Medical personnel management. Features of personnel work in healthcare institutions

The specificity of personnel work in health authorities and institutions lies in the fact that the scope of these organizations is under state control, regardless of the organizational and legal form of the institution.

Personnel work in healthcare institutions includes the following areas of activity:

1. Planning the organization's need for personnel.

2. Selection and admission of workers.

3. Development of employee incentive programs.

4. Evaluation of personnel performance.

5. Organization of training, advanced training of employees, certification.

6. Development of personnel adaptation programs.

7. Documentary support of personnel work at the enterprise Posherstnik S. The work of personnel services in health care institutions / / Personnel business. - No. 7. - 2003, p. fourteen .

Let us consider in more detail these areas of activity of personnel services in healthcare institutions.

The planning of the need for personnel of a healthcare organization is carried out by the personnel service on the basis of the staffing table approved by the head of the organization, as well as based on the actual staffing of medical workers.

Also, the planning of the number of personnel of a healthcare organization is carried out on the basis of separate regulations, for example, Order of the Ministry of Health of Russia dated June 9, 2003 N 230, which approved the staffing standards for employees and workers of state and municipal healthcare institutions and employees of centralized accounting departments under state and municipal institutions healthcare.

A new employee is accepted into the staff of an organization or institution in accordance with the staffing table ( unified form No. T-3, approved by the Decree of the State Statistics Committee No. 1), which contains a list of structural units, positions, information on the number staff units, official salaries, allowances and monthly payroll. The staffing of an organization, institution is approved, changed by order of the head or authorized person “Positions, tariff categories, qualification characteristics in medical and educational institutions”, ed. A.Yu. Kibanova. - St. Petersburg: Peter, 2005, p. 125.

The position to which the employee enters is indicated strictly according to the Qualification Handbook. In the absence of a job title in this handbook should take advantage All-Russian classifier professions of workers, positions of employees and wage categories (OKPDTR).

The qualification guide has been developed in accordance with the accepted classification of employees into three categories: managers, specialists and other employees (technical performers). The assignment of employees to one category or another is carried out depending on the nature of the work that is mainly performed and constitutes the content of the worker's work (organizational-administrative, analytical-constructive, information-technical).

The names of the positions of employees, the qualification characteristics of which are included in the Qualification Handbook, are established in accordance with the All-Russian Classifier of Occupations of Workers, Positions of Employees and Wage Categories OK-016-94 (OKPDTR).

This Qualification Handbook consists of two sections. The first section contains qualifications industry-wide positions managers, specialists and other employees (technical performers), which are widely distributed in institutions and organizations, including those on budget funding. And the second section presents the qualification characteristics of the positions of employees who are employed in research institutions, design, technology, design and survey organizations, as well as editorial and publishing divisions.

Qualification characteristics in institutions and organizations can be used both as normative documents of direct action, and serve as the basis for the development of internal organizational and administrative documents - job descriptions that contain a specific list official duties employees, taking into account the peculiarities of the organization of production, labor and management, as well as their rights and responsibilities. If necessary, the responsibilities that are included in the description of a particular position can be distributed among several performers.

Because the qualifications listed in Qualification Handbook, apply to employees of institutions and organizations, regardless of their industry affiliation and departmental subordination, they present the most typical work for each position.

The position must be indicated with an indication of the category, qualification, category, and the structural unit in which the employee is accepted is indicated in accordance with the organization's staffing table. The presence of the slightest deviation from regulatory documents in such documents as an employment contract, staffing of the organization, employment history, as well as in the employee's job description, can lead to adverse consequences (for example, litigation regarding the correction of violations).

Salaries of healthcare workers.

To date, there are many regulations governing the remuneration of employees of healthcare institutions.

Conventionally, they can be divided into three groups: regulations governing general approaches to the organization of the remuneration system for employees of all budgetary institutions, including healthcare, regulations on the remuneration system exclusively for employees of healthcare institutions, and departmental regulations.

The main document regulating the remuneration of employees of health care institutions is the Regulation on remuneration. It provides for uniform principles of remuneration for employees of health care institutions that are on budget financing. According to this provision, the wages of healthcare workers include:

Salary (the Regulation on wages provides for the conditions for its increase);

allowances;

Surcharges.

On fig. 1. the salary structure of medical personnel is presented in accordance with the regulation on remuneration.

Figure 1. Salary structure of medical staff.

The salaries of employees of health care institutions are determined on the basis of the Unified Tariff Scale (UTS), which includes 18 categories.

The regulation on remuneration defines the conditions that affect the establishment of the salary, namely the position of the employee, the area in which he works (rural, urban), skill level, academic degree or title.

The regulation on remuneration identifies factors that increase the level of remuneration of medical personnel (see Fig. 2).

Figure 2. Factors that increase the level of wages

Thus, medical workers working in rural areas are given higher salaries (rates) compared to the salaries (rates) of specialists engaged in these types of activities in urban areas. An increase in salaries is allowed by 25% (clause 2.3 of the Regulations on wages).

Salaries for deputies are set at 10-20% lower than the salary of the corresponding manager, taking into account the qualifications of this deputy, provided for by the ETS. If a specialist has a high qualification, confirmed by a certificate, and he is engaged in important and responsible work, in accordance with paragraph 2.5 of the Regulations on remuneration, he can be set a tariff rate based on 9-10 UTS categories.

When determining the amount of remuneration for the head of a healthcare institution, the number of estimated beds for which the institution is designed should be taken into account.

The indicators and the procedure for classifying healthcare institutions as groups for the remuneration of managers are given in Appendix No. 1 to the Regulations on Remuneration.

When honorary titles are awarded to medical workers, advanced training, changes in continuous length of service, the salary also increases (clause 2.7 of the Regulations on Remuneration). So, when a doctor is awarded the title of "Honored Doctor", his salary for the main job increases by one category, and when he is awarded the title "People's Doctor" - by two categories. If a doctor has two honorary titles, only one is accepted as a basis for increasing his remuneration (clause 3.12 of the Regulations on Remuneration).

In addition, salaries may be increased for employees of healthcare institutions if there are other conditions (section 4 of the Resolution on wages):

Particularly difficult and dangerous working conditions for health (if an employee of healthcare institutions (their structural divisions) is involved in the treatment of AIDS patients, HIV-infected, leprosy, mentally ill, tuberculosis patients). Their salary is increased by 60, 40, 30, 25 and 15% according to the List approved by the Ministry of Health of the Russian Federation in agreement with the Central Committee of the trade union of health workers of the Russian Federation, given in Appendix No. 2 to the Regulation on wages;

Work in hospitals for war veterans and special departments of hospitals (provided that departments in hospitals are used by at least 90% for the treatment of war veterans and persons equated to them in terms of benefits), as well as Rehabilitation Therapy Centers for internationalist soldiers. Medical and pharmaceutical workers of these institutions, salaries are increased by 15%, and for other employees - by 10%.

Other conditions.

According to sect. 5 of the Regulations on remuneration for employees of healthcare institutions, the following types of additional payments are made:

For work at night;

For work with the division of the shift into parts;

For combining professions;

For work in the specialty to medical directors and their deputies;

For work related to the provision of TB care;

Other types of surcharges.

Additional payments provided for medical staff by the regulation on remuneration are presented in Fig. 3.

Figure 3. Additional payments to medical staff

Work at night. The order of work at this time of day is regulated by the norms of Art. 96 of the Labor Code of the Russian Federation, according to which the time from 22 to 6 hours is considered night. The duration of work (shift) at night is reduced by one hour without subsequent working off. However, night work for medical workers is not subject to reduction. This follows from Art. 96, 350 of the Labor Code of the Russian Federation and Decree of the Government of the Russian Federation of February 14, 2003 N 101 "On the working hours of medical workers, depending on the position held."

The amount of additional payment for work at night is established by clause 5.1 of the Regulations on wages and is:

50% hourly tariff rate(official salary) for each hour of work at night. At the same time, this additional payment is paid to workers at the rate of the hourly tariff rate (salary), taking into account the increase for work in hazardous and especially difficult working conditions. And for medical, pharmaceutical workers, specialists and employees - based on the official salary for their position;

100% hourly tariff rate (official salary). In this amount, the surcharge is established for medical personnel engaged in the provision of emergency, ambulance and emergency medical care, field personnel and communication workers of ambulance stations (departments).

Work with the division of the shift into parts. Employees of health care institutions, with their consent, may be introduced a working day with the division of the shift into parts. The right to establish such a working time schedule is established by Art. 105 of the Labor Code of the Russian Federation. According to the norms of the mentioned article, when dividing the working day into parts, the total duration of working time should not exceed the established duration of daily work.

Additional payment for work with the division of the shift into parts is made on the basis of the official salary for the position held. The list of positions of employees who can be given the specified surcharges, and the amount of surcharges are determined by the head of the institution in agreement with the elected trade union body (clause 5.2 of the Regulations on wages).

Work with a combination of professions. The conditions and procedure for establishing an additional payment for combining professions (positions) or performing the duties of a temporarily absent employee are established in collective agreements (clause 5.5 of the Regulations on Remuneration). In this case, the combination of professions is understood as the performance by an employee in the same healthcare facility within the working day, along with his main job, due to employment contract, additional work in another position (profession) or the performance of the duties of a temporarily absent employee without releasing from his main job.

Work in the specialty of a doctor by managers and their deputies. In accordance with paragraph 5.3 of the Regulations on remuneration, doctors - heads of health care institutions and their deputies are allowed to work in the institutions in which they are employed, work in their specialty within the working hours of their main position. In this case, the additional payment will be up to 25% of the official salary of a doctor of the corresponding specialty. The exact percentage of the additional payment is established by the order of the head of the institution.

Work related to the provision of anti-tuberculosis care. Medical and other employees of healthcare institutions directly involved in the provision of anti-tuberculosis care, whose activities are associated with the risk of infection with Mycobacterium tuberculosis, in accordance with paragraph 5.6 of the Regulations on remuneration, an additional payment is established in the amount not exceeding 25% of the official salary (monthly tariff rate).

Allowances

The regulation on remuneration for employees of healthcare institutions establishes the following types of allowances (section 6 of the Regulation on remuneration):

For the duration of continuous work in healthcare institutions;

For working conditions;

Stimulating nature.

The list of allowances provided for by the regulation on remuneration is presented in fig. 4.

Figure 4. Allowances provided for by the regulation on the remuneration of medical workers

Continuous work in healthcare facilities. Depending on the position of the medical worker, the period of his continuous experience and the type of medical institution in which he works, the amount of the bonus to the official salary is established (clause 6.1 of the Regulations on Remuneration).

Allowances for working conditions. The amount of allowances paid for working conditions and the procedure for their payment are established in clause 6.3 of the Regulations on wages. They are paid in the following amounts:

30% to the salary (rate) of medical and pedagogical staff of psychiatric hospitals (departments) of a specialized type and forensic psychiatric departments for persons in custody;

20% to the salary (rate) of employees of health care institutions that diagnose and treat HIV-infected patients.

In accordance with Art. 146 of the Labor Code of the Russian Federation, remuneration of employees is made at an increased rate not only when performing heavy work, work with harmful, dangerous and other special working conditions, but also when performing labor functions in areas with special climatic conditions. Employees of medical institutions performing work in areas with special climatic conditions, Art. 10 of the Law of the Russian Federation of February 19, 1993 N 4520-1 "On State Guarantees for Persons Working and Living in the Far North and Equivalent Areas" establishes the amount of the percentage premium and the procedure for its payment.

Incentive bonuses. For the application of the achievements of science and advanced labor methods, high achievements in work, the performance of particularly important or urgent work (for the period of their implementation), as well as labor intensity, employees of health care institutions may be paid bonuses of a stimulating nature (clause 6.4 of the Regulation on wages ). They are accrued on the salary (rate) and are not limited to maximum sizes. Allowances are established by order of the head for a certain period, but not exceeding one year. In the event of a deterioration in performance or the completion of particularly important or urgent work, allowances are canceled.

