on this basis, determine the specific weights and absolute values of the time costs. The method is characterized by insignificant labor intensity and ease of observation and processing of the results obtained, the efficiency of the study, a wide coverage of observation of various objects, as well as the involvement of personnel in research with the simultaneous performance of their main work, etc. The disadvantages of the method include: obtaining only average values of the expenditure of working time and equipment usage time; lack of data on the sequence of execution of the studied processes, as well as possible changes, etc.
When conducting research, it is recommended to use analogue hour devices (watches, one- and two-hand stopwatches), special equipment that automatically fixes both the time and the content, structure and method of performing normalized processes (oscillography, photo-video and film equipment).
Filming ensures objectivity and high accuracy of registration of all elements of the labor process in time and space, as well as the conditions determining it, the completeness of the characteristics of the process under study (trajectory and speed of movements, distances of movement of objects of labor, sequence and degree of combination of techniques, actions and movements, etc. .)
Rationing of work of middle and junior medical personnel
Labor rationing of middle and junior medical personnel in outpatient clinics
The positions of middle and junior medical personnel in outpatient clinics are established according to the number of positions of outpatient doctors of a particular specialty (to calculate the number of positions of nurses and nurses in the corresponding offices). The positions of doctors of outpatient reception include all positions of doctors of outpatient and polyclinic institutions, except for the positions of doctors of clinical laboratory diagnostics, bacteriologists, radiologists, radiologists, physiotherapists, reflexologists, manual therapy, endoscopists, anesthesiologists-resuscitators, statisticians, doctors of points (departments) of medical care at home, physical therapy, sports medicine, functional or ultrasound diagnostics, health centers, city and district pediatricians as well as medical leaders of all ranks.
The need to allocate medical positions for outpatient admission is due to the fact that, depending on their number, according to staff standards, the number of positions of doctors and nurses in auxiliary and some other medical and diagnostic units is determined:
· The total number of positions of outpatient doctors: nurses in the treatment room, medical registrars (to calculate the number of positions of nurses in the treatment room, medical registrars);
The total number of positions of doctors (to calculate the number of medical statisticians);
· Change of work of a subdivision or institution (to calculate the number of nurses in a procedural, vaccination room, registry);
· The number of the population and its individual contingents (for calculating the number of nurses in vaccination rooms, nurses for collecting breast milk, etc.);
· Mixed procedure for establishing positions: to calculate the number of paramedics or filter nurses in the children's city polyclinic (change of work and the number of children).
Most of the current standard standards for outpatient clinics were approved more than 25 years ago: the standard standards for city and children's city clinics located in cities with a population of more than 25 thousand people are determined by order of the USSR Ministry of Health dated 10.11.1982 No. 999, in cities and urban-type settlements with a population of up to 25 thousand people. by order of the Ministry of Health of the USSR No. 900 dated September 26, 1978. In 2001, an order was approved according to the standard standards of children's polyclinics, which are part of city and children's city hospitals, medical units with hospitals (order of the Ministry of Health of Russia dated October 16, 2001 No. 371), however, the lack of substantiation of the main provisions of this order makes it unacceptable for health care practice.
By the nature and scope of activities of nursing staff assigned to outpatient doctors in various specialties, these positions can be divided into the following groups:
· Nurses carry out outpatient reception of patients together with the doctor;
· Along with outpatient appointments together with a doctor, nurses of district general practitioners, pediatricians, general practitioners (family medicine) also fulfill the doctor's prescriptions for the provision of appropriate diagnostic and treatment preventive care at home to the population of the site.
Nurses of surgeons, orthopedic traumatologists carry out dressings, application and removal of plaster, etc.
The first group includes most of the nursing positions of outpatient doctors. The normative ratio of middle and medical personnel in this group is, as a rule, 1: 1, that is, one position of a nurse is planned for one doctor's position. At the same time, in such specialties of doctors as neurology, endocrinology and dentistry, this ratio is violated and in accordance with the current staffing standards for one position of a doctor of these specialties, 0.5 positions of a nurse are established. It is difficult to find a logical explanation for such standards, and in the absence of appropriate recommendations at the sectoral level, the heads of health care institutions, on the basis of the rights granted to them to form the number of personnel in health care facilities, it is advisable to establish the number of posts of nursing staff in these specialties, corresponding to the medical one. By order of the Ministry of Health and Social Development of Russia dated April 14, 2006 No. 289, this provision for the children's dental clinic has been amended, and the positions of nurses in medical offices are established at the rate of 1 position for each position of a pediatric dentist, dentist-surgeon and orthodontist. This standard is quite consistent modern technologies treatment and diagnostic process in dentistry with the use of modern composite materials, “four-handed” work and ethical and legal norms for admitting a patient in a separate office.
