Organizational and methodological work in the clinic. Problems and tasks of the organizational and methodological cabinet (department) of the polyclinic: regulatory support, recommendations for optimizing work

LESSON STRUCTURE

1. Introductory word of the teacher - 15 min.

2. Control survey - 30 min.

3. Study of policy documents - 30 min

4. Independent work - 45 min.

5.Solving situational problems - 45 min.

6. Summing up - 10 min.

7. Assignment for the next lesson - 5 min.

LITERATURE

Main literature:

1. Lisitsin Yu.P. Public health and health care: Textbook - M: GOETAR - MED. 2002

Additional

1. Public health and health care: Textbook / ed. V.A. Minyaeva, - M: MEDpress. 2002

2. Public health and health care: Textbook / ed. V.A. Minyaeva, N.I. Vishnyakova. 4th ed. M: MEDpress-inform. 2006

3. Legal foundations of health care in Russia / ed. Yu.L. Shevchenko - M: GEOTAR Medicine. 2006

TEST QUESTIONS

1. The main medical institutions serving the urban population, their structure.

2. City polyclinic and polyclinic department of the hospital, the importance of outpatient care in the system of medical care for the population.

3. Organization of primary health care.

4. District principle and dispensary method of medical care for the population. City medical station. Regulations.

5. Tasks and duties of the local general practitioner. Systems of work of local doctors. General practitioner (family doctor).

6. Organization of admission and treatment of patients in the clinic and at home.

7. Registry, its types, structure and system of work.

8. Indicators of the activity of the polyclinic and hospital, the method of their calculation and analysis.

Information content of the lesson

A city polyclinic is created as an independent medical and preventive institution, a structural subdivision of a medical and preventive institution of an urban district, or is part of an inpatient polyclinic association to provide primary health care to the population according to the district principle.

Outpatient care is of paramount importance in the system Russian healthcare:

1. Mass character - about 80% of all those who applied for medical help start and finish their treatment in the clinic.

2. Publicity

3. Preventive focus

4. District principle of work, dispensary method.

The main task of the city polyclinic is to reduce the incidence, disability and mortality of the population, sanitary and hygienic education of the population, promotion of a healthy lifestyle.

Structure of the United City Hospital:

Control: Chief Physician, deputies: for the medical part, for the polyclinic section of work, for the administrative and economic part.

Approximate structure of the city polyclinic:

1.Management of the polyclinic, including AHCh

2. Information and analytical department:

Registration desk

Organizational method cabinet (statistics cabinet)

3.Treatment and prophylactic part:

Offices of district physicians (department)

Cabinets of specialists (surgical, ENT, ophthalmological, neurological, infectious diseases, dental department (office)

4. Auxiliary diagnostic department:

Functional diagnostic rooms (ECG, ultrasound, x-ray room,)

Radiology rooms,

Laboratory

emergency department medical care

7. Rehabilitation Department(physiotherapy room, physiotherapy room, etc.)

8. Departments of prevention(anamnestic room, room for instrumental methods of research, examination room for women, examination room for men, medical examination room for the population and patients, first-aid appointment, healthy lifestyle promotion room)

Day hospital

Hospital at home

Medical health center

Paramedic health center

Hospital structure

Reception department, specialized departments, auxiliary medical and diagnostic departments, pathoanatomical department, administrative and economic service.

Principles for the formation of departments: according to the nature of the diseases.

Types of departments (wards) according to the nature of diseases: therapeutic, surgical, infectious diseases, neurological and other narrow-profile departments.

Offices of the auxiliary medical and diagnostic department: functional diagnostics, physiotherapy, X-ray, laboratory, physiotherapy exercises, etc.

The most optimal number of beds is considered to be 60-70.

Preventive work

- dispensary work:

A. Medical examination of healthy people (carrying out preventive examinations at decreed age periods)

B. Clinical examination of patients (with chronic pathology, disabled people, participants in wars)

- Anti-epidemic work:

Early detection of infectious patients, timely signaling and hospitalization, monitoring of the infectious focus, organization and control of preventive vaccinations.

- Sanitary and educational work:

lectures and talks

evenings of questions and answers, debates

2 . Medical work

・Provision of medical care at the reception and at home

Provision of all types of specialized assistance:

Consultations with specialists, timely referral for hospitalization, selection and referral of patients for sanatorium treatment, etc. Medical – social help the sick and the disabled.

· Examination of temporary and permanent disability, referral to MSEK.

Organizational and methodological work

Organization of a sanitary asset and management of its work

· Maintenance of accounting and reporting documentation

· Liaising with institutions:

hospitals, dispensaries, sanatorium-type institutions, SES.

· Tracking the health of the population of the site, analysis of morbidity and disability, development of measures to reduce them.

Doctors work systems:

1. Rotation system

2. Two-link

3. Three-link

4. Team method

Order of the Ministry of Health and social development Russian Federation No. 282 dated April 19, 2007 "On approval of the criteria for evaluating the effectiveness of the activities of a local general practitioner"

The main purpose of introducing the criteria for the activities of a local general practitioner is to improve the quality of medical care and monitoring the health status of the population.

1. stabilization or decrease in the level of hospitalization of the population

2.reducing the frequency of emergency calls

3.increasing the number of preventive visits

4. completeness of coverage with medical and preventive care for persons under dispensary supervision

5. completeness of coverage with preventive vaccinations (diphtheria, hepatitis, rubella, influenza)

6. Decrease in mortality of the population at home with cardiovascular diseases, tuberculosis, diabetes mellitus.

7.reduction of deaths at home from circulatory diseases under the age of 60

8. stabilization of the incidence of diseases of a social nature (tuberculosis, arterial hypertension, diabetes mellitus, oncological diseases, complete coverage of medical supervision of categories of citizens eligible for a set of social services

9. justification for prescribing medicines and compliance with prescriptions for patients with a set of social services.

Organization of a sanitary asset and management of its work

Maintaining accounting and reporting documentation

Communication with institutions:

hospitals, dispensaries, sanatorium-type institutions, SES.

Tracking the health of the population of the site, analyzing morbidity and disability, developing measures to reduce them.

Dispensaries: their types, forms and methods of work. Evaluation of the quality of medical examination of the population.

Clinical examination is understood as active dynamic monitoring of the health status of certain contingents of the population (healthy and sick), taking these population groups into account for the purpose of early detection of diseases, dynamic monitoring and comprehensive treatment of patients, taking measures to improve their working and living conditions, prevent the development and the spread of diseases, restoration of working capacity and prolongation of the period of active life.

Clinical examination provides, first of all, the preservation of health in healthy people, the active identification of patients with early stages of diseases and the prevention of cases of disability; its ultimate goal is to preserve and strengthen the health and working capacity of the prophylactic contingent. This determines the social and hygienic essence (significance) of clinical examination. The dispensary method of observation is a function of the attending physicians of the general network of out-of-hospital institutions (polyclinics, outpatient clinics) serving the population at the place of residence and at the place of work, as well as doctors of specialized institutions - dispensaries and centers of the SSES.

Currently, there are various dispensaries (medical and physical culture, skin and venereological, anti-tuberculosis, narcological, cardiological, oncological, neuropsychiatric, etc.). Dispensaries and dispensary departments (offices) carry out measures for mass prevention aimed at preventing diseases, keep records of morbidity and mortality from pathology in their profile, and also carry out therapeutic measures, consult patients and provide organizational and methodological guidance to the work of general network doctors to combat relevant diseases. diseases. The tasks of dispensaries include: conducting training of general practitioners in relevant specialties; introduction of modern methods of prevention, diagnosis and treatment into the practice of medical and preventive institutions; promotion of healthy lifestyles.