For heads of healthcare institutions (chief physicians, directors, heads, chiefs), allowances are established by a decision of a higher healthcare management body for work aimed at developing the institution, applying advanced methods of diagnosing and treating patients, new medicines and medical equipment, advanced methods of ensuring sanitary - epidemiological well-being of the population.

Due to the specifics of their activities, doctors and paramedical personnel are on duty at home. They are introduced within the limits of the balance of working time of the relevant employees for the accounting period, as a rule, one month, for the main position and the position held in combination.

According to paragraph 7.1 of the Regulation on remuneration, the time spent on duty at home, both day and night, is taken into account as half an hour for each hour of duty. If it becomes necessary to call a doctor or senior staff specialist on duty at home to provide medical care, then the time spent on providing assistance is paid at the rate of the official salary of the doctor or paramedical worker for the hours actually worked, taking into account the time of the move.

Characteristics of health care personnel

According to the Decree of the Ministry of Labor Russian Federation dated August 27, 1997 No. 43 "On the harmonization of pay categories and tariff and qualification characteristics for the positions of healthcare workers of the Russian Federation" (hereinafter referred to as the Decree of the Ministry of Labor No. 43), the following categories of positions are used in medical institutions:

1. Leaders.

2. Specialists:

2.1. Specialists with higher medical education;

2.2. Specialists with higher professional education;

2.3. Specialists with secondary medical education (middle medical personnel);

3. Junior medical staff.

4. Other personnel of medical and labor workshops at health care institutions.

The main characteristics of the personnel of health care institutions also include general characteristics of the classification of employees, such as gender, age, education, work experience, marital status, etc.

Thus, the personnel of health care institutions is characterized by various characteristics. The specificity of the classification of this category of personnel lies in the legislatively fixed list of positions, according to which the salary category of the employee is established. But on the basis of the category and tariff-qualification characteristics, the amount of the salary is established, as well as allowances and additional payments to the employee of the healthcare organization.

Thus, in this chapter, the theoretical aspects of personnel management, scientific ideas and approaches to this problem were considered.

The features of personnel work in healthcare organizations are considered, the characteristics of the personnel of healthcare institutions are given.

Keywords

MEDICAL STAFF / QUALITY OF MEDICAL CARE./ HUMAN HEALTH RESOURCES / QUALITY OF MEDICAL CARE

annotation scientific article on health sciences, author of scientific work - Popovich Victor Konstantinovich, Shikina Irina Borisovna, Turchiev Andrey Georgievich, Baklanova Tatyana Nikolaevna

In an article on the role medical personnel when implementing a policy in the field of quality of medical care in medical institutions, a review of the opinions of different authors on the problem, as well as their own solutions, is considered. It is known that the quality of medical care is assessed by three main parameters: structural, technological and effective components. The first of the listed components involves taking into account and analyzing such characteristics as finances and material and technical resources, the human resources potential of the healthcare industry and their compliance with the obtained (expected) results. The leading role of personnel, as well as their importance in the activities of the industry, is explained by the fact that the volume of financial and logistical support for the health care system, when the appropriate conditions are created, is formed and recreated faster than its human resources potential. Restoration, stabilization and effective use of personnel are realistically feasible only after several years and even decades. The personnel policy includes organizational, staffing, managerial, social, financial, information policies and is combined with the plans and concept of medical facilities for managing the quality of medical care in a medical organization. Ensuring motivation for work focused on obtaining the final result, and for quality management is one of the main tasks on the way to improving the diagnostic and treatment process. For this purpose, both methods of economic incentives (a system of remuneration taking into account the contribution of each employee to the result obtained) and moral incentives are used: career advancement, awards and other forms of encouragement. Increasing the responsibility of each employee for the quality of the work performed, the implementation of improving the quality of the treatment and diagnostic process and the medical services provided in a continuous mode, directly depends on the improvement of the system of training and retraining of personnel. It is necessary that the increase professional level and the improvement of the staff of medical facilities was carried out continuously, both in everyday and prospective directions. Thus, strategic planning of the use of human resources in the implementation of the policy in the field of quality of medical care is one of the main tasks of management on the way to improving the quality of the treatment and diagnostic process and improves the clinical performance and economic efficiency of each medical institution.

ROLE OF HUMAN HEALTH RESOURCES IN REALIZATION OF THE POLICY OF MEDICAL CARE QUALITY

In the article, consideration is given to the role of human health resources in the realization of the policy of medical care quality in health care facilities ; various views on the problem together with authors" decisions are discussed. It is known that the quality of medical care is assessed by three key parameters: structural, technological and effective components. The first of the listed components assumes an account and analysis of such characteristics , as finance and material resources, human health resources and their conformity to the results expected. are formed quicker than the human health resource while forming corresponding conditions. administration, social, financial, and information components . It is compatible with plans and concepts of health care facilities in the field of heath care quality management. Labor focused motivation on a final result and quality management is one of the main objects in improving treatment and diagnostic processes. For this purpose, both methods are used: provision of economic incentives (payment for the input which a health care provider contributed to the result of treatment), and moral stimulus (career progress, awards, and other forms of encouragement). Increase in responsibility of each health care providers for the quality of the work performed, improvement in the quality of treatment and diagnostic processes and long-term medical care depend directly from improving the system of the personnel training and retraining. It is necessary that professional training of medical personnel in health care facilities should be carried out continuously, as in daily, and in perspective. Thus, the strategic planning of human health resources is one of the main goals of health care management aimed at improving the quality of treatment and diagnostic processes at realization of the policy in health care quality; such planning will help to increase clinical results and economic efficiency of each health care facility.

The text of the scientific work on the topic "The role of medical personnel in the implementation of the policy in the field of quality of medical care"

~ ~ ISSN 2071-5021

Electronic scientific journal El No. FS77-28654

"Social aspects of public health"

03/01/2011 UDC: 614.212: (470+571)

Popovich V.K.1, Shikina I.B.1, Turchiev A.G.2, Baklanova T.N.1

The role of medical personnel in the implementation of the policy in the field of quality of medical care

1 - City hospital No. 17. Moscow

2 - Multidisciplinary clinic "House of Health", Pyatigorsk Popovich V.K.1, Shikina I.B.1, Turchiev A.G.2, Baklanova T.N.1

Role of human health resources in realizing the policy of medical care quality

1 - City hospital №17, Moscow

2 - "House of Health" multi-purpose clinic, Pyatigorsk

The article, devoted to the role of medical personnel in the implementation of the policy in the field of quality of medical care in medical institutions, considers a review of the opinions of different authors on the problem, as well as their own solutions.

It is known that the quality of medical care is assessed by three main parameters: structural, technological and effective components. The first of the listed components involves taking into account and analyzing such characteristics as finances and material and technical resources, the human resources potential of the healthcare industry and their compliance with the obtained (expected) results.

The leading role of personnel, as well as their importance in the activities of the industry, is explained by the fact that the volume of financial and logistical support for the health care system, when the appropriate conditions are created, is formed and recreated faster than its human resources potential. Restoration, stabilization and effective use of personnel are realistically feasible only after several years and even decades.

The personnel policy includes organizational, staffing, managerial, social, financial, information policies and is combined with the plans and concept of medical facilities for managing the quality of medical care in a medical organization.

It is known that the quality of medical care is assessed by three key parameters: structural, technological and effective components. The first of the listed components assumes an account and analysis of such characteristics, as finance and material resources, human health resources and their conformity to the results expected.

The leading role of human health resources and also their significance in the activity of health care facilities can be explained by the fact that financial and material provisions of public health services are formed quicker than the human health resource while forming corresponding conditions. Restoration, stabilization, and effective usage of the medical personnel are really feasible only after several years and even some decades have passed.

The human health policy incorporates the following components: staff organization, administration, social, financial, and information components. It is compatible with plans and concepts of health care facilities in the field of heath care quality management.

Labor focused motivation on a final result and quality management is one of the main objects in improving treatment and diagnostic processes. For this purpose, both methods are used: provision of economic

labor, taking into account the contribution of each employee to the result), and moral incentives: career advancement, awards and other forms of encouragement.

Increasing the responsibility of each employee for the quality of the work performed, the implementation of improving the quality of the treatment and diagnostic process and the medical services provided in a continuous mode, directly depends on the improvement of the system of training and retraining of personnel. It is necessary that professional development and improvement of health facility staff be carried out continuously, both in daily and future directions.

Thus, strategic planning of the use of human resources in the implementation of the policy in the field of quality of medical care is one of the main tasks of management on the way to improving the quality of the treatment and diagnostic process and improves the clinical performance and economic efficiency of each medical institution.

incentives (payment for the input which a health care provider contributed to the result of treatment), and moral stimulus (career progress , awards, and other forms of encouragement).

Increase in responsibility of each health care providers for the quality of the work performed, improvement in the quality of treatment and diagnostic processes and long-term medical care depend directly from improving the system of the personnel training and retraining. It is necessary that professional training of medical personnel in health care facilities should be carried out continuously, as in daily, and in perspective.

Thus, the strategic planning of human health resources is one of the main goals of health care management aimed at improving the quality of treatment and diagnostic processes at realization of the policy in health care quality; such planning will help to increase clinical results and economic efficiency of each health care facility.

Key words: medical personnel, quality of medical care.

Key words: human health resources, quality of medical care.

The quality of medical care is assessed according to three main components: structural, technological and productive.

Each of the listed components involves taking into account and analyzing such characteristics as finances and material and technical resources, the human resources potential of the healthcare industry and their compliance with the obtained (expected) results.

At the same time, quality management of medical care is key issue health care, which determines both current and strategic prospects for the activities of any medical institution (HCI) . An important role in this process is assigned to medical personnel, since the attitude to work of each employee has a direct, in some cases decisive influence on the results of the diagnostic and treatment process.

The leading role and importance of personnel in the activity of the industry is explained by the fact that the volume of financial and logistical support of the health care system, when the appropriate conditions are created, is formed and recreated faster than its human resources. Restoration, stabilization and effective use of personnel are realistically feasible only after several years and even decades.

Prospects for the development of healthcare in the Russian Federation largely depend on the state of the professional level and quality of training of medical and pharmaceutical personnel, their multi-stage improvement over the course of labor activity, which is reflected in the "Concept of personnel policy in the healthcare of the Russian Federation" (2002), developed in accordance with the state policy of improving the level of public health.

The Concept emphasizes the main goal of the health personnel policy in the near future, which is to develop a system for managing the personnel potential of the industry. One of the key tasks is defined as “... reforming

health personnel service in accordance with the principles and requirements of the modern theory of scientific human resource management.

The concept reveals the main content of the personnel policy in the health care of the Russian Federation:

Priorities for the formation of personnel work in the industry in accordance with the directions of its reform;

Principles of planning and use of human resources for health care based on the improvement of the range of specialties and the system of certification of specialists;

The strategy for intensive development of human resources in healthcare based on the optimization of the system of medical and pharmaceutical education in accordance with the requirements of practical healthcare, medical science and branch management;

New principles of the system of remuneration of workers in the industry;

New development principles social partnership with the involvement of public medical and pharmaceutical organizations in the management of health care.

The Concept states that the problems of personnel management should be solved by modern technologies for hiring and diagnosing personnel, competent placement of personnel, taking into account the requirements of the workplace, the criteria for matching the employer's expectations and the potential of the medical worker, ensuring the professional growth of the employee. On the basis of the Concept, normative legal documents, sectoral programs, plans relating to various aspects of personnel policy are being developed. Its provisions are taken into account when forming strategic directions for the development of regional healthcare and the staffing needs of a particular health facility!

Thus, the personnel policy includes organizational, staffing, managerial, social, financial, informational policies and is combined with the plans and concept of medical facilities for managing the quality of medical care.