In recent years, due to the introduction of mandatory health insurance in territories where payment is made for certain medical services, classifiers are developed and approved medical services, which establish the appropriate time standards for the doctor and nurse. The feasibility of such a separate establishment of time norms for those specialties where the norms define an equal number of doctors and nurses raises serious doubts. So, for example, in one of the classifiers for otolaryngology, where, according to the staffing standards, one position of a nurse for one position of a doctor is established, the time spent on anterior nasal tamponade (including after bleeding) is determined in the amount of 2.0 UET for a doctor and 1.5 UET for a nurse, i.e. 20 and 15 minutes, respectively. It is unlikely that a nurse, having finished the procedure before a doctor, will provide assistance to another patient without an appropriate medical examination and prescriptions. The situation becomes more complicated when the indicated expenditure of a doctor's working time is less than that of a nurse. For example, to replace the cystostomy drainage, the urologist is set 3.0 EVEN, i.e. 30 minutes, and the nurse - 4.0 EVEN, i.e. 40 minutes. After completing this operation, the doctor will accept the next patient without a nurse, which may lead to a violation of the technology of the treatment and diagnostic process, which provides joint work a doctor and a nurse, or wait within 10 minutes for the nurse to complete this labor operation.
Thus, the establishment of different norms of time for separate labor operations for a doctor and a nurse contradicts the sectoral labor standards that determine the ratio between the number of positions of nurses and outpatient doctors in a particular specialty.
Moreover, as noted in the Recommendations, the determination of the time spent on individual labor operations, as well as on simple and complex medical services, can be considered only as an intermediate stage for the formation of standard costs for a more consolidated indicator recorded in the reporting and accounting documentation of a healthcare facility, i.e. to visit.
The normative number of junior medical personnel positions is also differentiated according to the specialties of outpatient doctors. So, in city polyclinics located in cities with a population of over 25 thousand people, the positions of nurses are established at the rate of 1 position for each position of a surgeon, traumatologist, orthopedist, infectious disease specialist; for every 2 positions of physiotherapy physicians, allergists-immunologists; for every 3 positions of other outpatient doctors.
Labor standards for middle and junior medical personnel in hospital institutions
The rationing of the work of middle and junior medical personnel in hospital institutions has certain features, which are listed below:
· The need to provide round-the-clock service for patients in the hospital;
· The indicator that serves as the basis for calculating the number of posts is the number of beds;
· Establishment of load (service) standards for the day of the patient's stay in the hospital or shift.
The standards for the number of middle and junior medical personnel in hospital institutions are expressed in the number of beds per position, or per one round-the-clock post. Depending on this, the norms of time are set either for the day the position is open, or for the day.
Stage I. The standard costs of working time of medical personnel in hospital institutions are determined per 1 patient per day or per day. The stay of the patient in the hospital for the calculation of standard indicators for labor is differentiated as follows:
· Day of admission;
· Day of treatment;
· Day of discharge.
The time spent is usually set on the basis of timing.
The calculation of the weighted average indicator of the cost of working time of a nurse or a nurse working daily on the day of the patient's stay in the hospital (Tday) is carried out according to the formula:
Tday = (tp + tl x 0.825 (m - 2) + tv) / (m x 0.825), (1)
where tp is the time spent by a nurse or doctor per patient on the day of admission;
tl is the time spent on a patient during the treatment period per day;
tв - time spent on the patient on the day of his discharge;
m is the average duration of inpatient treatment (in days).
A coefficient of 0.825 has been introduced into the formula, showing a reduction in the number of days of work of a nurse or a nurse during the entire period of stay due to holidays and weekends. When calculating the coefficient, 12 holidays and 52 days off are taken into account when working on a six-day working week: (365-52-12) / 365 ≈ 0,825.