The main documents that are issued for patients registered with the dispensary are the outpatient medical record and the dispensary observation control card, which record the timeliness of visiting the doctor and passing the next medical examination, the implementation of the prescribed types of treatment, recreational activities and employment recommendations.

Types of dispensaries: anti-tuberculosis, dermatological, venereological, cardiological, medical and physical education, oncological, neuropsychiatric, narcological, endocrinological, ophthalmological, mammological.

The structure of the polyclinic, the tasks and organization of the work of the registry. Physicians' system.

Primary medical and social care for the urban population is provided by outpatient clinics (territorial polyclinics serving the adult population) and institutions for the protection of motherhood and childhood (children's polyclinics and women's clinics).

The main organizational and methodological principles of the work of polyclinics and territorial medical associations (TMOs) are locality (assigning a standard number of residents to a medical position) and widespread use of the dispensary method (systematic active monitoring of the health status of certain contingents). The main planned and normative indicators regulating the work of polyclinics are: the standard for district coverage (1,700 people per 1 position of a district therapist); load rate (5 visits per hour at the reception in the clinic and 2 - when servicing patients at home by a therapist); staff standard district physicians (5.9 per 10,000 inhabitants over 14 years of age).

The measure of the capacity of polyclinics is the number of visits per shift (more than 1200 visits - category I, less than 250 visits - category V). TMOs, to a greater extent than polyclinics and antenatal clinics, meet the new principles of organization and financing of primary medical and social care. They can more effectively organize the work of family doctors (Order of the Ministry of Health of the Russian Federation No. 237 of 26.08.92). In a number of TMOs, conditions have been created for family medical care, for example, joint work at the site of the therapist, pediatrician and gynecologist (obstetric-pediatric-therapeutic complex - APTC). At the same time, the indicator of work is not the dynamics of attendance, but changes in the state of public health (decrease in morbidity, disability, infant mortality, the number of advanced oncological diseases, the health status of patients from dispensary groups, etc.).

The main activities of primary medical and social care institutions are: preventive work, clinical examination, hygienic education and education of the population, promotion of a healthy lifestyle; medical and diagnostic work (including examination of temporary disability); organizational and methodological work (management, planning, statistical accounting and reporting, analysis of activities, interaction with other healthcare institutions, advanced training, etc.); organizational and mass work.

The clinic is headed by the chief physician. The structure of the polyclinic includes: a registry, a prevention department, treatment and preventive departments and offices, treatment and diagnostic units, an administrative and economic part, a rehabilitation treatment department, etc. The continuity of the work of a polyclinic and a hospital is assessed by the number of patients prepared for planned hospitalization, and the exchange of documentation before and after their treatment in the hospital.

City Polyclinic is created as an independent medical and preventive institution, a structural subdivision of a medical and preventive institution of an urban district or is part of an inpatient polyclinic association to provide primary health care to the population according to the district principle.

The main task of the city polyclinic is to reduce the incidence, disability and mortality of the population, sanitary and hygienic education of the population, promotion of a healthy lifestyle.

Doctors work systems:

Interleaved system

Two-link

Three-link

brigade method

Approximate structure of the city polyclinic:

1.Management of the polyclinic, including AHCh

2. Information and analytical department:

Registration desk

Organizational method cabinet (statistics cabinet)

3.Treatment and prophylactic part:

Offices of district physicians (department)

Cabinets of specialists (surgical, ENT, ophthalmological, neurological, infectious diseases, dental department (office)

The publication is intended, first of all, for employees of regional institutions providing organizational and methodological assistance to medical institutions of administrative territories, as well as heads of healthcare at the municipal level, including chief physicians of the Central District Hospital.

Organizational and methodological work includes:

Implementation of analytical work to assess the state and dynamics of development of the healthcare system of the relevant administrative territory, the state of public health, the medical and demographic situation and other factors external environment that affect the level of public health;

Organization and improvement of the system of accounting and reporting on the activities of government bodies and healthcare institutions, the results of functioning, the dynamics of the state of health of the population;

Development of long-term and current plans for the activity of the healthcare system of the administrative territory, targeted programs in priority areas of development, organization of their implementation, monitoring and evaluation of the effectiveness of implementation;

Organization and conduct of targeted inspections, expert evaluation of the activities of individual health services and institutions with the visit of experts to the field and the provision of organizational, methodological and advisory assistance;

Determining the need for medical personnel in various forms of continuous learning, planning together with personnel services health authorities work to improve the skills of medical workers, organizing and holding conferences, seminars, visiting boards, medical councils, meetings, etc.;

Organization of outreach assistance to rural residents.

In everyday practice, the role of analytical activity is significantly increasing, its quality level is increasing based on the use of modern technologies for collecting and processing statistical data, transmitting medical information, methods of analysis, justification and formation of strategies.

IN Lately the requirements for the organization of planned work are significantly increased on the basis of a more complete account of the influence of environmental factors, the conditions for the functioning and development of the industry, and the forecast of the most probable prospects. The strategic components of planning are being strengthened. Plans for current activities are built in accordance with the directions for the implementation of strategic goals. A system of plans is being formed that unites various levels of management. Planned activities are linked with their resource provision. The program-targeted approach continues to be widely used to solve complex or interdepartmental problems. At the planning stage, forms of control are determined and criteria are developed for evaluating the effectiveness of the implementation of planned activities used for their implementation of management mechanisms.

The need to intensify the diagnostic and treatment process requires improvement innovation activities in healthcare authorities and institutions, organizing it on the basis of today's ideas about marketing, business planning of innovations, organizational forms ah and methods of implementation.

Increasing the level of therapeutic and preventive and consultative and diagnostic assistance to the rural population in modern conditions provides for the strengthening of the material and technical base and human resources of rural health, the development optimal model medical care of the rural population in health care institutions in various stages provision of medical care and, as an additional measure, the use of mobile forms of medical care for special purposes.

Thus, one of the most important functions of the health management body is delegated to health care institutions (republican, regional, regional hospitals, central district hospitals) - the development of draft plans for the activities of the subordinate health care system, organization, control and evaluation of their implementation. In this aspect, the provision of organizational and methodological assistance to the rural population, including outreach assistance, being the main functions of the organizational and methodological departments of health care institutions of the indicated levels and fully corresponding to their area of competence, is planned independently, and the procedure for adopting the plan reflects the procedure regulated for hospital departments.

The plan of organizational and methodological work (hereinafter referred to as the plan) is a list of specific tasks, determines the procedure, timing, sequence of activities for the planned period of time, establishes specific performers and provides for resource, including financial, support for planned activities, its amount and sources of investment .

The plan consists of the main part and appendices.

The main part of the plan includes sections:

1. Development of the material and technical base of healthcare.

2. Training and advanced training of personnel.

3. Preventive work.

4. Organization of detection of socially significant pathology.

5. Improvement of diagnostic, medical, rehabilitation care and introduction of modern technologies.

6. Sanitary and hygienic education.

7. Scientific research.

8. Monitoring the implementation of the plan.

Applications should be a set of the following documents:

Analytical information about the state of medical care to the population and the activities of healthcare institutions at the time of the development of the Plan.