Ensuring motivation for work focused on obtaining the final result, and for quality management is one of the main tasks on the way to improving the diagnostic and treatment process. For this purpose, both methods of economic incentives are used (a remuneration system taking into account the contribution of each employee to the result obtained) and moral incentives: career advancement, awards and other forms of encouragement.

When forming plans for the implementation of the policy in the field of quality of medical care in any inpatient medical facility, the leading role in strategic planning is assigned to the management of human resources, the qualitative composition of which largely determines the result of the treatment and diagnostic process.

The main objectives of the personnel policy of health facilities should be:

Ensuring the high quality of human resources;

Preservation of the stability of the staff;

Creation of a system of continuous professional growth of employees;

Formation of a favorable socio-psychological climate in the team;

Social protection of medical workers;

Formation of corporate culture.

The efficiency of the healthcare industry, as well as the entire national economy, is largely determined by knowledge, skills and abilities.

leaders at various levels. In this regard, the guarantee of the professionalism of each manager is his continuous education. Basic principles of professional education of a manager in modern conditions- consistency, continuity, scientific character, commitment, prospects, development of leadership qualities in a manager, individualization and differentiation educational process, a combination of organized learning with self-education.

The cornerstone task of the organizational and staffing policy of health facilities is staffing with highly qualified specialists in strict accordance with specific needs. For these purposes, a system of contracts is used with state educational institutions of higher and secondary vocational education for targeted training of specialists (radiologists, pathologists, anesthesiologists, resuscitators, etc.) in internship and clinical residency, training of paramedical personnel from among the employees of health facilities!

The hospitals use various methods testing of personnel for professional suitability. So, when hiring, a preliminary assessment of the future employee is carried out by the management and specialists of the personnel department of the health facility, as well as the heads of structural divisions, taking into account compliance with the requirements of the vacant position. The assessment is carried out on the basis of the submitted documents, analysis of the submitted resume, personal conversation, questionnaire in order to identify professional training, justify the desire to work in a particular structural unit, as well as the reasons for dismissal from the previous job.

Increasing the responsibility of each employee for the quality of work performed within the framework of the treatment and diagnostic process and the ongoing medical services provided largely depends on the improvement of the system of training and retraining of personnel. It is necessary that professional development and improvement of health facility staff be carried out continuously.

Everyday training is necessary so that the staff has the opportunity to get acquainted with the latest achievements of domestic and world medicine directly at the workplace, and not by the "trial and error" method. This significantly reduces the time for the introduction of new technologies, the frequency of complications and, as a result, reduces mortality.

Advanced training is the process of preparing medical specialists for the implementation of planned innovations (for example, high technologies) and for working with new modern equipment (magnetic nuclear resonance tomography, etc.).

An atmosphere aimed at stimulating the desire of each employee to master modern technologies, broaden their horizons, and improve their professional level should be created in the healthcare facility. In the absence of sufficient material resources to encourage an employee, management can use other methods of motivation: sending an internship to Russian medical centers, providing an opportunity to master related medical specialties, creating conditions for scientific activity, etc.

The introduction of new medical technologies requires a new approach to the training of nursing staff, including universal training in modern standards practical activities nurse. Classes on this subject in subdivisions should be held separately with chief, senior, ward, procedural, dressing nurses.

Quality control required the introduction of new accounting and reporting documentation. For this purpose, a special defect log has been developed in some medical facilities. nurses, which is conducted in each department by senior nurses with fixation

comments of the head nurse during rounds. Each deviation from the standard has its own approved score.

Strict control over the implementation of standards in healthcare facilities leads to a decrease in the number of identified defects in the organization of medical care, primarily in patient care.

The introduction of new methods of care and performance of functional duties allow, along with other activities, to significantly improve the quality and intensify the treatment and diagnostic process, reduce the average length of stay of the patient.

An analysis of the effectiveness of training medical personnel is carried out regularly at meetings of the medical council of the institution, where an annual report on personnel work is heard, as well as reports from the qualification and certification commissions.

In everyday work, both the business qualities of employees and their observance of deontological principles should be studied. Managers (deputy chief physicians, chief nurses, heads of departments, head nurses) evaluate the quality of work of each employee, study their job satisfaction, competence in solving the tasks. An important criterion is the patient's assessment of satisfaction with the quality of medical care provided by this employee (anonymous survey).

The promotion of each employee should go in two directions, including career growth and advanced training. To take the right management decisions in the field of personnel policy in health care facilities, the list of reserve employees for senior positions should be approved annually.

Based long-term plans development of healthcare facilities, the personnel department draws up a personnel development plan, which takes into account the need to open new departments, services, introduce new technologies, equip modern equipment, and selects the appropriate team of subdivisions (Fig. 1).

Rice. 1. Structural diagram "Organization of the training process".

The information policy of health care facilities as an element of personnel policy is aimed at obtaining high-quality information on the needs of departments and bringing all initiatives of the administration and management decisions to employees.

The development of personnel abilities and qualifications is carried out through continuous internal and external training. Despite the difficulties with financing, health care facilities should set as one of the priorities of their personnel policy the mandatory advanced training of doctors and paramedical personnel once every five years with the receipt of certificates and certificates.

Doctors undergo professional retraining mainly at the faculties of postgraduate education of state educational institutions of higher professional education. The training of paramedical personnel is carried out in accordance with the schedule in state educational institutions of secondary and higher professional education.

The introduction of new medical technologies requires a new approach to the training of nursing staff. In this regard, the role of the deputy chief physician for nursing staff and / or the head nurse of the health facility is increasing.

Time has shown the need to develop modern nursing standards based on the assessment of the quality of medical care as the main factor in its improvement. The nurse must adhere to the standards practical work when performing each type of activity in the same way as a doctor fulfills the standards of the diagnostic and treatment process for various pathologies.

Thus, providing adequate motivation for quality work and quality management of medical care is one of the main tasks of clinical management. Strategic planning for the use of human resources in the implementation of a policy to improve the quality of medical care can improve clinical performance and cost-effectiveness of health facilities!

Bibliography

1. Economic methods in healthcare management. / Vardosanidze S.L., Vorobyov S.V., Golovina S.M., Gololobova T.V., Gorbunkov V.Ya., Grigoryeva T.N., Gryaznova T.Yu., Daraev Yu.M., Devyatko V.N., Dubodelova N.K., Zhilinskaya E.V., Kovaleva V.V., Kozachenko O.A., Lindenbraten A.L., Magaev K.A., Minin O.G., Proschensky B. M., Ragozny A.D., Solovieva N.B., Timofeev L.F., Timofeeva T.A., Filippova V.I., Shikina I.B., Shipova V.M. / Ed. acad. RAMS O.P. Shchepina. M., 2006. 308 p.

2. Vardosanidze S.L., Shikina I.B., Sorokina N.V. Motivation of medical personnel in a multidisciplinary hospital. // Health manager. 2006. No. 10. pp.44-49.

3. Mikhailova Yu.V., Son I.M., Sokhov ST., Danilova N.V.,. Shestakov N.N., Sasina N.S., Takhtarova Yu.N. Status and prospects for the development of human resources in the healthcare system. // Healthcare of the Russian Federation. 2008. No. 1. P.52-54.

4. Polessky V.A., Martynchik S.A., Zaporozhchenko V.G., Martynchik E.A., Kucherenko V.Z. Evolution of quality system models: international practice // Healthcare Economics. 2005. No. 8. pp. 25-36.

5. Order of the Ministry of Health of the Russian Federation of July 3, 2002 No. 210 "On the concept of personnel policy in the healthcare of the Russian Federation".

6. Health Management / Ed. V.Z.Kucherenko. M.: TEIS. 2001. 448 p.

7. Shikina I.B., Vardosanidze S.L., Voskanyan Yu.E., Sorokina N.V. Problems of ensuring patient safety in modern healthcare. // M., Publishing house: OOO "Glossarium". 200b. 33b p.

8. Cossutta R., Masserini A.B., Colombelli P. Evaluation of quality of life in patients with systemic sclerosis by the SF^ questionnaire // Arthritis and Rheumatism. 2000 Vol. 9. P. 77b.

1: Vardosanidze SL, Vorobev SV, Golovina SM, Gololobova TV, Gorbunkov VYa, Grigoreva TN, Gryaznova TYu, Daraev YuM, Devyatko VN, Dubodelova NK, Zhilinskaya EV, Kovaleva VV, Kozachenko OA, Lindenbraten AL, Magaev KA, Minin OG, Proshchenskiy BM, Ragoznyy AD, Soloveva NB, Timofeev LF, Timofeeva TA, Filippova VI, Shikina IB, Shipova VM. Economic metody v upravlenii zdravookhraneniem. Shchepin OP, editor. Moscow; 200b. 308p.

2. Vardosanidze SL, Shikina IB, Sorokina NV. Motivatsiya meditsinskikh kadrov v usloviyakh mnogoprofilnogo statsionara. Manager zdravookhraneniya 200b;(10):44-49.

3: Mikhaylova YuV, Son IM, Sokhov ST, Danilova NV, Shestakov NN, Sasina NS, Takhtarova YuN. Sostoyanie i perspektivy razvitiya kadrovogo potentsiala sistemy zdravookhraneniya. Zdravookhranenie Rossiyskoy Federatsii 2008;(1):52-54.

4. Polesskiy VA, Martynchik SA, Zaporozhchenko VG, Martynchik EA, Kucherenko VZ. Evolyutsiya modeley sistemy kachestva: mezhdunarodnaya praktika. Ekonomika zdravookhraneniya 2005; (8):25-3b.

5. Prikaz Minzdrava RF dated 03.07.2002 No. 210 "O kontseptsii kadrovoy politiki v zdravookhranenii Rossiyskoy Federatsii".

6. Upravlenie zdravookhraneniem. Kucherenko VZ, ed. Moscow: TEIS; 2001. 448 p.

7. Shikina IB, Vardosanidze SL, Voskanyan YuE, Sorokina NV. Problemy obespecheniya bezopasnosti patsientov v sovremennom zdravookhranenii . Moscow: Glossary; 200b. 33b p.

8. Cossutta R, Masserini AB, Colombelli P. Evaluation of quality of life in patients with systemic sclerosis by the SF^ questionnaire. Arthritis and Rheumatism; 2000;9:77b.

Introduction. The problem of improving the quality of dental services is relevant at the present stage, when everything is greater value acquires the factor of "product quality", which ensures its competitiveness. A high-quality service that is in demand provides institutions with sustainable profits and financial stability. However, the provision of a quality service is a complex matter and depends on many factors: the quality of materials and technologies, the equipment used, people and other elements of the external and internal environment of a medical institution.

The provision of dental services is a complex problem, while in modern conditions the "human factor" plays an increasingly important role in achieving a high level of quality. medical workers involved in the creation and manufacture of products. Under these conditions, the importance of general education and professional training of medical personnel is increasing. In turn, the level of professional training of dentists and its growth largely depends on the constancy of the composition of the workforce. The stability of the team can be ensured by reducing the staff turnover, which, due to the prevailing conditions in healthcare, is now typical for many institutions.

Personnel turnover in modern conditions is associated with a complex set of motives of a socio-economic, social, social and psychological nature, due to the participation of a person in social production. Difficulties in the financial situation, a decrease in the number of services and other reasons have a serious impact on the turnover of staff in dental institutions. Many qualified doctors and paramedical workers leave their jobs, often change jobs in search of better conditions labor and financial rewards. In the process of staff turnover, the influence of many social aspects of production on labor efficiency and the quality of services provided, both at the level of treatment and preventive measures and at the level of health care, is manifested.