Under the specified regime, that is, nurses are working daily, providing individual care for seriously ill patients, dressing rooms, procedural rooms, barmaids, and nurses.
Calculation example
The time spent by a nurse for the organization of individual care for seriously ill patients per 1 day of the patient's stay is 100 minutes on the day of admission, 80 minutes daily during the treatment period and 70 minutes on the day of discharge. The weighted average with an average length of stay of a patient equal to 13 days, calculated according to formula 1, is 83.5 minutes.
(100 + 80 × 0.825 × (13 2) + 70) / (13 × 0.825) ≈ 8.4.
There are about 10% of seriously ill patients in the department, therefore, this indicator per one hospitalized person is 8.4 minutes (83.5: 10).
Most nurses and nurses in hospitals work around the clock. In this case, a 2 or 3 power service system is introduced.
The use of a 2-stage system provides for the care of patients by a doctor and a nurse. At the same time, the ward nurse fully and directly serves the patient, and the sanitary cleaner performs only sanitary and hygienic functions in the wards and utility rooms. The forced performance by ward nurses of the functions of junior medical personnel, for example, cleaning premises in the absence of an adequate number of nurses, undoubtedly worsens the quality of medical care and contradicts sanitary and hygienic requirements.
In a 3-degree system, a doctor, a nurse and a nurse are involved in patient care.
The calculation of the weighted average costs of the working time of a nurse or a nurse per day of hospital stay (Tsut) is calculated using a formula similar to formula 1, but without taking into account the coefficient 0.825:
Tsut = (tp + tl x (m - 2) + tv) / m, (2)
All designations correspond to formula 1, calculated not for a day, but for a day of a patient's stay in the hospital.
The weighted average cost of time is calculated separately for patients admitted as planned and for emergency indications, and for surgical departments, in addition, for operated and non-operated patients. Then given specific gravity emergency hospitalization and operational activity are determined by the indicator of the average time spent by a nurse or a nurse per patient. This method of calculation makes it possible to model an effective indicator of the average time spent per patient according to the department profile, depending on changes in the basic working conditions: an increase or decrease in the volume of emergency hospitalization, the number of surgical interventions, changes in the average length of hospital stay, etc.
Calculation example.
The cost of a nurse's working time per patient per day by periods of hospital stay, admitted on an emergency basis and in a planned manner.
Calculations of the time spent on one patient per day, carried out according to formula 2, show that for those admitted in a planned manner with an average length of stay equal to 12 days, they will amount to 40.8 minutes:
(73.8 + 34.6 (12 2) + 70.2) x 12 ≈ 40.8.
Working hours for patients admitted on an emergency basis, with an average hospital stay of 8 days, will amount to 107.4 minutes: (396.6 + 60.8 (8 2) + 97.8) / 8 ≈ 107, 4.
The average time required for a 10% emergency hospitalization is 47.5 minutes: (107.4 x 10 + 40.8 x 90) / 100 ≈ 47.5.
The average time required for a 30% emergency hospitalization is 61.8 minutes: (107.4 x 30 + 40.8 x 70) / 100 ≈ 61.8.
Thus, an increase in the proportion of hospitalization for emergency indications from 10 to 30% leads to an increase in the cost of a nurse's working time per patient per day from 47.5 to 61.8 minutes, i.e., by 30%.
Stage II. The calculated load (service) norms for medical personnel of hospital institutions are expressed in the number of patients served per day or per day according to the formula:
NB = (B x k) / T, (3)
where Nb - norms of the load on the hospital's medical staff;
B - daily working hours of medical personnel (in a six-day working week) or daily working hours;
k is the coefficient of using the working time of nursing staff for the main and auxiliary activities;
T is the 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, that is, the time of direct contact of the personnel with the patient, namely, the performance of various kinds of procedures and manipulations. However, some categories of medical personnel do not have any contact with patients at all, for example, a cleaning nurse with a two-level service system, therefore, their main activity is to perform a direct production task.
All the preparatory work done to perform the main activity and carried out both in the presence and in the absence of the patient is an auxiliary activity: preparation and cleaning of the workplace, preparation for manipulation, procedure, transfer to another department, etc.