Report on the implementation of the Plan and target programs for the previous year.

Conceptual Provisions strategic development health care in the future.

The list of the main planned indicators (landmarks) and the rationale for the likelihood of their achievement in the planning period.

Draft regulatory documents required for the implementation of planned activities.

Projects of new targeted comprehensive programs to address interdepartmental problems.

1. Development of the material and technical base of healthcare

As the main activities for the first subsection, the following can be planned:

Construction of new institutions, buildings;

Carrying out major and current repairs of buildings, premises;

Landscaping works;

Development of the vehicle fleet;

Technical re-equipment and updating of obsolete equipment, etc.

The second subsection may include activities for:

Liquidation (re-profiling) of low-capacity hospitals, not staffed with medical personnel, poorly equipped, medical institutions;

Strengthening the outpatient-polyclinic link through the opening of new institutions, offices, receptions, the development of new forms of service in polyclinics;

The introduction of hospital-replacing technologies (day hospitals, day hospitals, hospitals at home);

Differentiation of the bed fund according to the intensity of the treatment and diagnostic process, the creation of beds (departments) for nursing care, hospices, the formation of institutions or departments of a medical and social nature.

Specification of planned targets should be carried out in accordance with the strategic goals of regional and municipal healthcare systems aimed at reorienting medical care from the inpatient to the outpatient level. Attention should be paid to the expediency of not only strengthening, but also modernizing the diagnostic, laboratory and rehabilitation base of outpatient clinics, opening specialized rooms for the profiles of medical specialties that meet the real needs of the population, changing the nature of the activities of existing rooms in accordance with the introduction of new medical technologies. services (outpatient surgery, specialized day hospitals, preventive units, etc.).

The urgency of the problem of supplying medical institutions with consumables also justifies the expediency of reflecting ways to solve it in planning documents.

2. Training and advanced training of personnel

Targeted training of specialists based on targeted orders from regional and municipal governments;

Advanced training of employees at central bases, in the GIDUV system, in foreign medical centers and others educational institutions with a break from production;

On-the-job training at cyclic, intermittent, part-time courses, seminars;

Conducting medical and nursing conferences, congresses, meetings;

Organization of professional competitions;

Participation in organizing the work of scientific societies.

The work on personnel training is planned by the organizational and methodological departments in coordination with the personnel health services in the region (municipality).

3. Preventive work

Planning of preventive work provides for the formation of a list of activities for the following subsections:

Vaccination;

Chemoprophylaxis;

Activities in the foci of infection;

Activities at agricultural facilities (livestock, dairy farms, etc.).

All activities included in this section of the Plan are carried out in contact with the state sanitary and epidemiological surveillance authorities in accordance with current instructions and methodological recommendations according to the established schedule.

4. Organization of detection of socially significant pathology

Annual examination of contingents subject to periodic examinations and dispensary observation;

Accelerated clinical examination of persons with identified pathology;

Practical assistance of regional (district) institutions in surveying the population of districts;

Registration of the examined and police records of the identified pathology;

Carrying out systematic consultations on the identification of diseases and the provision of advisory assistance on the diagnosis, treatment and rehabilitation of this group of patients, including in regional, district and central specialized institutions.

The plan is built in the context of the type of pathology in the listed areas of work.

5. Improving diagnostic, therapeutic, rehabilitation care and the introduction of modern technologies

The main directions of organizational activities of this section include:

Monitoring the quality of diagnostics and treatment based on the results of consultations conducted by highly qualified specialists in regional (municipal) institutions (subdivisions), as well as during visits to subordinate healthcare institutions;

Regulation of taking on dispensary observation and control of contingents of prophylactic patients;

Organization of centralized control of the correctness of registration of death certificates.

Planning can be carried out according to the objects subject to control (institutions, services, divisions, specialists), according to the forms of control (conducting an expert assessment of medical documentation), according to indicators characterizing the state of the process of providing assistance (implementation individual plans treatment, provision of successive medical care, timely hospitalization, consultation, according to the validity of the selection of patients for treatment in institutions of a different level, to hospital-replacing technologies), according to the activity of medical intervention (surgical treatment), according to the results (restoration of working capacity of patients, timeliness of referral to MSEC) and in the context of other performance indicators.

Implementation section highlights modern technologies prevention, diagnosis, treatment, rehabilitation to be introduced into the activities of health care institutions and appropriate organizational measures for implementation.

6. Sanitary and hygienic education

Activities covering hygiene education may include:

Creation, distribution, control of activities, development of various organizational forms of sanitary education of the population - "Health Universities", "Health Schools" in polyclinic institutions, "Schools for Convalescents" for inpatients;

Preparation of a profiled sanitary asset for the care of patients at home, primarily from among relatives;

Use of various forms of mass dissemination of hygienic knowledge among the population (appearances in the media, organization of exhibitions, publication of educational materials);

Organization of meetings with medical workers (lectures, conversations, explanations, recommendations);

Spreading modern forms attracting people to healthy lifestyle life.

7. Scientific research

The process of preparing a draft plan and the procedure for its adoption

Regional priorities for the development of medical care for the population are determined in accordance with the directions public policy in the field of public health, taking into account regional characteristics and resource opportunities. Despite the differences in regions in most subjects of the Russian Federation, the main areas are similar - tuberculosis; HIV AIDS; diabetes; vaccination; safe motherhood and childhood.

The plan of organizational and methodological work of the republican, regional, regional hospital, CRH is a structural component of a unified plan for the development of regional (municipal) health care, which determines the hierarchical system of long-term and current planning of the activities of governments and health care institutions of the region (municipality).

The procedure for adopting the plan includes its discussion at the medical council of the institution, either as an independent issue, or as an integral part of the discussion of the results of the institution's work, the progress in the implementation of targeted programs over the past period. The regulation of the procedure for adopting the plan provides for mandatory participation in the discussion of representatives of the apparatus of the health management body of the appropriate level, and for the Central District Hospital - representatives of the district administration. The optimal level of hearing for regional institutions is the collegium of the health authority, if the plan concerns only medical activities, and the regional government, if the plan is comprehensive.

After discussion, the comprehensive plan is approved by the head (deputy) of the administration of the corresponding level, and if the plan is intradepartmental, then by the head of the relevant health management body. The approved plan is a guiding document that is mandatory for execution.

Control over the implementation of the plan

The current control over the implementation of the plan by quantitative and qualitative criteria is carried out by the organizational and methodological department (office) of the organization that compiled it.

Sections of the plan, which provide a list of activities, levels of their implementation, deadlines, responsible, dates of planned execution, it is advisable to supplement columns for dates of actual execution and costs for their implementation. For control use the data of the state statistical reporting. It is verified on the spot by district curators during scheduled visits.

Transparency of activities is ensured by simultaneous public hearing of the curator and persons responsible for carrying out the planned events.

It is methodologically more effective to hear not one district on the maximum possible number of questions, but several districts on one issue. This makes it possible to cover the problem in a multifaceted way and choose the best approaches to its solution, arising from the accumulated practical experience.

An important instrument of control is the semi-annual (depending on the importance of the issue) interim hearing of the implementation of the plan in the health management apparatus of the region and the administration of the territory.

Examples of private hearing questions include:

Organization and effectiveness of examinations of the population and clinical examination;

Treatment of patients with chronic diseases;

Carrying out anti-epidemic measures;

On the role of regional institutions as organizational and methodological centers;

Information about teaching aids;

Analysis of the work of institutions, etc.