Excessive turnover has a significant impact not only on the quantitative indicators of the activities of dental institutions, but also on the qualitative characteristics of the services provided. At the same time, in some departments of institutions, not only the number of employees can change, but also the gender and age and qualification and educational structure of the team, which will accordingly affect the quality of medical care provided and the indicators characterizing the activities of the institution. The deterioration in the performance of medical facilities is explained by the fact that instead of leaving highly qualified specialists, new employees who do not have sufficient work experience can be hired. It is known that for a certain period of time (the first 1-2 months) the labor productivity of new employees will be somewhat lower than it was at the previous place of work. The quality of dental care provided may also deteriorate.

5.1. Human resources of medical institutions

The labor potential of an employee of a medical organization is not a constant value, it is constantly changing. The working capacity of a person and the creative abilities accumulated (accumulated) in the course of labor activity increase with the development and improvement of knowledge and skills, health promotion, improvement of working and living conditions. But they can also decrease if, in particular, the state of health of the employee worsens, the working regime becomes tougher, etc. Speaking about the personnel management of healthcare facilities in the context of innovative development, it must be remembered that the potential is characterized not by the degree of preparedness of a doctor or other employee of a healthcare facility at the moment to occupy a particular position, but by his capabilities in the long term - taking into account age, education, practical experience, business qualities, level of motivation.

The formation of the market has already set a number of new tasks, the solution of which is impossible on the basis of old ideas, approaches and methods. In this regard, the issues of restructuring personnel work have acquired particular urgency today. In healthcare, the problems of intensifying production, increasing its efficiency, better using expensive and scarce human resources came to the fore, began to acquire key importance for the survival and adaptation of dental health facilities to the new economic situation for them.

Improving the efficiency of the production of medical services now, more than ever before, turned out to be dependent on the degree of participation in these processes of all production workers: from a nurse to the head physician of a health facility. Modern technology and production require not only high qualifications and performance discipline of workers, but also their creative participation in production, the search for reserves for its rationalization.

In recent years, many dental institutions have been using in their daily practice systems of competitive replacement of managerial positions and the election of managers, increasing the cost of staff training, career selection and career guidance, actively cooperating with consulting centers on personnel issues, etc. Measures are being taken to improve the personnel management system in the country as a whole, however, the requirements for innovative development of healthcare institutions in the framework of improving the quality of medical services are accompanied by the formation of new goals and objectives. Under the current conditions, traditional measures to improve work with personnel are not enough.

Trends in the personnel situation in healthcare in Russia. In market conditions, when the basis of any activity is to obtain maximum profit with minimal cost it is very easy to slip into the formation of distorted morality in the professional medical environment. In this regard, it should be noted that distortions of morality are the most dangerous for any organizational system and not just for the healthcare system. Quantitative measurements in this area are greatly hampered by the lack of generally recognized values, therefore, when characterizing the morality of medical workers, one should mainly use qualitative indicators.

In the context of the implementation of the principles of the market in domestic healthcare, the most destructive effect on the staff of doctors is exerted by some processes that are typical for private business activities, but the germs of these processes are also observed in the state (municipal) system of healthcare facilities.

First of all, it is demoralization . It manifests itself in the loss of morality both by society as a whole and by individual groups of workers, including doctors. Some specialists behave immorally, beyond self-control, which prohibits drunkenness, self-destruction, rudeness and aggression. Such specialists, as a rule, work outside the accepted standards for providing medical care to the population and the level of quality of the services they provide is low. In the eyes of the patient, the demoralized doctor has neither respect nor authority.

Another destructive process that threatens the medical environment is deintellectualization , i.e. unwillingness to engage in intellectual work. This process turns a medical worker with a higher education (doctor) into an artisan, because such a specialist stops thinking creatively and independently analyzing his actions. He is incapable of self-education. If this type of doctor begins to predominate among the higher medical personnel of health care facilities, then the natural result is the loss of the intellectual potential of the health care system.

Equally important in modern times is ethical nihilism . The denial of the norms of behavior in society, the fetishization of the superiority of one's own will over the will of the patient, the formation of paternalism lead to inhumanity. There is a threat of the formation of professional crimes in the medical environment in the form of a business of selling donor organs, corpses, manipulation of consciousness for money, bribery, etc. An indifferent attitude to the suffering of the patient, to his fears, unwillingness to treat patients attentively and sympathetically lead to the fact that the feedback between the patient's condition and the doctor's actions to correct and prescribe treatment is lost. The immediate consequence of this is an increase in morbidity, mortality and disability.

Ultimately, these issues should be considered as parameters of the production culture in the healthcare industry in the form of a type of relationship between administrators, doctors and nursing staff. Up to now, in the majority of domestic health care facilities, an authoritarian style of management and a culture of strict hierarchical subordination prevail. The strict vertical “chief doctor - attending physician - paramedical worker” in itself is not ideal, since it creates tension in the teams for the production of medical services and causes conflict situations in health facilities. Authoritarian relations in health care facilities generate a lack of manageability, a predominance of punishments over rewards, de-intellectualization and demotivation of medical personnel, which negatively affects the level of quality. And, nevertheless, the main problem for the domestic healthcare system is the lack of qualified medical personnel, and, above all, doctors, including dentists.

The shortage of doctors is the leading cause of the decline in the availability and quality of medical care. In a real situation, medical personnel, as a rule, are concentrated in stationary medical facilities. Showing a relatively good dynamics in the provision of medical positions in healthcare facilities in the Far East of Russia (Fig. 5.1.), Today it is not customary to say that we are not talking about the number of physical persons of doctors, but about the number of positions of doctors in the staff lists of healthcare facilities.

Rice. 5.1. Dynamics of the medical workforce from 1970 to 2015 in the Far Eastern Federal District
(number of doctor positions per 10,000 population)

Therefore, in most domestic health facilities, the so-called system is practiced. “part-time jobs”, when a doctor, nurse or other specialist in a medical facility constantly combines work in the main position with work for 0.5 to 1.3 positions in the form of duty in hospitals, appointments in clinics, etc. In such a situation, a “working day” individual doctors lasts from 12 to 34 consecutive hours. There is no need to talk about the level of quality of medical services produced in such conditions ...

In rural areas, where there is usually a shortage of doctors, there is an increasing process of transition of medical care to pre-medical technologies by replacing the vacant positions of doctors with the positions of paramedics and nurses. In dentistry, this is the process of replacing dentists with dentists (dental hygienists).

In recent years, many attempts have been made to achieve an optimal balance in the provision of medical personnel for urban and rural health facilities, between specialist doctors and general practitioners, between hospitals, polyclinics and other health facilities. In countries with a centrally planned economy, the distribution of medical personnel to the most needy regions was decided administratively. In the former USSR, for example, graduate doctors had to work “by assignment” for three years, while the doctor could not return to the city until another young specialist arrived to replace him.

In the conditions of a market economy and changes in legal mechanisms in modern Russia, it is currently unrealistic to apply a system of forced distribution of graduates of higher and secondary educational medical institutions, although even among parliamentarians “relapses” periodically appear as proposals for the forced distribution of graduates. Thus, the optimal distribution of university graduates in the health care system is a rather difficult task, even if a sufficient number of doctors are being trained throughout the country.

Assessing the “sufficiency indicator” of primary health care doctors (PHC) in world practice, they are guided by the following criterion: there should be at least 30 doctors per 10,000 people (or 1 primary care doctor for 3,300 people). Specialist doctors in economically developed countries tend to have a higher social status and income compared to general practitioners.

In countries with a centrally planned economy, the distribution of medical personnel to the most needy regions was decided administratively. In Cuba, as in their time in the USSR, for example, graduate doctors must work for two years in the countryside, while the doctor cannot return to the city until another young specialist arrives to replace him. There are other less radical examples. In particular, the intelligentsia were forcibly evicted to the countryside during the cultural revolution in China in 1966-1976, and in some Latin American countries, graduates of higher medical educational institutions before receiving diplomas, they had to work for a certain time in social sphere in the most needy regions, usually within one year.

In countries with a market economy, models based on the principle of material interest most often operate. In the US, medical students tend to pay tuition fees and are heavily in debt by the time they complete their university course. So, in 1989, 80% of medical graduates found themselves in this position. Under the government's National Health Corps program, needy medical students receive financial assistance to pay for their studies, on the condition that they make a commitment after graduation to work for a predetermined number of years in regions chosen at the discretion of government agencies, usually in rural areas or in non-prestigious urban areas.

There is information about other mechanisms for attracting university graduates to work in municipal healthcare facilities. For example, in the province of São Paulo in Brazil, individual villages can attract doctors by offering them higher wages and all sorts of benefits, including housing costs. This approach has made it possible to drastically reduce the number of rural settlements that are not staffed with doctors.

In the Far East of Russia, the training of future doctors is carried out in four medical universities, but there is no tendency to reduce the number of graduates (Table 5.1.).

Admission and graduation rates of students of state medical universities of the Far Eastern Federal District (2005 - 2010)

No. p / p	University of the Far Eastern Federal District	2005	2006	2007	2008	2009	2010
reception	release	reception	release	reception	release	reception	release	reception	release	reception	release
1.	Honey. I GU
2.	AGMA
3.	VSMU
4.	FESMU
5.	Total
6.	Release (%)		73,9		67,6		83,2		86,0		80,1	83,1

The state of human resources of health care facilities is currently characterized by the continuing disproportionate provision of medical personnel, the imbalance of their training, serious problems in providing medical care to the rural population, the lack, in some cases, of the necessary qualifications of personnel, as well as disharmony in the distribution of resources. The revealed patterns make it possible to consider it necessary to continuously improve the management of human resources, the implementation of corrective actions for economic planning and forecasting the number of medical personnel.

Use of the personal potential of health care facility employees. The most important goal of personnel management is the use of the personal potential of each employee, which is a complex characteristic of the employee's ability to act as an active subject of production activity. The personal potential of an employee has a complex structure and is distinguished by the structural unity of all its elements (Fig. 5.2.).

Rice. 5.2. Components of the personal potential of healthcare facility employees

The principle of effective use of a person's personal potential, which underlies personnel management at the present stage, is implemented in three main areas:

I. Creation of the necessary conditions for the comprehensive development of the personal potential of an employee of a healthcare facility.

II. Providing conditions for the most complete mobilization of the potential of an employee of a healthcare facility to achieve their tasks.

III. Continuous and systematic development of the professional qualities of doctors, nurses, etc. in accordance with the long-term objectives of the development of the production of medical services.

The increasing importance of the subjective factor in modern conditions in a new way raises the question of the role of the personnel management function in improving production efficiency. The main directions in which this impact is carried out are diverse: careful selection, selection and evaluation of personnel in accordance with the requirements of the position or workplace; special education, vocational training and training; continuous learning in accordance with the needs of updating knowledge; strengthening the real dependence of wages and other rewards on the results of work.

The impact of personnel management on the efficiency of the production of medical services and their quality is also evidenced by the fact that production, social development and education of people are a single process. Therefore, taking into account the social characteristics of the management object and the impact on them of improving the results of the functioning of a particular healthcare facility is one of the leading tasks of management, and, in particular, such a function as personnel management. Specific sociological research in the work of personnel management allows:

ü to resolve issues related to the regulation of the process of becoming an experienced, qualified doctor or other member of the team - the choice of a profession, adaptation to a medical facility, the formation of a certain attitude to work, etc.;

ü take into account the socio-psychological aspects of the selection and placement of personnel;

ü explore interpersonal relationships in the workforce;

ü assess the demographic structure of the team;

ü study job satisfaction;

ü apply means of socio-psychological influence on the personal life of an employee (everyday life, leisure) to maximize the activation of his personal potential (life, leisure).

Necessary condition effective management the personnel of the health care facility is the understanding by the participants of the labor process of the goals and means of achieving them. We are talking about the formation of a mechanism that allows those working in health care facilities to equally effectively influence both the development of action plans and the choice of methods and ways of implementing the plans. The correct functioning of such a mechanism is possible under the condition of a well-established communication system at the enterprise, which provides a clear understanding by each member of the HCI team of their functions, both in the personal labor process and in the activities of the production team as a whole.