During the working day, the staff needs a short rest, eating, and carrying out sanitary and hygienic measures. These costs are related to the personal time required.
Interdisciplinary teaching materials recommend to devote about 10% of the working time to personal necessary time. The experience of labor rationing in health care shows that the coefficient of working time for main and auxiliary activities for most positions of medical personnel (except for auxiliary medical and diagnostic services) is 0.923, i.e., out of 6.5 hour working day, about 30 minutes are allocated to other types of work. : (6.5 - 0.5) / 6.5 = 0.923.
For further calculations, you can take a coefficient of 0.9.
Calculation example.
The calculated norms of the load of a nurse for the organization of individual care for seriously ill patients with the cost of working time per hospitalized person is 8.4 minutes; The load (service) rates, calculated according to formula 3, are 42 hospitalized:
(6.5 × 60 × 0.9) / 8.4 ≈ 42.
Calculation example.
The calculated load norms for a nurse with a working time per patient per day equal to 47.5 minutes, determined by formula 3, are 27 hospitalized: (24 × 60 × 0.9) / 47.5 ≈ 27,
and at a cost equal to 61.8 minutes - 21 patients: (24 × 60 × 0.9) / 61.8 ≈ 21.
Stage III. The standard for the position of medical personnel of a hospital institution, expressed in the number of beds per position, is calculated by the formula:
Nk = (Nb x 365) / R, (4)
where Nk is the number of beds per position;
Nb - load in the number of patients per day (from formula 3);
R is the planned number of days the bed will work in a year.
The value of the indicator R in formula 4 is:
· For city, regional hospitals - 330–340 days;
· For hospitals located in rural areas - 320 days;
· For infectious diseases hospitals - 310 days;
· For maternity hospitals - 300 days.
Calculation example.
The norm for the position of a nurse for the organization of individual care for critically ill patients of a department of a city hospital, calculated according to formula 4, with the time spent per patient per day equal to 8.4 minutes and the number of patients served equal to 42, is 45 beds ((42 x 365 ) / 340) for one position.
Calculation example.
To ensure the activities of the ward nurse of the department in the conditions of a city hospital with a working time per patient per day equal to 47.5 minutes, and an estimated load of 27 patients, a 24-hour post with 29 beds ((27 x 365) / 340) is required, and at a cost equal to 61.8 minutes and a load rate of 21 patients, there is a 24-hour post for 23 beds ((21 x 365) / 340).
The calculation of the number of posts to ensure the work of a round-the-clock post is carried out according to the formula:
Dpost = (24 × 60 × 365) / B, (5)
where Dpost is the number of posts to ensure the work of a round-the-clock post;
B - the annual budget of the working time of the position.
The annual budget of working time (B in formula 5) is calculated according to the formula presented in the Methodological Recommendations "Development of technology for the regulation of labor in health care":
B = m × d - n - z,
where B is the annual budget of working time;
m is the number of hours of work per day for a five-day working week;
d is the number of working days in a year for a five-day working week;
n is the number of hours of shortening the working day or shift on pre-holiday days (throughout the year);
z is the number of working hours per vacation period, which is determined by multiplying the weekly working hours by the number of vacation weeks.
In accordance with Art. 350 of the Labor Code of the Russian Federation for medical workers, a reduced working week is established - no more than 39 hours. Decree of the Government of the Russian Federation of February 14, 2003 No. 101 in connection with special conditions For a number of categories of medical personnel, a reduced working week has been established, amounting to 24, 30, 33 and 36 hours.
In accordance with the clarification of the Ministry of Labor of Russia dated December 29, 1992 No. 5, approved by Resolution No. 65 of December 29, 1992, the daily working time is calculated according to the estimated schedule of a five-day working week with two days off on Saturday and Sunday. The length of the working day is determined by dividing the weekly working hours by 5 days.
In accordance with Art. 95 of the Labor Code of the Russian Federation, the duration of a working day or shift immediately preceding a non-working holiday is reduced by 1 hour.