Final report on the implementation of the plan

The final report on the implementation of the plan is compiled either in tabular or descriptive form by sections of it and includes the following headings:

Planned tasks to be solved;

Baseline indicators at the beginning of the planning period;

Activities carried out (a, b, c, etc.);

Results of the current year;

Efficiency mark.

The report is compiled explanatory note with an analysis of the results achieved, and in the absence or insufficient effectiveness of the measures taken, with an analysis of the causes, a critical assessment of the defects in the implementation of measures and possible measures to improve their quality.

A report on the implementation of measures according to the plan of organizational measures by the departments of the institution that supervises subordinate medical institutions is provided at the request of the organizational and methodological department (office) on time according to the profile of the department, indicating the performers in the following aspects:

Preparation of questions for hearing at meetings, boards of the administrative apparatus (scheduled / unscheduled, level);

Writing business reviews on the profile of departments;

Release teaching materials by curation area (which ones);

Pedagogical work (courses, seminars, lectures, individual training of specialists);

Business trips to supervised territories (where, purpose, duration, scheduled / unscheduled, brigade / individual, what kind of assistance was provided);

Participation in meetings, conferences, congresses, etc. (which ones, the topic of the speech, the level of regional, interregional, international).

When analyzing the progress of the plan, they strive not so much to set new tasks, but to determine the effectiveness of already known approaches to solving the set ones.

The publication was prepared on the basis of the guidelines "Planning organizational and methodological work and organizing outreach assistance to medical institutions" dated 10/15/2002 N 2002/107.

MINISTRY OF HEALTH CARE
Khabarovsk Territory

About instructions for planning organizational and methodological work

In order to improve the planning of organizational and methodological work in the main areas of public health protection and the organization of outreach medical care, as well as the establishment unified requirements to the process of preparing and adopting a plan of organizational and methodological measures in the healthcare system of the Khabarovsk Territory

I affirm:

1. Instructions for planning organizational and methodological work and organizing visiting institutions of the Khabarovsk Territory (hereinafter referred to as the Instruction) (attached).

I order:

1. Managers structural divisions the Ministry of Health to use the attached Instructions in their work when planning organizational and methodological measures and organizing outreach medical care to the population of the Khabarovsk Territory.
2. Heads of health management bodies of municipalities, medical and preventive and educational institutions of health care of the region to be guided by the attached Instructions when planning organizational and methodological measures and outreach medical care to medical institutions of the region.
3. To impose control over the implementation of this order on the First Deputy Minister of Health of the Khabarovsk Territory V.E. Tropnikov.

Minister of Health
V.M. Savkova

Appendix. Instructions for planning organizational and methodological work and organizing outreach assistance to medical institutions

Appendix
to order
Ministry of Health
Khabarovsk Territory
of May 14, 2003 N 130

1. General Provisions

In accordance with the Concept of Health Development and medical science in Russian Federation further improvement of organizational and methodological work in healthcare at all levels is aimed at:
- improving the quality of medical care to the population;
- to strengthen the preventive component in the activities of healthcare institutions;
- provision of state guarantees in the provision of qualified medical care to the rural population through the strengthening of primary health care and the development of outreach forms of medical care;
- improving the efficiency of resource use, the formation of rational systems of phased medical care and the introduction of resource-saving technologies;
- expanding the influence of healthcare on the formation and implementation of state policy in the field of public health protection at all levels of government;
- coordination of interaction between various services and departments in solving complex medical and social problems.
The purpose of this Instruction is to establish uniform requirements for planning organizational and methodological work, which is an integral part of the management activities of the healthcare management system at all levels. The instruction was developed on the basis of the Methodological recommendations of the Ministry of Health of the Russian Federation dated October 15, 2002 N 2002/107 "Planning organizational and methodological work and organizing outreach assistance to medical institutions."
The concept of organizational and methodological work includes:
- implementation of analytical work to assess the state and dynamics of the development of the health care system municipality the region, the state of health of the population, the medical and demographic situation and other environmental factors that affect the level of health of the population;
- organization and improvement of the system of accounting and reporting on the activities of government bodies and healthcare institutions, the results of functioning;
- development of long-term and current plans for the activity of the healthcare system of the municipality of the region, target programs in priority areas of development, organization of their implementation, control and evaluation of the effectiveness of implementation;
- organization and conduct of targeted inspections, expert evaluation of the activities of individual health services and institutions with the departure of experts to the field and the provision of organizational, methodological and advisory assistance;
- determination of the need for medical personnel in various forms of continuous training, planning, together with the personnel services of health authorities, work to improve the skills of medical workers, organizing and holding conferences, seminars, visiting boards, medical councils, meetings, etc.;
- organizing outreach assistance to rural residents.
The most important function of the health management body of the municipality is the development of action plans for the subordinate health system, organization, control and evaluation of their implementation. In this aspect, the provision of organizational and methodological assistance to the rural population, including outreach assistance, is planned independently by the organizational and methodological departments of the indicated levels.

2. Plan of organizational and methodological work

The plan of organizational and methodological work (hereinafter referred to as the Plan) is a list of specific tasks, determines the procedure, timing, sequence of activities for the planned period of time, establishes specific performers and provides for resource, including financial, support for planned activities, its amount and sources of investment .
The plan consists of the main part and appendices.
The main part of the Plan includes sections:
1. Development of the material and technical base of the health department.
2. Training and advanced training of personnel.
3. Preventive work.
4. Organization of detection of socially significant pathology.
5. Improvement of diagnostic, medical, rehabilitation assistance, introduction of modern technologies.
6. Sanitary and hygienic education.
7. Scientific research and innovation.
8. Control over the implementation of the Plan.
Applications should be a set of the following documents:
- analytical information about the state of medical care to the population and the activities of healthcare institutions at the time of the development of the Plan;
- report on the implementation of the Plan and target programs for the previous year;
- conceptual provisions of the strategic development of health care for the prospective period;
- a list of the main planned indicators (landmarks) and justification of the likelihood of their achievement in the planning period;
- draft regulatory documents required for the implementation of planned activities;
- drafts of new targeted comprehensive programs for solving problems of an interdepartmental nature.

2.1. Development of the material and technical base of healthcare

The section on the development of the material and technical base of health care covers measures to strengthen and maintain the fixed assets of health care institutions (buildings, vehicles, supply systems, technical and medical equipment, inventory), as well as a list of measures as part of the restructuring of the medical care system.
As the main activities for the first subsection, the following can be planned:
- construction of new institutions, buildings;
- carrying out capital and current repairs of buildings, premises;
- landscaping works;
- development of the vehicle fleet;
- technical re-equipment and updating of obsolete equipment and tools.
The second subsection may include:
- measures for the liquidation (re-profiling) of low-capacity hospitals, understaffed medical personnel, poorly equipped medical institutions;
- strengthening the outpatient-polyclinic link through the opening of new institutions, offices, receptions, the development of new forms of service in polyclinics;
- introduction of hospital-replacing technologies (day hospitals, day hospitals, hospitals at home);
- differentiation of the bed fund according to the intensity of the treatment and diagnostic process, the creation of beds (departments) for nursing care, hospices, the formation of institutions or departments of a medical and social nature.
Planned tasks should be drawn up in accordance with the strategic goals of the healthcare system, aimed at reorienting medical care from the inpatient to the outpatient level. It is advisable to strengthen and modernize the diagnostic, laboratory and rehabilitation base of outpatient clinics, open specialized rooms for the profiles of medical specialties that meet the real needs of the population, change the nature of the activities of existing rooms in accordance with the introduction of new technologies for medical care (outpatient surgery, day specialized hospitals, preventive units, etc.).