Evaluation of labor productivity‒ is one of the functions of managing the organization, aimed at determining the level of efficiency of the functioning of the management of the health facility. It characterizes his ability to have a direct impact on the activities of any production or non-production unit. The indicators of the final results of labor of employees of the management apparatus, as well as its content, are influenced by a combination of various factors, the classification of which is given in Table. 5.2.

MEDICAL STAFF- a set of persons who have received a medical education and qualification (title) in special educational institutions or trained directly in healthcare institutions and admitted to medical and pharmaceutical activities in the manner prescribed by law. To honey. personnel include doctors, pharmacists, average honey. and farm. staff, as well as junior medical staff. M. to. in accordance with the level and profile of education and training carry out preventive, sanitary-educational, diagnostic, therapeutic, pharmaceutical, organizational work and patient care.

In all honey. institutions of the country, including honey. educational institutions and research institutes, in 1979 960.5 thousand doctors and St. 2.7 million nurses. The vast majority of doctors (St. 88%) and paramedical workers (St. 83%) work in institutions of the Ministry of Health. Junior medical and support staff totals approx. 3 million people

Stomatol, assistance to the population is provided by dentists and specialists with secondary medical care. education - dentists; in 1976 there were 53.5 thousand dentists and 48.8 thousand dentists in the USSR.

In addition to M. to., a significant number of non-medical specialists work in health authorities and institutions. These include biologists, physicists, chemists, engineers and technicians of various qualifications, accountants, economists, etc. The totality of persons of medical and non-medical specialties and professions employed at work in health authorities and institutions, as well as at medical enterprises. industry, are united by the concept of "health personnel". In the 50-70s. 20th century in connection with scientific and technological progress, strengthening the integration of scientific honey. research, the growth of medical equipment. institutions of difficult diagnostic and to lay down. equipment in activities to protect public health has increased the role of persons immediately. professions and specialties. At the end of the 70s. their number has reached almost 30% of the total health workforce.

Great work done over the years Soviet power in accordance with the Leninist personnel policy, it made it possible to basically meet the needs of highly developed socialist health care and take the USSR first place in the world in terms of the number of doctors and the provision of the population with them. From 1913 to 1978, the number of doctors in the country increased 33 times, and the number of nurses - 57 times. In 1978, more than one third of all doctors in the world worked in the USSR. The dynamics of the growth in the number of doctors of all specialties and the provision of the population with doctors in the USSR (including in the Union republics) for the period from 1913 to 1978 are presented in Table 1, and the growth in the number of nurses in the USSR by specialties for the period from 1940 to 1975 - in table 2.

The leading place in the implementation of the complex to lay down.-Professional activities belongs to the doctor.

In 1913, there were only 28.1 thousand doctors and 46 thousand paramedical workers in the country, the provision of the population with medical personnel was at an extremely low level and amounted to 1.8 and 2.9 per 10 thousand inhabitants, respectively. The process of organizing a new health care system after the accomplishment of the Great October Socialist Revolution was accompanied by the sabotage of a certain part of conservatively minded health workers. Guided by the instructions of V. I. Lenin, the Bolshevik doctors and a large group of conscious non-party doctors achieved rallying honey. specialists to solve the problems of creating a new, progressive system of protecting the health of the people. In a relatively short period of time, the vast majority of medical workers took an active part in the fight against epidemics, selflessly worked in hospitals to treat soldiers of the Red Army and the wounded on the fronts of the civil war, and set about building Soviet healthcare with great enthusiasm. The task of creating the Soviet intelligentsia, set by the party, was successfully solved, including the training of doctors and other medical professionals. specialists, closely connected with the working class and the working peasantry, selflessly devoted to the party, the people and the motherland. For maintenance of the country M. to. the network of the higher and average special honey was expanded. and pharma, educational institutions (see).

Decrees of the Central Committee of the All-Union Communist Party of Bolsheviks of June 1, 1931 “On medical personnel”, the Central Executive Committee and the Council of People's Commissars of the USSR of September 3, 1934 “On the training of doctors”, as well as a decree of the Central Committee of the All-Union Communist Party of Bolsheviks and the Council of People's Commissars of the USSR of June 23, 1936 "On the work of higher educational institutions and on the management of higher education" contributed to the further improvement and expansion of the training of M. to. Training of doctors began to be carried out in three main profiles: general medicine, pediatrics, and sanitary business. Since 1936, the training of dentists and pharmacists has been organized.

During the Great Patriotic War, medical workers, together with the entire Soviet people, worked selflessly at the front and in the rear; they achieved high rates in the treatment of the wounded and sick, the terms of their treatment were significantly reduced - over 72% of the wounded and 90% of the sick soldiers and officers were returned to duty. Huge successes have been achieved in the prevention of epidemics and the prevention of the spread of inf. diseases at the front and in the rear. Decree of the Council of Ministers of the USSR of December 1, 1944, in order to improve the theoretical and practical training of doctors at the medical, sanitary and pediatric f-takh honey. in-t was established 6-year term of study; stomatol. and farm, f-you were transferred to a 5-year term of study. Of great importance for improving medical care for the population of the Far East, Siberia, the Non-Chernozem zone, the Kazakh, Ukrainian, Belarusian, Latvian and Lithuanian SSRs was the discovery in 1950-1958. in these districts of the country new honey. institutions of higher education.

Improving the level and quality of medical care to the population, due to the creation and expansion of large medical institutions. centers in the Far East, Siberia, Kazakhstan, an increase in the contingent of doctors and other honey. specialists sent to these districts, in conjunction with other factors of social development (intensive housing construction, the development of a network of preschool institutions, the creation of favorable living conditions, etc.), contributed to the attraction of workers, engineers and other specialists to the districts of Siberia and the Far East, where, in accordance with the decisions of the XXV Congress of the CPSU, a huge amount of work is being carried out to implement the program for the integrated development of the natural resources of these districts, vital for our country.

To improve the quality of preparation and placement of honey. personnel, accelerating the growth in the supply of them to the population of all union republics and, first of all, economically important districts of the country, including rural areas, decisions of the XXIV and XXV congresses of the CPSU, resolutions of the Central Committee of the CPSU and the Council of Ministers of the USSR are of decisive importance on issues of work with personnel and improvement of public health.

The resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve public health" (1977) defined a set of major measures for the development of health care for a long period, the creation of favorable working conditions for doctors and other health workers in the most critical areas of health care, such as outpatient clinics. assistance (local service), emergency medical care, rural honey. institutions, etc.; measures are outlined to subdivide the territorial therapeutic and pediatric areas; Attention is drawn to the need to improve the selection, use and education of personnel.

M.'s preparation to. the highest qualification is carried out in 83 honey. and farm, in-max and 9 honey. f-tah high fur boots in 5 specialties (doctor-medical business, doctor-sanitary business, pediatrician, dentist, pharmacist). Besides, on medical - biol, f-those of the 2nd Moscow medical institute preparation on specialties the doctor-biochemist, the doctor-biophysicist and the doctor-cybernetician is carried out, and in Tomsk honey. in-te - biochemist. With introduction of internship (see) primary (undergraduate) specialization of doctors has developed. Graduates to lay down. f-tov pass primary specialization on internal diseases, surgery, obstetrics with gynecology, psychoneurology; pediatric f-tov - on pediatrics, inf. diseases of childhood, pediatric surgery; dental f-tov - in therapeutic, surgical and pediatric dentistry. The doctors who finished a dignity. - a gigabyte. f-t, undergo a one-year internship at the place of distribution. The training of doctors in narrower specialties is carried out in accordance with the system of postgraduate specialization of medical personnel established in the USSR through residency at the relevant departments of medical sciences. in-comrade, in research institutions, and also in in-ta and on f-ta of improvement of doctors and on the basis of large to lay down. - prof, institutions.

In the USSR systematic purposeful work on preparation of honey is carried out. scientific and scientific-pedagogical personnel. In 1976, in scientific institutions and universities of the health care system, St. 75 thousand scientific and scientific-pedagogical workers. There is a rapid increase in the number of these personnel. So, for example, the number of scientific honey. personnel by 1976 compared with 1950 increased by 3 times. In working with scientific and scientific-pedagogical personnel, great attention is paid to the development of scientific schools, the involvement of talented youth in scientific research, and the observance of the principle of competitive selection of personnel. Much work is being done on the ideological and political education of these cadres, the formation of a Marxist-Leninist communist worldview in them, high civic responsibility for fulfilling their duty to the people and the state.

Preparation of medium honey. personnel is carried out in medical schools (see) on 13 specialties: paramedic, midwife, paramedic-midwife, dignity. medical assistant, medical assistant-laboratory assistant, nurse, nurse for children to lay down.-prof. institutions, dentist, dental technician, medical optical technician, technician for installation and repair of X-ray and electromedical equipment. The training of nurses in anesthesia-resuscitation and nurses in dentistry has begun. Training of pharmacists with secondary education is carried out in pharmaceutical schools (see Pharmaceutical education).

In the coming years, further expansion of the honey network is envisaged. schools on the basis of large diversified and specialized BC, increase in training of number of nurses, including for children's preschool institutions. Schools began to function to improve the skills of specialists with secondary medical education. and farm, education.

The junior medical staff undergoes practical training directly in the medical profession, institutions, in hospital wards. The training of junior nurses in nursing is carried out according to the curriculum approved by the M3 of the USSR for 4 months. off-duty (272 teaching hours).

Training planning. Planning for the training of specialists for the bodies and institutions of the healthcare system, improving their knowledge, as well as state interdepartmental and inter-republic planning for the distribution of young specialists, allow for a further systematic increase in the number of qualified specialists in healthcare institutions. Gosplan of the USSR and M3 of the USSR establish all-Union plans for the development of honey. education, terms of training and plans for the distribution of specialists graduating from higher medical. educational institutions, plans and terms for training scientific personnel and improving the knowledge of medical staff.

The most generalizing indicator characterizing the level of development of health care is the provision of the population of M. to., And above all, doctors. Therefore, planning the training of doctors and paramedical workers is one of the important sections in the development of a health development plan for the near and long term. This work provides definition of the perspective need for M. to., necessary for the volume provided by the plan of development of health care to lay down. - the professional, the help to the population, and also for providing other sections of work where doctors and experts with average honey are used. education.

The indicators of need and availability of specialists are measured by the number of doctors and nurses per 10,000 inhabitants. M3 of the USSR periodically determines the approximate planned standards for the need for specialists in the population of the country as a whole and each republic separately. In accordance with the "Basic guidelines for the preparation of a five-year plan for the development of health care and medical science for 1981-1985." on average in the USSR for 10 thousand inhabitants for 1990, standards were established for doctors, nurses, pharmacists and pharmacists with a secondary education, which will ensure the further improvement of public health. These indicators are differentiated by individual republics, taking into account the state of health care in them, the development of a medical network. institutions, medical universities, research institutes, as well as the characteristics of the age and sex structure of the population, morbidity, etc. For example, the standards for the population's need for doctors per 10 thousand inhabitants. slightly higher than the all-Union in the Estonian SSR, the Latvian SSR and the RSFSR. The additional requirement for specialists is also determined, i.e. the difference between the total planned requirement and the number of specialists at a given time. When determining the amount of additional need, the loss of M. to. is taken into account: natural loss (death, retirement, temporary cessation of work, etc.), transfers from one institution to another, moving to other republics, etc. Age is also taken into account -gender structure of specialists, legislation on the duration of labor activity of various groups of specialists and other indicators. Based on the determination of the general planned and additional needs for specialists, the target figures for the admission of students to medical institutions are set. and pharma, educational institutions and plans for the release of specialists, taking into account the dropout of students for the entire period of study.

Developed by M3 of the USSR "Fundamentals of Health Development for 1976-1990" include the plan of preparation of medical personnel, according to the Crimea number of doctors in the USSR by 1990, and also experts with average honey. education will increase significantly.