If a day off and a non-working holiday coincide, the day off is transferred to the next working day after the holiday. For the purpose of rational use of weekends and non-working days by employees, the Government of the Russian Federation has the right to postpone weekends to other days. As a rule, as a result of such transfers during the year there are 7 or 8 pre holidays... 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 working days, holidays, non-working days and pre-holidays in a year, it is advisable to use the Production calendar.
In 2009 - 250 working days in a five-day working week, 7 pre-holiday days.
In connection with the adoption of the Labor Code of the Russian Federation, a transition was made to the calculation of labor leave in calendar days (Article 115 of the Labor Code of the Russian Federation), but the duration of the vacation remained the same. In calculating the annual budget, it is advisable to determine the vacation time as the product of the weekly working time by the number of weeks.
Calculation example.
The annual budget of the working time of the position of a nurse in a city hospital with a 39-hour working week, 28-day leave (in the number of calendar days), calculated for 2009, is 1787 hours: (39/5) × 250 - 7 - 4 × 39 = 1787 h, or 107 220 min (60.0 × 1787).
Calculation example.
The number of positions of nurses to support the work of a 24-hour post with an annual budget of working hours 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 according to the formula:
Dotd = (Dp × K) / P, (6)
where Dotd is the number of posts in the department;
Дп - the number of posts per 1 post;
K is the number of beds in the department;
P is the number of beds per 1 post (according to the standard).
Calculation example.
In a department with 30 beds, with a standard indicator of 20 beds per 1 post, and the number of positions of a nurse (ward) to ensure the work of one round-the-clock post, equal to 4.916 positions (with a 39-hour working week and 28-day leave), 7.374 ward nurse positions: (4.916 × 30) / 20 = 7.374.
The calculation was carried out according to formula 6.
Features of the regulation of work of middle and junior medical personnel in day hospitals
In recent years, hospital-substituting types of care have been significantly developed. Established standards the position of the senior nurse is established for the medical personnel of day hospitals (regardless of the total number of beds). The positions of nurses are introduced at the rate of 1 position for 15 beds, the positions of ward nurses or junior nurses for patient care are established in accordance with the positions of nurses (Order of the Ministry of Health of Russia dated 09.12.1999 No. 438).
The volume of work of middle and junior medical personnel is associated with the need to organize care and fulfill medical appointments during the daytime, and in different institutions, the hours of the day hospital are determined depending on the specific local conditions and range from 5 to 9 hours daily. In some cases, two-shift work of the day hospital is practiced. When calculating, it is necessary to take into account the number of days of work of the day hospital in a year: on a five-day or six-day working week, without days off and holidays, etc.
The calculation of the number of nursing and junior medical personnel in day hospitals can be performed based on the data of photo-timing observations. However, given the laboriousness of photo-timing observations to determine the norms of time in health care institutions, it can be recommended to use the existing normative base for labor for these groups of personnel in hospital institutions, but taking into account the working hours of the day hospital.
Headcount planning ward nurses, junior nurses for patient care, ward nurses, ward nurses-cleaners of hospital institutions are carried out by establishing round-the-clock posts for a certain number of beds. When organizing the work of this personnel, the load (service) rates in the daytime, as a rule, increase, at night - they decrease. For example, when planning one post for 20 beds in the daytime, you can set the load to 15 beds, and at night - 40-50 beds.
However, the differences in the composition of patients in the day hospital as compared to the conventional hospital department, the mobility of patients and the ability to self-service make it possible to take the total value of the indicator of the number of beds per post as the basis for planning the number of nursing and junior medical personnel in the day hospital.
The calculation of the number of positions of ward nurses, ward nurses in the day hospital is carried out according to the formula:
Ddays = Dpost x (T / W) x (K / N), (7)
where Ddnevn is the number of positions of ward nurses and nurses in the day hospital;
Dpost - the number of positions of nurses or nurses to ensure the work of a round-the-clock post;
T is the number of hours of work of the day hospital during the year;
W is the number of hours of operation of the round-the-clock post per year;
K is the number of beds in the day hospital;
N is the standard number of hospital beds with round-the-clock stay for 1 post.
Calculation example.
The day hospital of a therapeutic profile with 25 beds is open from 10 am to 6 pm, that is, 8 hours daily for 303 days (in a six-day working week).