2.2. Training and advanced training of personnel

This section of the Plan includes a list of the main activities for the training of medical personnel and other specialists in the healthcare system (economists, accountants, medical equipment maintenance technicians, etc.):
- targeted training of specialists based on targeted orders from regional and municipal governments;
- advanced training of workers at central bases, in the system of institutes for advanced training of healthcare professionals, in foreign medical centers and other educational institutions with a break from work;
- advanced training on the job at cycle, intermittent, part-time courses, seminars;
- holding medical and nursing conferences, meetings;
- organization of professional competitions;
- Participation in organizing the work of scientific societies.
The work on personnel training is planned by the organizational and methodological departments in coordination with the personnel health services in the district (municipality).

2.3. Preventive work

Planning for preventive work should be aimed at maintaining and strengthening the health of the population, strengthening the preventive focus in the activities of all health services and social sphere in general, improvement information system optimization of resources and financing of preventive measures by state and non-state structures, improvement of the information system, strengthening the role of scientific research in the field of maintaining and promoting health and preventing diseases, timely adequate and widespread use of new developments in planning this section of work, timely and high-quality training of personnel involved in preventive work among the population, including methods and means of hygienic education and upbringing.
Preventive work planning provides for the formation of a list of activities in the following sections:
01.01. - measures aimed at primary medical, social and socio-hygienic prevention of diseases in order to reduce the incidence;
01.02. - measures aimed at improving the effectiveness of secondary medical and social prevention of diseases in order to reduce losses due to temporary and permanent disability, reduce mortality, and improve the quality of life;
01.03. - measures to implement prevention programs, ensure the standards of physical development, strengthen the neuropsychological status, ensure the availability of social and medical prevention measures (creation of health centers and schools, physical development centers, etc.).
In addition, when planning preventive work, it is necessary to provide for activities in subsections:
- vaccination;
- chemoprophylaxis;
- anti-epidemic and preventive measures in the foci of infection;
- preventive measures at agricultural facilities.
These activities are carried out in contact with the state sanitary and epidemiological surveillance authorities in accordance with the current instructions and methodological recommendations according to the established schedule.

2.4. Sanitary and hygienic education

Health education activities include:
- creation, distribution, control of activities, development of various organizational forms of health education of the population ("Health Universities", "Health Schools" in polyclinic institutions, "Schools for Convalescents" for inpatients);
- preparation of a profiled sanitary asset for the care of patients at home, primarily from among relatives;
- use of various forms of mass dissemination of hygienic knowledge among the population (appearances in the media, organization of exhibitions, publication of educational materials);
- organization of meetings with medical workers (lectures, conversations, explanations, recommendations);
- the spread of modern forms of attracting the population to a healthy lifestyle.

2.5. Organization of detection of socially significant pathology

Measures to organize the identification and medical examination of the population with socially significant diseases (tuberculosis; HIV / AIDS; sexually transmitted diseases (STDs); various forms of drug addiction; mental disorders) include:
- annual examination of contingents subject to periodic examinations and dispensary observation;
- accelerated clinical examination of persons with identified pathology;
- practical assistance of regional (district) institutions in the examination of the population of districts;
- registration of the examined and police records of the identified pathology;
- conducting systematic consultations on the identification of diseases and the provision of advisory assistance on the diagnosis, treatment and rehabilitation of this group of patients, including in regional, regional and specialized institutions of municipalities.
The plan is built in the context of the type of pathology in the listed areas of work.

2.6. Improving diagnostic, therapeutic, rehabilitation care

The main directions of organizational activities of this section include:
- measures for in-depth examination of people with a low level of health in the centers (offices) of medical prevention, diagnostic centers (offices), clinics or other medical institutions that have the necessary diagnostic capabilities;
- implementation of quality control of diagnostics and treatment based on the results of consultations conducted by highly qualified specialists in regional (municipal) institutions (subdivisions), as well as during visits to subordinate healthcare institutions;
- planning and implementation of health technologies (normalization of lifestyle, provision of a balanced diet, exclusion bad habits, optimization of motor activity using training loads and available types of physical education and sports, etc.);
- pharmacological methods of health promotion;
- organization of dispensary observation and control of the effectiveness of the ongoing medical examination of patients;
- organization of centralized control of the correctness of registration of death certificates.
Planning can be done:
- by objects subject to control (institutions, services, divisions, specialists);
- according to the forms of control (conducting an expert assessment of medical documentation);
- according to indicators characterizing the state of the care process (implementation of individual treatment plans, provision of successive medical care, timely hospitalization, consultation, the validity of the selection of patients for treatment in institutions of a different level, for hospital-replacing technologies);
- according to the activity of medical intervention (surgical treatment);
- according to the results (restoration of working capacity of patients, timeliness of referral to MSEC).

2.7. Scientific research and innovation

The planning of scientific research topics is carried out in accordance with the applied tasks of practical health care, which may include certain issues of public health, the provision of medical care and the development of strategically important directions for the development of the health care system.
Innovative activity implements scientific, technical, socio-economic, organizational and other activities aimed at the introduction and replication of scientific and medical documentation, new medical technologies permitted for use. When planning innovation activities, it is necessary to take into account personal responsibility for the completeness, quality and timely receipt of the main results, clinical and economic justification, resource support for activities, training of specialists for the development of advanced domestic and foreign experience in the prevention, diagnosis and treatment of diseases.
The section on the introduction of new medical technologies covers modern technologies for prevention, diagnosis, treatment, and rehabilitation to be introduced into the activities of healthcare institutions.

2.8. Plan implementation control

The current control over the implementation of the Plan by quantitative and qualitative criteria is carried out by the organizational and methodological department (office) of the organization that compiled this Plan.
Sections of the Plan, which contain a list of activities, levels of their implementation, deadlines, responsible persons, dates of the planned implementation, it is advisable to supplement the columns "date of actual implementation" and "costs for their implementation." For control use the data of the state statistical reporting.
An important control tool is the semi-annual (intermediate) hearing of the implementation of the Plan in the health management apparatus, for example:
- organization and effectiveness of examinations of the population and clinical examination;
- treatment of patients with chronic diseases;
- carrying out anti-epidemic measures;
- analysis of the work of medical institutions, etc.

3. The process of preparing the draft Plan and the procedure for its adoption

The plan is developed with the participation of the main specialists of the corresponding level and, upon completion of the development, is endorsed by them. The purposefulness of plans and the effectiveness of planned targets depend on the correctness of setting goals, the choice of strategies for achieving them, the concentration of efforts on the selected priorities, taking into account the territorial characteristics and resource capabilities of health facilities.
The plan of organizational and methodological work of the regional hospital, CRH is a structural component of a unified plan for the development of regional (municipal) health care, which determines the hierarchical system of long-term and current planning of the activities of government bodies and health care institutions.
The procedure for adopting the plan includes its discussion at the medical council of the institution, either as an independent issue, or as an integral part of the discussion of the results of the institution's work, the progress in the implementation of targeted programs over the past period.
The regulation of the procedure for adopting the plan provides for mandatory participation in the discussion of representatives of the apparatus of the health management body of the appropriate level, and for the Central District Hospital - representatives of the district administration. After the discussion, the Plan is approved by the head (deputy) of the administration of the corresponding level.
The approved Plan is a guiding document that is mandatory for execution.