The basis of the state plan for the distribution of young professionals is based on a thorough study of the level of M.'s provision to the population of the republics, regions, honey. services of departments of the USSR that do not have their own educational institutions, the composition of students (their possible mobility due to their state of health, marital status, desire to work in a particular specialty, etc.), as well as applications for specialists from health authorities and institutions, the Academy of Medical Sciences USSR and scientific institutions, min-in and departments of the USSR.

The planning of the distribution of young specialists is constantly being improved; it provides for the maximum satisfaction of the needs of each of the republics, regions, and territories in M. to. Ch. arr. at the expense of graduates of educational institutions located on their territory, as well as at the expense of young specialists sent from other republics (for example, specialists whose training is not provided for in educational institutions of this republic). The distribution plans indicate the number of specialists sent to work in medical institutions in rural areas (for the country as a whole and for each republic separately). In accordance with the Constitution of the USSR, state distribution plans guarantee that every young specialist will get a job immediately after graduation in a particular region of the country, taking into account the profile of his training in an educational institution.

For the Soviet health care is characterized by a high percentage of employment of graduates of medical. educational institutions as planned. The rights and obligations of young specialists are defined by the Regulations on the inter-republican, interdepartmental and personal distribution of young specialists, which provides for the responsibility of planning bodies, ministries and departments, heads of organizations, institutions and educational institutions for the development and implementation of these plans, the creation of appropriate production and housing for young specialists - living conditions.

Of great importance in the further improvement of this work is the resolution of the Council of Ministers of the USSR "On improving the planning of training specialists and improving the use of graduates of higher and secondary specialized educational institutions in the national economy" (1978).

The Decree of the Central Committee of the CPSU and the Council of Ministers of the USSR "On the further development of higher education and improving the quality of training of specialists" (1979) provides for further improvement in the planning of training of specialists, their distribution at an earlier date - 1-3 years before they graduate from educational institutions, with subsequent transition to the development of five-year distribution plans and bringing the indicators of the plan to enterprises and universities.

Scientifically substantiated planning of preparation of M. to. and their distribution promoted achievement of high security of the population of the USSR M. to., especially doctors. Among the doctors and paramedical staff there are representatives of all nationalities and nationalities. All union and autonomous republics have their own national cadres who know local customs and customs and the language, which makes it easier for them to communicate, especially with the rural population living in hard-to-reach districts.

During all the years of the existence of Soviet power, energetic measures were taken to eliminate the uneven provision of doctors to the population of the Union republics, as well as the urban and rural population. Thus, in 1940, the total number of doctors in the USSR increased by 5.5 times compared to 1913, and in the Central Asian republics by 14-30 times. In subsequent years, there was no longer such a sharp difference in the growth rates of the number of doctors, but in the republics of Central Asia they always remained higher than in the RSFSR, the Ukrainian SSR and the average for the USSR. As a result, a significant convergence has been achieved in the levels of provision of doctors to the population of all Union republics.

Much attention is paid to the direction of young professionals to work in medical. village institutions. Only in 1976, 15.6 thousand doctors were sent to rural institutions, which contributed to a significant increase in their number in rural areas; at the same time, the role of urban health care institutions in providing medical care to the rural population has increased. Particular attention is paid to providing qualified specialists to healthcare institutions providing medical care to the rural population, therapeutic, pediatric and workshop sites, ambulance and emergency medical care stations, as well as institutions in intensively developing districts and industrial centers. The Decree of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve public health" (1977) provides for the preferential direction of young specialists who have graduated from medical universities, to lay down. , as well as to work in the central district, district-tsy, rural precinct-tsy and outpatient clinics. Doctors, pharmacists, paramedical workers and pharmacists with secondary education working in health care institutions in rural areas are provided with a number of benefits: purchase of food products at state farms at state retail prices, priority purchase option cars, loans for household equipment and construction of houses, annual additional paid 3-day vacation (with work experience of St. 3 years), a monthly allowance for the duration of work, etc. As a result of improved work on the distribution of personnel, the staffing rate of doctors to lay down , institutions (the ratio of occupied medical positions to full-time, in%) increased significantly and reached 95.9% in 1976 in the country as a whole (1970 - 90%). The provision of doctors to the population of Siberia, the Far East, Kazakhstan and the republics of Central Asia has significantly increased. The staffing of therapeutic and pediatric areas with doctors has improved, in a number of republics and regions it has reached 99-100%; the number of vacant medical positions and the number of part-time doctors have decreased.

Increased attention to the rational use of M. to., improving their placement and scientific organization labor.

For consideration of topical issues of M.'s work to. and preparation of recommendations at M3 of the USSR and min-wahs of health care of union republics councils on personnel and the scientific organization of work are created.

Advanced training and certification of medical personnel. The specifics of the work of a health worker requires him to constantly improve his knowledge throughout professional activity. In the USSR, a slender state system advanced training of doctors and other health workers at f-takh and in in-tah of improvement of doctors, as well as in large regional, regional, republican, city-tsakh, in clinics of medical universities, research in-takh (see,). Classes in the advanced training system are conducted under the guidance of the teaching staff with the wide use of the best practices of medical work. institutions, the latest achievements of honey. science, cybernetics and scientific organization of labor.

Of great importance for improving the system of advanced training of doctors are the resolutions of the Central Committee of the CPSU and the Council of Ministers of the USSR on the development of health care and honey. Sciences (1960, 1968), the resolution of the Council of Ministers of the USSR "On the system of advanced training of doctors" (1963), as well as the resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve public health" (1977), in which measures are outlined on further improvement of the system of advanced training of medical workers.

In order to improve the qualifications and proper use of personnel, certification of medical specialists and paramedical workers is also carried out. The procedure for certification of honey. and pharma, workers established by M3 of the USSR together with the Central Committee of the trade union of medical workers. A doctor-specialist in one of the specialties is a doctor who has completed an internship, clinic, residency (see Clinical residency), postgraduate studies (see Postgraduate studies, postgraduate studies) or who has worked in this specialty for at least 3 years and completed specialization courses. The qualification of a medical specialist is determined by three qualification categories: the highest, the first and the second.

The highest qualification category is awarded to doctors who have at least 10 years of experience in this specialty, who are fluent in modern methods of prevention, diagnosis and treatment, who have good knowledge of related disciplines, who have good performance indicators, who actively participate in the advanced training of doctors and nursing staff, in the propaganda of honey. and gig. knowledge; they are appointed, as a rule, by the heads of large departments (department, laboratory) of institutions of republican, regional, regional subordination. Doctors of the highest qualification category hold the positions of chief specialists of the Ministry of Health of the Union (Autonomous) Republic, regional (regional) health departments, etc.

The first qualification category is assigned to doctors with at least 7 years of experience in their specialty, with practical experience and good theoretical training in their specialty, knowledge of related disciplines, mastering modern methods of prevention, diagnosis and treatment of patients, taking part in advanced training of nursing staff and in a dignity. - a gleam, to work among the population; they provide management of the department (department, laboratory) of health care institutions of city or district subordination, work as chief specialists of the city health departments.

The second qualification category is assigned to doctors with at least 5 years of work experience in their specialty, well-prepared in theoretical and practical issues of their specialty, owning modern methods of prevention, diagnosis, and treatment.

Doctors precinct BC and outpatient clinics located in rural areas, local therapists and pediatricians, doctors of emergency and emergency medical care, departments and stations dignity. aviation qualification categories can be obtained with a shorter length of service: at least 7, 5 and 3 years, respectively; they are given priority right to pass certification. During certification, the principle of voluntariness is observed. It is carried out in the specialties provided for by the nomenclature of medical positions. Specialist doctors who have received the highest or first qualification category established a monthly salary increase.

Certification is carried out by certification commissions created by the Ministry of Health from among the chief specialists, employees of universities, research institutes, etc., which consider certification materials (application and report of a specialist on work over the past 3 years, etc.); in case of a positive decision, the corresponding qualification category is assigned and a certificate is issued. Recertification is possible after at least 3 years. Attestation of pharmacists is carried out in the highest, first and second qualification categories and in three specialties: a pharmacist-organizer of the pharmaceutical business, a pharmacist-technologist and a pharmacist-analyst.

Certification of paramedical workers (dentists, paramedics, nurses, laboratory assistants, radiologists, etc.) is carried out in accordance with the provisions on the certification of these personnel. Qualification of paramedical personnel is established by the attestation commission only for the first qualification category. Nurses with a secondary medical education and admitted in the prescribed manner to honey. activity, in order to pass certification, they must have at least 5 years of work experience in the specialty, including the last 3 years of working in the same institution. To obtain a qualification category, a nurse must have good training in her specialty and good performance in work, actively participate in the work of the council of nurses, train junior nurses in nursing, in the sanitary lumen. work and social life of the institution.

Selection, training and advanced training of management personnel. The Communist Party and the Soviet government pay great attention to the selection, training and advanced training of leading cadres as an important condition successful implementation grandiose plans for communist construction and improvement of the quality of all work outlined by the 25th Congress of the CPSU. This is evidenced by the resolutions of the Central Committee of the CPSU and the Council of Ministers of the USSR "On the further improvement of the system of advanced training for managers and specialists of the national economy" (1977) and "On the organization of the Academy of the National Economy of the USSR" (1977). The tasks of improving the selection and training of leading health personnel, increasing the exactingness of them in relation to the management of health care bodies and institutions and the quality of medical care for the population are defined in the resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR "On measures to further improve public health" (1977).

Significant work has been done in the health authorities to improve the composition of management personnel and create a reserve of specialists for promotion. Advanced training of this category of workers is carried out in 14 advanced training courses for doctors, more than 70 cycles of general and thematic improvement according to unified curricula and programs, in which considerable attention is paid to studying the basics of healthcare management and its economics, scientific organization of labor and topical issues organization of medical care to the population. Particular attention is paid to improving training on the effective use of human, financial and material resources of health care, to the ability of leaders to organically combine the achievements of medical. sciences with the advantages of socialist health care, to educate health workers in the spirit of the "Doctor's Oath Soviet Union».

In improving the quality of medical care for the population, the chief specialists of the ministries in health care of the union and autonomous republics, regional (territorial) health departments play an important role (see Chief Specialist). Their preparation and improvement of knowledge are carried out on complex cycles, on specialized wedges, departments with the participation of the departments of social hygiene and healthcare organization. To improve the skills of the management staff of the M3 apparatus of the USSR and the union republics, directors of research institutes and rectors of universities, healthcare universities are organized (see), special classes are held on the application of modern scientific methods of management in healthcare and honey. science.

The concern of the CPSU and the Soviet government for medical workers. The CPSU and the Soviet government highly appreciate the work of medical workers and show great concern for them. This is evidenced by the establishment in 1965 of the annual celebration of the Day of the Medical Worker, the proclamation in the Fundamentals of Legislation USSR and Union Republics on Health (1969) provisions that the professional rights, honor and dignity of health workers are protected by law. Recognition of the highly humane nature of the doctor's work was reflected in the establishment of the honorary titles "Honored Doctor of the RSFSR" and other republics, as well as "People's Doctor of the USSR" (see Honorary Titles). The doctor's great responsibility to the people and society is emphasized in the "Oath of the Doctor of the Soviet Union" (see), which all young doctors take after graduating from a medical school.

In accordance with the decisions of the XXV Congress of the CPSU in the medical teams. institutions, a lot of work is being done to educate in the spirit of communist morality and humanism, the goal of which is to instill love for one's profession, a sense of responsibility for one's work, and a careful attitude to a sick person; socialist emulation and mentorship are widely developed. Every year, for high performance in providing medical care to the population, health workers are awarded the “Excellent Health Worker” badge, the most outstanding health workers are awarded the title of Hero of Socialist Labor (see Physicians - Heroes of Socialist Labor), Lenin and State Prizes and honorary titles are awarded. For great services in protecting the health of the people, medical workers are awarded orders and medals of the Soviet Union; only in the ninth five-year plan, orders and medals of the USSR were awarded to approx. 12 thousand health workers and medical science.