Therefore, T = 2424 h (8 × 303). A 24-hour post of a ward nurse in the therapeutic department of a city hospital is installed for 20 beds, cleaning attendants - for 30 beds (with a two-stage service system). To ensure the work of a 24-hour post, 4,916 positions are required (with a 39-hour work week and 28-day vacation). Calculations according to formula 7 show that in this day hospital in 2009, 1,696 positions of nurses and 1,131 positions of nurses are needed.
In accordance with the procedure for rounding off posts, 1.75 posts of a ward nurse and 1.25 posts of a ward nurse-cleaner can be introduced into the staffing table.
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 social forms condition of human existence and constitutes his eternal natural necessity. All areas of work require regulation. In this regard, the regulation of labor in health care becomes even more urgent.
Currently, there is no unified labor regulation base for medical and prophylactic institutions, which affects the quality of medical services provided. All the developed materials in the field of labor regulation, which are used in the organization of labor in health care institutions, were either developed in the late 1980s, or were published several years ago without serious revision, taking into account the current situation in the modern health care system of the Russian Federation. Modern organization Labor rationing in health care requires improvement in terms of determining and using in further calculations the coefficients of using working time for main and other activities, as well as for operational and auxiliary time.
As can be seen from the work done, scientifically grounded labor standards, correctly reflecting specific conditions, ensure an increase in labor productivity. If labor standards are underestimated, they can generate pessimism, which negatively affects productivity results, if the standards are overestimated, they are impracticable. In both cases, the growth of labor productivity will be inhibited. Thus, all changes in the organization of labor and production, technology and work technology are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise. Labor rationing is the basis of labor planning.
In health care organizations, work on labor rationing should be carried out in a timely manner in order to further reduce the time spent on providing medical services to the population, taking into account the use of new labor methods, best practices, as well as the improvement of workplaces and equipment used. The result of using the proposed methodological recommendations will be the developed rational load norms for the medical personnel of medical and preventive institutions.
Bibliography
1 . Valchuk E.A. Socio-economic norms and standards. Their use in health care management // Medicine. - 1998. - No. 2.
2. F.N. Kadyrov Incentive pay systems in health care. M .: Grant, 2000.
3. Organization and regulation of labor / Ed. V.V. Adamchuk. - M .: ZAO Finstatinform, 1999.
4 . V.M. Shipova Organization of labor rationing in health care / Ed. acad. RAMS O.P. Shchepina. M .: Grant, 2002.
5 . Adamchuk V.V., Romanov O.V., Sorokina M.E. Economics and Sociology of Labor: Textbook for universities. - M .: UNITI, 1999.
6. Economics Course: Textbook / Ed. B.A. Reisberg. - INFRA-M, 1997.
7. Methodical recommendations "Development of technology for labor rationing in health care", approved by the Ministry of Health and Social Development of Russia on 20.12.2007 No. 250-PD / 704. The authors and developers are employees of the State Institution National Research Institute of Public Health of the Russian Academy of Medical Sciences: O.P. Shchepin, A. L. Lindenbraten, V.M. Shipova, V.V. Kovalev, N.K. Grishina, V.I. Filippova, S.M. Golovina, O. A. Kozachenko, N.B. Solovyov.
8. Shipova V.M. Planning the number of medical personnel in hospital institutions. M .: Grant. 1999.
9.Margulis A.L., Shilova V.M., Gavrilov V.A. - M .: Agar, 1997.
A reduced working time of no more than 39 hours per week is established for medical workers. Depending on the position and (or) specialty, the duration of the working hours 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" for medical workers, the following shortened working hours are established depending on the position they hold and ( or) specialties:
36 hours a week - according to the list according to Appendix No. 1; For example, healthcare professionals working in infectious diseases hospitals, departments, wards, as well as in offices; dermatovenerologic dispensaries, departments, medical workers working with HIV-infected, etc.
33 hours a week - according to the list according to Appendix No. 2; (an outpatient doctor who performs exclusively outpatient reception of patients in treatment-and-prophylactic organizations, institutions (polyclinics, outpatient clinics, dispensaries, medical centers, stations, departments, offices)
30 hours a week - according to the list according to Appendix No. 3; (doctors, as well as nursing staff working vtuberculosis (anti-tuberculosis) healthcare organizations and their structural units;
24 hours a week - for medical workers directly carrying out gamma therapy and experimental gamma irradiation with gamma drugs in radio manipulation rooms and laboratories.