4. Final report on the implementation of the Plan

The final report on the implementation of the plan is compiled in a tabular or descriptive form by sections and includes the following headings:
- planned tasks to be solved;
- Baseline indicators at the beginning of the planning period;
- activities carried out (a, b, c...);
- results of the current year;
- efficiency mark.
According to the report, an explanatory note is drawn up with an analysis of the results achieved, and in the absence or insufficient effectiveness of the measures taken, with an analysis of the causes, a critical assessment of defects and possible measures to improve their quality.
A report on the implementation of measures according to the plan of organizational measures by the departments of the institution that supervises subordinate medical institutions is provided at the request of the organizational and methodological department (office) on time according to the profile of the department, indicating the performers in the following aspects:
- preparation of questions for hearing at meetings, collegiums of the administrative apparatus (scheduled / unscheduled, level);
- writing business reviews on the profile of departments;
- release of methodological materials for the curation area (which ones);
- pedagogical work (courses, seminars, lectures, individual training of specialists);
- business trips to the supervised territories (where, purpose, duration, scheduled / unscheduled, brigade / individual, what kind of assistance was provided);
- participation in meetings, conferences, congresses, etc.

5. Organizational and methodological assistance to healthcare institutions

Leading institutions of the regional level provide organizational and methodological assistance to municipal institutions, practically help both the CRH (interdistrict centers) and primary health care institutions on a wide range of issues related to the organization and improvement of the quality of the treatment and diagnostic process, improvement of prevention, technological improvement of activities, optimization management, including increasing the level of planning.
The organizational and methodological department (office) of the leading (head) health care facility is designed to solve three major blocks of tasks:
1. Formation of commissions and mobile teams from the employees of the institution. Planned departure of curators and teams of curators to subordinate institutions, regional centers for organizational, methodological, advisory and practical assistance; listening to their reports, taking into account the work done, creating and maintaining a regional card index of recommendations.
2. Development of materials of strategic (program), operational (plans), directive (orders) significance for the health management apparatus:
- to control the implementation of directive documents of the administrative apparatus of various levels;
- organizational support for the work of medical councils, commissions (together with the administration of the institution);
- to popularize best practices in improving the health of the population (together with leading experts).
3. Drawing up a consolidated annual report, its analysis, execution of conclusions based on the results of the work, market reviews, collections of the main indicators of the work of medical institutions and public health (with the participation of leading experts).
Diagnostic, therapeutic and rehabilitation medical care for patients who apply to institutions is regulated by the job descriptions of the relevant departments and rules internal regulations institutions.

6. Organization of outreach medical care to residents of rural areas

The low density of the rural population, employment in personal subsidiary plots, seasonality and urgency of the main agricultural work, the remoteness of medical (especially specialized) care from the places of residence of patients, the poor development of transport communications at significant distances, the high cost of travel - all this reduces the level of appeal and hospitalization of the rural population .
Unsatisfactory working conditions in the agricultural sector, which in most industries do not meet sanitary and hygienic requirements due to non-compliance with sanitary norms and rules, contribute to the emergence of diseases, which, with low detection and insufficient treatment, leads to the development of advanced cases, chronicity of pathological processes, and high mortality. Brucellosis, intestinal infections, diseases of the musculoskeletal system, diseases of the respiratory organs (dust bronchitis), and vibration disease are more common in the countryside than in cities. This implies the need to intensify visiting forms of organizational, advisory and practical assistance to rural health care.
Consideration should also be given to the long term qualified specialists from the performance of their duties in their main job, the disorder of their life upon departure, irregular working hours.
Emergency and urgent care for patients with complex pathologies requiring surgical interventions is provided year-round by the department of emergency and planned advisory care of regional hospitals or the Center for Disaster Medicine by means of air ambulance (airplane, helicopter) or fixed vehicles.
Scheduled assistance to specialists of the Central District Hospital is provided by curators, specialists from regional hospitals and advisory polyclinics. To provide assistance to rural health facilities, by order of the health authority, both full-time and freelance specialists from regional medical institutions (adults and children), maternity hospitals, dispensaries, an AIDS control and medical prevention center, and other diagnostic and treatment centers are assigned.
The most experienced, highly qualified specialists are involved in field work.
Of great practical importance is the participation of specialists from regional institutions in the work of draft commissions.
The content of assistance provided by regional institutions to district health facilities is:
- coordination of health management;
- implementation of strategic decisions of the health management apparatus;
- systematization of organizational and methodological work of municipal health care systems;
- practical assistance to the management and specialists of the Central District Hospital, other institutions of the municipal level;
- strengthening of intradepartmental quality control of medical care;
- strengthening expert work at all levels;
- holding seminars, etc.
The curator provides organizational and methodological assistance, introduces standards of medical care and organizes control over their observance.
In addition to the visits of the main specialists, the curation of rural health facilities is carried out by specialists from the departments of higher educational institutions of the medical profile. With the participation of the teaching staff of the departments of medical universities, field conferences are held, incl. scientific and practical, seminars, meetings.
Advisory assistance on the issues of diagnosis, treatment and rehabilitation of patients is provided in the clinics of the Central District Hospital, in district hospitals, at home, in a hospital.
According to the instructions of the administration of the region during the preparation of medical councils, visiting boards, meetings, conferences, the quality of medical care for the rural population in municipal institutions (CRH, UB, FAPs) is controlled; the material, technical and personnel potential, the possibilities of licensing the services of the Central District Hospital are being studied; the results of responding to public complaints are monitored. In parallel, methodological assistance is provided.
Mobile hospital medical councils with the participation of heads of administrations and the medical community of the districts justify themselves, at which the results of an expert assessment of the activities of the district services are discussed, and consultative reception of patients by specialists of regional institutions is organized.
In the course of providing primarily practical assistance, comprehensive, targeted, preventive examinations and medical examinations of the population are organized. The CRH specialists monthly examine the population served by district hospitals and FAPs.
Possible forms of field work:
- individual visits of specialists, including emergency ones, at the request of the municipal health care facility; at the expense of the receiving party;
- departures of teams of 2 - 5 specialists (adults and children), who are given preference in planned work, as they are more cost-effective compared to individual visits;
- mobile (field) outpatient clinics (polyclinics).
The brigade form of serving the population has firmly established itself. The brigades formed in the structure of mobile outpatient clinics serve patients according to the plan approved by the chief physician and coordinated with the territorial health authorities.
A team of 5-7 specialists is recruited taking into account the wishes of the districts and works on average for four days (the first and fourth - in the Central District Hospital, one each - in district hospitals). The population is notified in advance about the composition of the brigade through the media (regional newspapers, radio), through paramedics.
On average, the strength of mobile teams consists of 5 - 6 specialists (therapist, surgeon, pediatrician, obstetrician-gynecologist, neurologist, ophthalmologist, paraclinical specialists, organizational and methodological work). The composition of the team of specialists is completed taking into account the interests of the region, if necessary, it is expanded by other specialists, in particular, phthisiatricians, dermatovenereologists, etc.
In preparation for a planned trip to the regions, an analysis of the epidemic situation in the region is carried out; study of the quality and effectiveness of outpatient care, in particular, for the rural population, by levels (CRH, RB, UB, rural outpatient clinics); assessment of staffing of doctors and nursing staff, their qualifications.
In the districts of the region, before the arrival of the brigade, a flow of patients is formed, mainly a dispensary group, as well as groups for receiving prompt assistance from an ophthalmologist, traumatologist, oncologist at the rate of 2-3 operations per visit. It is necessary to equip traveling teams with equipment for examination and treatment of adults and children.
During the visit, patients are examined in the central district hospital, and, if necessary, at feldsher-obstetric stations, in rural outpatient clinics and district hospitals.
The duration of travel work ranges from several hours to 10 days, averaging 2.4 days.
The practice of replacing, at the request of the head physician of the corresponding health facility, for a long time (from 7 to 35 days) the absent specialists of the Central District Hospital, mainly of a surgical profile (vacation, study, specialization), is increasingly being used.
According to the schedule, the CRH employees provide assistance to the population assigned to district hospitals, medical outpatient clinics, FAPs. The brigades are staffed with CRH doctors in such a way as to provide from 6 to 12 trips to the rural area per year; they most often include a pediatrician, gynecologist, therapist, neurologist. During the trips, the specialists of the Central District Hospital provide, first of all, advisory assistance, primarily to pregnant women and children. The number of consultations usually ranges from 25 to 30 per visit.
Dispensary observation of patients with peptic ulcer, diabetes mellitus, gastritis, nephritis, rheumatic heart disease, rheumatoid arthritis, etc. requires special attention. Purposeful departure of the brigade 2 - 3 times a year allows you to examine almost the entire dispensary group. During the visit, patients are also selected for therapeutic and surgical treatment in the Central District Hospital and in regional institutions, and in some cases practical assistance is provided directly on the spot. It is mandatory to analyze the work of rural medical workers, monitor the course of dispensary observation, the course of treatment after the previous consultation, and also give recommendations for improving medical care.
The introduction of telecommunication technologies is of prospective importance for health care, which allows using new principles for the transfer of medical information between clinical centers and the Central District Hospital, contributes to the development of "Internet" technologies, although the organizational experience of implementation and use is only accumulating.
It is also possible to work in such a form as mobile paramedical stations to ensure that in sparsely populated points of observation of patients in hospitals at home, the delivery of necessary medicines to patients.
The technical report of specialists is compiled in sections:
- inspected everything;
- sick people were detected, incl. with a diagnosis for the first time in life;
- outpatient treatment is recommended at the place of residence;
- inpatient treatment is recommended at the place of residence;
- sent to the regional polyclinics for additional examination, "D" registration;
- Sent to regional hospitals.