Legislation of the USSR on the rights and obligations of medical workers. To implement the ambitious tasks set by the Communist Party in the field of health care, immediately after the establishment of Soviet power, the country began to develop legislation on health care and the basis for the legal regulation of medical practice. In the decree of the All-Russian Central Executive Committee and the Council of People's Commissars of the RSFSR "On professional work and the rights of medical workers" (1924), prof. activities of health workers, their rights and obligations. It was established that "every health worker engaged in practical medical activities is obliged, in cases requiring emergency medical care, to provide first aid in accordance with the instructions ...".

On July 1, 1970, the Fundamentals of the Legislation of the USSR and the Union Republics on Health Care were put into effect (see Health Legislation), which regulated the activities of health authorities and medical workers. By the Decree of the Presidium of the Supreme Soviet of the USSR of June 18, 1979 "On the Introduction of Amendments and Additions to the Fundamentals of the Legislation of the USSR and the Union Republics on Public Health", a number of articles of the Fundamentals of Legislation were amended or supplemented in accordance with the new edition of the Constitution of the USSR.

In particular, they reflect the ever-increasing role of Soviet people, including medical workers, in environmental protection (Article 3 of the Fundamentals of Legislation); Article 12 was supplemented with a new part with the following content: “A doctor who has not worked in his profession for more than three years must be sent for an internship at an advanced training institute or other relevant healthcare institutions, followed by admission to medical practice in the manner determined by the Council of Ministers of the USSR”; amendments were made to Article 16, which obliges not only medical workers, but also pharmacists not to disclose information about diseases, intimate and family life of citizens that became known to them by virtue of the performance of their professional duties, and Article 37, which expands the rights of doctors and other health workers in free the use of any of the modes of transport available in a given situation in the provision of first aid in cases that threaten the patient's life. Amendments and additions have been made to a number of other articles in the Fundamentals of the Legislation of the USSR and Union Republics.

Staffing of healthcare institutions with medical personnel. Staffing standards are the basis for completing health care facilities of M. to., which are determined depending on the indicators of the health development plan, the profile of the institution, the organizational forms of providing medical care, the organization of the work of institutions and the work of medical staff. It is taken into account that the unit of measurement of the volume of medical care is a medical position, which means a certain amount of work of a doctor, for example, the number of outpatient visits per position in a polyclinic, the management of a certain number of patients in a hospital per one medical position, etc. The workload norms of doctors are taken into account , as well as the duration of the working day, holidays, etc.

Vacancies of the teaching staff in universities and scientists in research institutes are filled by competition in the prescribed manner.

Medical personnel abroad

Great progress in the preparation of honey. personnel have been achieved in the socialist countries. The provision of the population with doctors in these countries has increased significantly and in some of them has begun to exceed the provision of the population of a number of capitalist countries. (The number of doctors of all specialties and the availability of them to the population of some foreign countries are presented in Table 3).

Preparing honey. personnel in the socialist countries is produced in state educational institutions. Education in higher medical. educational institutions of these countries is available to all workers, it is free, most students receive a state scholarship. Measures are being taken for postgraduate training of specialists with higher and secondary education, ensuring the improvement of the knowledge of specialists in accordance with the objectives of health development in these countries. The study of the experience of preparing M.K. in the USSR, serious attention is paid to the ideological and political education of medical students. educational institutions and healthcare professionals.

The USSR renders great assistance to developing countries in the preparation of national M. to., raising their qualifications. At the University of Friendship of Peoples. Patrice Lumumba has honey. f-t, on which by 1979 St. 1500 doctors from 80 developing countries. In addition, due to the lack of national cadres of doctors and paramedical personnel, specialists from the USSR and other socialist countries are sent to these countries at the request of government agencies. In a number of countries after the proclamation of their independence, Soviet doctors and doctors from other socialist countries make up a significant part of the available medical. specialists. They lead big to lay down. and preventive work, assist in the preparation of secondary medical. personnel from the youth of these countries. Many Soviet teachers work for honey. f-tah high fur boots of a number of developing countries.

Training of doctors in the capitalist countries is carried out on honey. f-tah high fur boots (France, Germany, England) or in special colleges. As a rule, the entire period of study consists of pre-medical, pre-clinical, clinical periods and internships. Education in most countries is paid, in connection with this higher medical. education is inaccessible to low-income segments of the population. After completing the internship, the young doctor is entitled to work as a general practitioner. The need for general practitioners in connection with the development of specialized medical care has decreased; therefore, many young doctors continue to specialize in a narrower profile; the terms of specialization vary depending on the nature of the specialty (see Medical Education).

Military medical personnel

Military medical personnel - military personnel with a special medical education and military training. They carry out to lay down. - prof, actions for preservation and strengthening of health of personnel of Armed Forces of the USSR, honey. provision of troops, as well as the leadership of honey. units, institutions and subdivisions in peacetime and wartime. To the military medical personnel include generals and officers of honey. service, as well as ensigns, midshipmen and long-term servicemen with honey. education: doctors, dentists, pharmacists, dentists, dental technicians, pharmacists with secondary education, paramedics, X-ray technicians, laboratory assistants, nurses, sanitary instructors, disinfectors. Military medical personnel may be on active duty or in the reserve. Military honey. cadres are an integral part of the military cadres, which are a decisive force in strengthening the country's defense capability and raising the combat readiness of the army and navy. The first doctors (called healers) appeared in the Russian army in the 17th century. (see Healer). For the training of military physicians with a secondary education (sub-doctors), special schools were created at large hospitals, which were transformed in 1838 into military paramedic schools with a 4-year training period. The training of military pharmacists with a secondary education (pharmacists) was carried out in military hospitals, and with a higher education (pharmacists) - in the pharmaceutical departments of the Moscow and St. Petersburg Medical and Surgical Academies. Dentists, X-ray technicians and laboratory technicians with secondary education began to be drafted into the army only after the Great October Socialist Revolution. Their preparation was carried out in civilian honey. schools, as well as through retraining of military paramedics.

The widespread implementation of preventive measures in the Soviet Army led to the creation of a junior medical unit. specialists - sanitary instructors (see. Sanitary instructor). Initially, their training was carried out in military hospitals, and since 1924 in schools for medical instructors. Nurses in the positions of military personnel also began to be drafted into the army only after the Great October Socialist Revolution. Prior to that, they served in the army for free employment (see. Nurse).

After the Great October Socialist Revolution, the Red Army (until July 1918) was recruited by military personnel on a voluntary basis. On July 29, 1918, the decree of the Council of People's Commissars of the RSFSR "On the conscription and admission to military service of former officers, doctors, paramedics, medical assistants and military officials" was signed, and on November 12, 1918, the decree "On the conscription of medical doctors for active military service" . On August 28, 1919, the Decree of the Council of Defense "On the call for active military service of men - dentists (dentists)" was adopted. In 1918-1919. to replenish the army, fifth-year students of honey were released ahead of schedule. f-tov un-tov, and at the Main Military Hospital the Higher medical school for the training of medical assistants. Subsequently, a number of measures were taken to improve the M.'s training system: reorganization (1925) of the Military Medical Academy (see), the creation (1926) of the School of Medical Assistants (transformed into the Leningrad Military Medical School), the opening of Kharkov and Kiev (1939) military medical schools, and in the period from 1939 to 1943 - the Naval Medical Academy, the Kuibyshev Military Medical Academy and military medical faculties - at the 2nd Moscow, Kharkov and Saratov honey. in-tah. With the beginning of the Great Patriotic War, the training time for doctors and paramedics was temporarily reduced. Training of senior doctors of the regiment, divisional and corps doctors was carried out at district advanced training courses for doctors, and from June 1944 at the military medical f-those at (see).

Accounting, study, training and placement of military medical. personnel during the Great Patriotic War were carried out in the Main Military Sanitary Directorate (personnel and training department), in the military sanitary departments of the fronts (personnel departments), in dignity. departments of districts and the army (personnel departments). The work of the military medical. personnel during the Great Patriotic War was adequately appreciated by the Communist Party and the Soviet government: 44 military doctors were awarded the title of Hero of the Soviet Union (see Doctors - Heroes of the Soviet Union), 285 doctors were awarded the Orders of Lenin, St. 3.5 thousand - orders of the Red Banner, approx. 15 thousand - orders of the Patriotic War I and II degree, St. 86 thousand - orders of the Red Star.

In the postwar period, the system for training military medical personnel was further developed (see Military doctor, Medical education, military medical education).

Table 1. DYNAMICS OF GROWTH IN THE NUMBER OF PHYSICIANS OF ALL SPECIALTIES AND PROVISION OF THE POPULATION WITH DOCTORS IN THE USSR AND UNION REPUBLICS FOR THE PERIOD FROM 1913 TO 1978

Number of doctors (at the end of the year, in thousands)

Number of doctors per 10,000 population

Ukrainian SSR

Byelorussian SSR

Uzbek SSR

Kazakh SSR

Georgian SSR

Azerbaijan SSR

Lithuanian SSR

Moldavian SSR

Latvian SSR

Kirghiz SSR

Tajik SSR

Armenian SSR

Turkmen SSR

Estonian SSR

Table 2. GROWTH IN THE NUMBER OF AVERAGE MEDICAL PERSONNEL FOR SOME SPECIALTIES IN THE USSR for the period from 1940 to 1975 (at the end of the year, in thousands)

Medical specialties	Number of paramedical personnel
Medical specialties
Paramedic
Paramedic-obstetrician

Nurse
Medical laboratory assistant
Assistant health officer and assistant epidemiologist
Radiographer and radiologist
Dental Technician

Table 3. NUMBER OF PHYSICIANS OF ALL SPECIALTIES AND SUPPLY OF THE POPULATION OF SOME FOREIGN COUNTRIES (according to the data of 1973-1979)

	Absolute number of doctors (thousands)	Number of doctors per 10 thousand population
Bulgaria



Mongolian People's Republic


Czechoslovakia
Yugoslavia
Great Britain

Bibliography: Bases of the legislation of the USSR and union republics about health care, M., 1970; Petrovsky B. V. Successes of the Soviet health care for years of the ninth five-year plan, M., 1976; 60 years of Soviet healthcare, chief. ed. B. V. Petrovsky, p. 101, M., 1977.

D. D. Venediktov, A. M. Shishova; Yu. S. Aeanin (military).

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Page 29

Ministry of Health and Social Development of the Russian Federation

State budget educational institution

higher professional education

SARATOV STATE MEDICAL UNIVERSITY

Them. V. I. RAZUMOVSKY

Department of "Health Organizations,

public health and medical law"

Head department - associate professor M.V. Yerugina

Curator - Art. teacher G.N. Bochkareva

COURSE WORK

on the topic:

"Personnel policy in a medical institution"

Completed: cycle cadet

professional retraining

in the specialty "Organization of healthcare, public health and medical law",

Saratov 2015

Introduction ………………………………………………………………………………….………3

Chapter 1. Personnel policy in health care as a strategic

1.1. Goals and directions of personnel policy……………………………………………………..7

1.2. Principles of formation of personnel policy……………………………………..……12

1.3. Types of personnel policy……………………………………………………………………………………………………………………………………………………………………………………..15

Chapter 2 Analysis and improvement of the personnel management system in the Central District Hospital of the Volgograd Region

2.1. General information about the activities of the MEI _________ CRH…………………………………..20

2.2. Analysis of the ongoing personnel policy in the MEI _________ Central District Hospital…………………….…..23

2.3. Peculiarities existing system HR management and personnel policy in the MUSIC _________ CRH………………………………………………………………………………..26

Conclusion ……………………………………………………...……………………………..30

Bibliography………………………………………………………………..………….33

Introduction

The personnel policy in a medical institution determines the philosophy and principles implemented by the management in relation to its personnel. Personnel policy can be defined as a system of goals, principles and the resulting forms, methods and criteria for working with personnel, applicable to all categories of employees.