Certain categories of medical workers can be provided with annual additional paid leave. The duration of additional leave is established by the Government of the Russian Federation.
According to Article 22 of the Federal Law "On the Prevention of the Spread of Disease Caused by the Human Immunodeficiency Virus (HIV Infection) in the Russian Federation", employees of enterprises, institutions and organizations of the state and municipal health care systems who diagnose and treat HIV-infected people, as well as people who work which is associated with materials containing the human immunodeficiency virus, a bonus is paid to the official salary, a shorter working day and additional leave for work in especially dangerous working conditions are established. 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 granting benefits to employees at risk of contracting the human immunodeficiency virus in the performance of their duties," employees of health care organizations who diagnose and treat HIV-infected people, as well as employees of organizations whose work is related to materials containing the human immunodeficiency virus, the working time is 36 hours per week and the annual paid leave is 36 working days (taking into account the annual additional leave for work in hazardous working conditions).
Resolution of the Ministry of Labor of Russia of August 8, 1996 N 50 "On approval of the procedure for granting reduced working hours (36 hours per week) and annual paid leave of 36 working days (taking into account the annual additional leave for work in hazardous working conditions) to employees healthcare organizations that diagnose and treat HIV-infected people, as well as employees of organizations whose work is related to materials containing the human immunodeficiency virus "approved the procedure for granting reduced working hours and annual paid leave to healthcare workers, the categories of which are given in the annex to this resolution ...
Thus, the resolution defines the categories of workers who are assigned a reduced working time (36 hours per week) and an annual paid leave of 36 working days (taking into account the annual additional leave for work in hazardous working conditions). It is also stipulated that the reduced duration of the working day (shift) based on the 36-hour working week is approved for the categories of workers specified in the decree only on the days when they were actually employed in work in hazardous working conditions.
Labor Code of the Russian Federation Article 350. Some features of the regulation of the work of medical workers
A reduced working time of no more than 39 hours per week is established for medical workers. Depending on the position and (or) specialty, the duration of the working hours of medical workers is determined by the Government of the Russian Federation.
For medical workers of health care organizations living and working in rural areas and in urban-type settlements, the duration of part-time work may be increased by a decision of the Government of the Russian Federation, adopted taking into account the opinion of the relevant All-Russian Trade Union and the All-Russian Association of Employers.
(see text in previous edition)
In order to implement the program of state guarantees of free provision of medical care to citizens in an emergency or urgent form, medical workers of medical organizations, with their consent, may be on duty at home.
Duty at home - the stay of a medical worker of a medical organization at home while waiting for a call to work (to provide medical assistance in an emergency or urgent form).
When taking into account the time actually worked by a medical worker of a medical organization, the time of duty at home is taken into account in the amount of one second of an hour of working time for each hour of duty at home. The total duration of the working time of a medical worker of a medical organization, taking into account the time of duty at home, should not exceed the standard working time of a medical worker of a medical organization for the relevant period.
The positions of heads, deputy heads of medical organizations subordinated to federal executive bodies, executive bodies of the constituent entities of the Russian Federation or local self-government bodies, heads of branches of medical organizations subordinate to federal executive bodies are replaced by persons under the age of sixty-five years, regardless of the duration of the labor contracts. Persons holding these positions and having reached the age of sixty-five years are transferred, with their written consent, to other positions corresponding to their qualifications.
The founder has the right to extend the term of office of an employee holding the position of the head of a medical organization subordinate to federal body executive power, the executive power body of the constituent entity of the Russian Federation or local government body, until it reaches the age of seventy years on the proposal general meeting(conferences) of employees of the specified medical organization.
The head of a medical organization subordinate to a federal executive body, an executive body of a constituent entity of the Russian Federation or a local self-government body has the right to extend the term of office of an employee holding the position of deputy head of the said medical organization or the position of head of a branch of a medical organization subordinate to the federal executive body, until they reach the age of seventy years in the manner prescribed by the charter of a medical organization.
Art. 350 of the Labor Code of the Russian Federation. Some features of the regulation of the work of medical workers
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