7. Efficiency of using the method

When assessing the nature and scope of organizational and methodological assistance, information and analytical assistance in the preparation, publication and distribution of various materials ( guidelines, information letters, collections of indicators of health and work, bulletins; preparation reference materials at the request of higher organizations; information for health education of the population and patients through the media, incl. nosocomial, with the help of special stands, consultations and participation in preventive examinations population (separately adults and children), the number of patients examined by instrumental methods (endoscopy, ultrasound, ECG, etc.).
Serious objective difficulties in organizing outreach assistance to municipal and district institutions are exacerbated by shortcomings in the organization, in particular, the lack of continuity in the outreach work of specialists from regional institutions of various profiles due to imperfect coordination of their activities in the districts.
Increasing the efficiency of organizational and methodological work at all levels of healthcare organization, planning the structure of expenses for the formation of field teams, the duration of field work, the approximate level of service for the rural population by air ambulance will improve the quality, efficiency and accessibility of medical care, first of all, to the rural population.

Annex 1. Folder of the curator of the health facility

Attachment 1
to the Instruction
for planning
organizational and methodological
work and organization of outreach
assistance to medical and preventive
institutions

The dossier on medical and preventive healthcare institutions includes sections:
1. Assessment of the health of the population of the city, district (demographic situation, performance indicators of the municipal health authority according to the annual report, materials from previous inspections, recommendations, written appeals from citizens).
2. Network of health institutions, organizational structure, availability of licenses for the right to engage in medical activities.
3. Material and technical base (the state of medical institutions, the percentage of depreciation of medical equipment and medical instruments, the prospects for medical and technical equipment, the compliance of the municipal healthcare development program (city, district) with the provisions of the healthcare development concept of the Russian Federation).
4. Provision of the population with doctors and paramedical workers, staffing of the administrative apparatus; work with a reserve; the availability of job descriptions for employees, the provision of housing for health workers; control of the personnel development plan (conferences, seminars, improvement courses).
5. Availability of organizing orders and control over their execution.
6. The state of fire safety (the presence of an order, a fire prevention plan, instructions, briefing, availability of fire extinguishing equipment).
7. Compliance with safety regulations: creation of an attestation commission for labor protection; the presence of an introductory briefing log when applying for a job; instructions; measuring the resistance of the ground loop and electrical wiring insulation; availability of an order for employees responsible for electrical facilities; operation of the oxygen economy under pressure.
8. Compliance with the security regime of the healthcare facility (the results of checking the condition of buildings and its premises for the presence of suspicious foreign objects, the possibility of entry of foreign vehicles; checking the integrity and safety of seals and seals, locks in unused premises, leasing buildings, structures and premises of the healthcare facility, interaction with ATC authorities in terms of notification of cases of unauthorized persons entering the territory or premises of a healthcare facility; identifying people who are in hospital, whose identity is not confirmed by documents; appeals to healthcare facilities of persons with injuries and wounds that do not exclude criminal origin, adjustment and briefing of duty personnel institutions; the readiness of medical facilities to provide assistance to victims with injuries and burns, the availability of an irreducible supply of medicines and Supplies; the composition, addresses and telephone numbers of the duty service reinforcement teams, the procedure for notifying and gathering employees in health care facilities, the presence of an order from the hospital to limit visits of patients with relatives until 18:00.
9. Work with the administration of the city, district for the protection of public health. The effectiveness of interdepartmental commissions on socially conditioned diseases.
10. Implementation of the decisions of the collegium of the territorial health authority.
11. Organizational and methodological work.
12. Compliance with the sterilization and disinfection regime in the institution.
13. Treatment and preventive care:
a) the quality and availability of outpatient care:
- introduction of new technologies and forms of medical care (day hospitals, hospitals at home, day hospitals);
- the work of prevention and rehabilitation departments, the conversion of beds in district hospitals into nursing care departments for the treatment of patients according to medical and social indications, medical outpatient clinics with a day hospital; timely transfer of patients in need of medical and social assistance to boarding schools;
- mode of operation of the institution; provision of paid services to the population, enterprises, organizations;
- continuity in the examination, treatment and rehabilitation of patients between the clinic and the hospital;
- restructuring of the hospital bed fund;
- equipping the hospital with diagnostic and medical equipment;
- a system of emergency care, hospitalization and discharge of patients;
- organization of drug supply;
- organization of resuscitation care for women and children, analysis of indicators of maternal and child mortality;
b) the system of control over the circulation of narcotic drugs:
- an order for admission to work with narcotic drugs;
- permission from ATC;
- journal of accounting, storage of narcotic drugs and psychotropic substances in accordance with the requirements of the Ministry of Health of the Russian Federation;
- log of acceptance and destruction of used ampoules;
- work of the commission on the use of narcotic and psychotropic substances;
- work with special prescription forms.
14. Organization of the quality of work of emergency and emergency medical care.
15. Organization of the work of the municipal health authority in the conditions of CHI and VHI:
- protocols of the licensing and accreditation commission;
- control of terms and quality of treatment of the insured;
- itemized monthly use of budget funds and CHI.
16. Implementation of standards for the volume and quality of medical care at various stages and levels of health care facilities of the city, district.
17. The work of the clinical expert commission.
18. Work of auxiliary services (laundry, communication, transport).
19. Sanitary condition of health care institutions.
20. Conclusions and suggestions.

Note.
When developing Appendix N 1, the order of the Ministry of Health of the Saratov Region N 101-p dated 01/20/2001 "On curation municipal institutions health care of cities and districts of the region, regional medical institutions by the Ministry of Health for 2001".

Annex N 2

Appendix No. 2
to the Instruction
for planning
organizational and methodological
work and organization of outreach
assistance to medical and preventive
institutions

1. Full name, position, place of work.
2. Date of departure.
3. Settlement, institution, which received assistance.
4. Purpose of departure:
- introduction of new methods, technologies;
- education;
- practical help;
- carrying out preventive examinations.
5. Results (filled in accordance with the headings of the Curator's Folder within the competence of the specialist).
The nature of assistance by sections:
- organizational and methodological work includes the results of outpatient checks, stationary institutions, emergency medical care according to statistical indicators, according to ongoing documentation, standards for patient management, etc.;
- medical and advisory work (the number of patients consulted by age groups, the number of operations, manipulations, benefits);
- pedagogical work (lectures, conferences, seminars, workshops; their topics, number of participants).
6. Recommendations.
The report is drawn up in duplicate and certified by the signatures of the seconded specialist and the heads of the institution to which assistance was provided. One copy remains in the health facility to implement the recommendations, the other is transferred to the organizational and methodological department of the institution that sent the employee on a business trip.

First Deputy Minister
V.E. Tropnikova

The text of the document is verified by:
Official mailing list

1. General Provisions

1. Real job description determines the duties, rights and responsibilities of the head of the organizational and methodological department of a healthcare institution.
2. A person with a higher professional education and work experience in the field of organizational and methodological work or healthcare management for at least 5 years.
3. The head of the organizational and methodological department must know the basics of the legislation of the Russian Federation on health care; legal documents regulating the activities of healthcare institutions; the basics of organizing medical and preventive care in hospitals and outpatient clinics, emergency and emergency medical care, disaster medicine services, sanitary and epidemiological services, drug supply to the population and health care facilities; theoretical basis, principles and methods of clinical examination; organizational and economic foundations for the activities of health care institutions and medical workers in the context of budgetary insurance medicine; fundamentals of social hygiene, organization and economics of healthcare, medical ethics and deontology; legal aspects of medical activity; general principles and basic methods of clinical, instrumental and laboratory diagnostics of the functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, course features, principles of complex treatment of major diseases; rules for the provision of emergency medical care in a life-threatening condition of the patient; bases of examination of temporary incapacity for work and medico-social examination; fundamentals of health education; internal labor regulations; rules and norms of labor protection, safety measures, industrial sanitation and fire protection.
In his specialty, the head of the organizational and methodological department must know the basics of social hygiene and healthcare organization; the history of the formation and development of healthcare; organization of outpatient care for the population; organization of inpatient care for the population; organization of medical and preventive care for workers industrial enterprises; organization of specialized assistance to the population; organization of medical care for the rural population; organization of obstetric and gynecological care; organization of medical care for adolescents; organization of medical care for children; organization of emergency and urgent care to the population; organization of medical examination of the population; fundamentals of health care management; fundamentals of health planning and economics; theory and methods of sanitary statistics; population health statistics; health statistics; issues of international statistics; fundamentals of medical cybernetics; demographic and economic features of the region (district); prospects for the development of the region (district); the state of health of the population in the region (district); sanitary-epidemic and ecological situation in the region (district); indicators characterizing the state of health of the population in the region (district); the main indicators characterizing the activities of the health care facilities of the region (district); functions, rights, obligations, organization of work of employees of the organizational and methodological department.
The head of the organizational and methodological department should be able to calculate the indicators of public health and the performance indicators of a medical institution, unit; draw up a draft plan for the development of health care in the region, district, institution to include it in the plan for the socio-economic development of the region (district); plan development based on an analysis of the specific situation in the region (district) various kinds medical assistance to the population; organize work on the introduction of best practices in healthcare institutions of the district; organize the implementation of elements scientific organization labor in medical institutions of the district; organize a system for monitoring the implementation of planned activities; to instruct health care facility workers on organizational and methodological work, methodological meetings, conferences for the exchange of experience; analyze and evaluate primary statistical information.
4. The head of the organizational and methodological department is appointed to the position and dismissed by order of the head of the institution in accordance with the current legislation of the Russian Federation.
5. The head of the organizational and methodological department is directly subordinate to the head of the institution or his deputy.

2. Job responsibilities

Organizes the work of the organizational and methodological department. Provides organizational and methodological assistance to employees of the institution, subordinate health care facilities and their employees. Provides consulting assistance in his specialty. Participates in the preparation of statistical reports, incl. annual report, information and analytical materials. Organizes visits of medical specialists to subordinate health facilities. Supervises the work of subordinate middle and junior medical staff assists them in fulfilling their official duties. Supervises the implementation of safety and labor protection rules by middle and junior medical personnel. Participates in training sessions to improve the skills of medical personnel in their specialty. Plans its work and analyzes the performance of its activities. Ensures timely and high-quality execution of medical and other documentation in accordance with established rules. Carries out sanitary-educational work. Complies with the rules and principles of medical ethics and deontology. Qualified and timely executes orders, orders and instructions of the management of the institution, as well as legal acts on their professional activities. Complies with the rules of internal regulations, fire safety and safety, sanitary and epidemiological regime. Promptly takes measures, including timely informing management, to eliminate violations of safety, fire and sanitary regulations that pose a threat to the activities of the healthcare institution, its employees, patients and visitors. Systematically improves his skills.

The head of the organizational and methodological department has the right to:
8. give orders that are obligatory for execution by employees of the organizational and methodological department;
9. participate in the selection and placement of personnel in their specialty;
10. make proposals to the management of the institution to encourage and impose penalties on employees of the institution in their activities;
11. make proposals for the development and improvement of the activities of the institution;
12. request from management, receive and use information materials and legal documents necessary for the performance of their duties;
13. to take part in conferences and meetings that deal with issues related to its work;
14. pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;
The head of the organizational and methodological department uses all labor rights in accordance with Labor Code RF.

4. Responsibility

The head of the organizational and methodological department is responsible for:
9. timely and high-quality implementation of the duties assigned to him;
10. organization of their work, timely and qualified execution of orders, orders and instructions from higher management, regulatory legal acts on their activities;
11. rational and efficient use of material, financial and human resources;
12. compliance with internal regulations, sanitary and anti-epidemic regime, fire safety and safety;
13. maintaining the documentation provided for by the current regulatory legal acts;
14. providing, in accordance with the established procedure, statistical and other information on their activities;
15. Ensuring compliance with executive discipline and performance of their duties by employees subordinate to him;
16. readiness of the department to work in emergency situations.
For violation of labor discipline, legislative and regulatory legal acts, the head of the organizational and methodological department may be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the misconduct.