The personnel policy of a medical institution justifies the need to use in practice specific methods of recruitment, placement and use of personnel.

The main goal and conceptual tasks for the implementation of personnel policy in health careare as follows:

1. Ensuring the further development of an integrated system for planning human resources, taking into account the structure of the needs of the industry, their rational distribution and effective use.

2. Increasing the professional level of healthcare workers on the basis of further development of the system of continuous education, improvement of the system of state educational standards for training specialists.

3. Improving the standard of living of healthcare workers, bringing the wage system in line with the complexity, quantity and quality of medical care.

4. Ensuring the legal and social protection of an employee of the industry, the development of state and social insurance, increasing the effectiveness of labor protection measures.

5. Carrying out the reform of the health personnel service in accordance with the principles and requirements of the modern theory of scientific human resource management 1 .

The implementation of the tasks set should ensure an optimal balance between the processes of updating and maintaining the quantitative and qualitative composition of the industry's employees, the development of human resources in accordance with the needs of practical healthcare, the requirements of current legislation and the state of the labor market.

Relevance of the topicis associated with the increasing role of personnel in the functioning and development of a modern organization: the main factor in competitiveness is its human and social capital. In the context of reforming the Russian health care system, this provision remains insufficiently meaningful, and the existing medical organizations personnel policy is inadequate to the requirements of today.

In addition, the nature of the relationship between a person and an organization is currently changing, which is reflected in the recognition of their mutual interest in each other. It is impossible to ignore the fact that in Russian healthcare there is an active process of generational change, when people who have different values regarding their professional activities come to a medical institution, and the process of managing them requires a rethinking of the ideological foundations and practical models for implementing personnel policy. Therefore, it should be stated that in modern conditions it is necessary to change the personnel policy of a healthcare institution, transferring it to a new quality. One of the factors in the modernization of the personnel policy of a healthcare institution is the manager's managerial culture: by creating performance standards for others, the manager transmits his own values, understanding and vision of the personnel management process.

The personnel policy of a modern organization is a complex, multi-level socio-cultural phenomenon. Its belonging to a number of social phenomena is due to the fact that the area of human resources policy is the space of social interactions within the organization between its management and staff. The nature of these interactions and their effectiveness depend on the content and structure of the value system, which is the ideological basis of personnel policy. Its practical manifestation is found in the regulation of various aspects of personnel work. 2 .

The personnel policy is designed to ensure the adaptation of the system to the requirements of the social environment and increase the integration of elements within the system. The culture of personnel policy consists in a certain level of implementation of the personnel management process. The low level of personnel policy culture is the basis for its modernization 3 .

Diagnostics of the culture of the personnel policy of a modern healthcare institution should be carried out at two levels: ideological and practical. The ideological level is presented by the value orientations of the heads of healthcare institutions in relation to personnel, as well as their ideas about the main directions of personnel work. The practical level (personnel policy "in action") is assessed by the state of personnel work carried out by functional managers and specialists.

The personnel work of a modern healthcare institution does not have a systemic character, which is manifested in the absence or insufficient development of a number of its areas (staff planning, work with a reserve of managers, maintenance and development organizational culture). In addition, in most health care institutions, personnel work does not have organizational structure and carried out by specialists with an insufficient level of professional training 4 .

The following issues remain unresolved in the area of human resources management:

1. Inconsistency of the number and structure of personnel with the scope of activities, tasks and directions of reforming the industry.

2. The presence of disproportions in the structure of medical personnel:

 between general practitioners and narrow specialists, doctors and paramedical workers;

 between different territories, urban and rural areas;

 between specialized care institutions and primary care.

3. Imperfection of the legal framework.

4. Inconsistency of training of specialists with the needs of practical health care and the tasks of structural restructuring of the industry.

5. Lack of evidence-based methods for planning the number of medical personnel.

6. Insufficient social protection of healthcare workers.

7. Low level of remuneration, which is not conducive to attracting and retaining specialists in the industry.

8. Strengthening the trend of outflow of young professionals from the industry.

9. Low level of participation in solving personnel issues of professional public organizations.

aim This course work is the disclosure of the topic "Personnel policy in a medical institution."

Tasks work in disclosure theoretical aspects the concept of "personnel policy", namely:

goals and directions of personnel policy, principles of formation, types;

as well as:

analysis of the ongoing personnel policy and possible ways to improve it on the example of the _________ Central Regional Hospital of the Volgograd Region.

Object of study: personnel policy in a medical institution.

Subject of study: the specifics of the personnel policy of a healthcare institution as strategic framework personnel management systems.

Chapter 1. Personnel policy in a medical institution as a strategic onethe basis of the personnel management system

1.1. Goals and directions of personnel policy

The strategy of personnel policy in health care depends on the degree of social orientation of the state, the recognition by society of the high economic importance of health as an important component of the country's labor potential.

Personnel policy in health care should include three interrelated areas:

 planning and optimization of the number and structure of personnel;

 improvement of personnel training;

 health human resource management 5 .

Main goal of personnel policyin the near future is to develop a system for managing the personnel potential of the industry, based on rational planning for the training and employment of personnel, the use of modern educational technologies and effective motivational mechanisms to provide healthcare authorities and institutions with personnel capable of solving the problems of improving the quality of medical and medicinal products at a high professional level. assistance to the population 6 .

The main directions of personnel policy in a healthcare institution

1) Improving the planning and use of human resources.

The planning of the number and structure of health personnel should be built in accordance with the Program of State Guarantees of Free Medical Care for Citizens of the Russian Federation, based on a long-term forecast of the population's need for medical, medicinal and sanitary and hygienic provision, built taking into account the demographic situation, the dynamics of public health, and the natural movement of personnel , the nature of migration processes and the tasks of structural restructuring of the industry.

It is advisable to improve planning on the basis of the development and use of staffing standards. The current standards should become an effective tool for leveling regional, social (urban-rural, center-periphery) and structural (by types of assistance, types of institutions and specialties) disproportions in the distribution of human resources, as well as ensure proportionality in the development of primary and specialized types of medical care, treatment and prevention. Perspective standards should form the basis of plans for admission to educational medical institutions, be taken into account in the professional orientation of graduates, retraining of specialists, the formation of state (federal) and target (subjects of the Russian Federation and municipalities) orders for the training of specialists. Improving planning is ensured by the development of criteria for assessing the state of human resources and evidence-based approaches to determining the need for specialists of various qualifications, the further development of the range of specialties of health workers.

The main directions for increasing the efficiency of using human resources in health care are:

 elimination of duplication of functions;

 redistribution of functions between different professional groups of medical personnel;

 transformation of the structure of medical personnel on the basis of the formation of the “Institute of General Practitioner”;

 streamlining the job structure of health care institutions based on the use of progressive regulatory framework;

 modernization of workplaces, improvement of technical equipment of labor 7 .

Increasing the importance of nursing staff in providing medical and medico-social care, in organizing and managing nursing requires taking measures to improve the training of specialists with secondary vocational education, to develop new organizational forms and technologies for nursing care to the population, and legal regulation of nursing activities. 8 .

Raising the professional level of specialists is ensured by the creation of a certification system for specialists based on the development of professional standards.

Professional standards will make it possible to form common approaches to the development of standards for various sections of medical care and will contribute to the rational use of human resources in health care. Certification of health workers should be carried out in accordance with the system of standards being developed 9 .

2) Improving the training system.

The successful implementation of personnel policy largely depends on the quality of training of industry employees and the creation of the necessary conditions for their further professional growth.

The selection of applicants from among professionally oriented school graduates contributes to the stabilization of the personnel potential. The learning process, methodological approaches, content of curricula in the main disciplines should be constantly improved, respond flexibly to changing health care needs, and focus on training specialists in new areas.

The methodological basis for improving the system of lifelong education at all levels in the context of industry restructuring should be industry (state) qualification requirements (standards) for healthcare professionals and managers. For each specialty, volumes must be determined necessary knowledge, including a reasonable set of theoretical questions and practical skills.

In accordance with modern requirements for the professional level of medical personnel, it is necessary to improve the entire interconnected system of documents regulating the educational process of educational medical and pharmaceutical institutions. The use of modern technologies of multidisciplinary and problem-targeted teaching methods will ensure an increase in the effectiveness of the educational process. In the process of learning, it is necessary to carry out professional adaptation, using for these purposes the passage of industrial practices at the place of future work. It is necessary to increase the role of additional payments to scholarships as a stimulating factor in improving student performance.

3) Quality work force. Moral and material motivations.

Improving the quality of the working environment includes issues of wages, the creation of appropriate working conditions and the use of working time.

The current situation with a low level of wages and terms of payment in the industry hinders the further development of human resources, negatively affects the state and quality of medical care to the population.

It is necessary to take measures to significantly increase the remuneration of health workers, ensure the growth of real wages and eliminate the unjustified gap in wage levels in the real sector of the economy and the public sector.

4) Healthcare human resource management.

The solution of strategic tasks of personnel policy in health care depends on the organization of labor resources management in the industry. The new conditions for the functioning of health care impose increased requirements on the potential of the personnel service, the functions and responsibilities of which should be significantly expanded.

The most important condition for the effectiveness of personnel policy and modern management personnel is the strengthening of the personnel service in government and health care institutions on the following principles:

1. The number of full-time positions of personnel service specialists is determined by the number of employees.

2. Established human resources positions should be staffed by specialists who have received training in the field of personnel management.

3. The professional and official composition of personnel service specialists is determined by a list of tasks that need to be addressed in modern conditions 10 .

The main tasks facing the health personnel service are:

1. Forecasting the need for personnel in specific specialties and planning their training.

2. Recruitment, selection, training, development and motivation of personnel for the effective performance of work; assessment of the quality of work performed; remuneration, promotion, transfers, demotion, dismissal of staff.

3. Maintaining optimal relationships between employers and employees based on compliance with the law, ensuring a fair wage system, social protection of employees, creating favorable industrial relations and a healthy climate, ensuring labor protection and other conditions that positively affect the quality of work and the quality of life of employees.

4. Promoting the employment of health workers through increasing the professionalism and competitiveness of the workforce in the labor market.

5. Interaction with other departments, organizations and institutions on labor and personnel issues.

Legal regulation of the structure of the personnel service of health authorities and health care institutions is carried out by regulating all aspects of its activities, determined by the regulations on the body and structural divisions, professional job descriptions, staffing tables, etc.

The fulfillment of functional duties and the solution of modern problems of working with personnel require managers and specialists of the personnel service to possess multidisciplinary professional knowledge (legal, economic, pedagogical, psychological, etc.), as well as skills and abilities in the field of modern personnel technologies. The problems of personnel management should be dealt with by professionals who are able to navigate the labor market well, perform analytical work, own modern technologies for hiring and diagnosing personnel, competently participate in the placement of personnel, taking into account the requirements of the workplace and the potential of the employee, ensuring the professional growth of employees.

5) Increasing the role of self-government.

In solving personnel issues, it is necessary to expand the participation of public medical and pharmaceutical organizations. The activities of public organizations are of great importance in the legislative sphere, in resolving issues of career guidance, medical education, advanced training, attestation for a qualification category, in ensuring the protection of the rights of medical workers in the event of labor disputes and in cases of professional liability, as well as in the field of medical ethics 11 .

The strengthening of public control and the development of self-government are the most optimal form of interaction in the joint implementation of the personnel policy of government bodies and healthcare institutions, educational institutions with public organizations. In order to further develop social partnership, it is planned to hold consultations on various aspects of personnel policy and work together to improve the legal framework that ensures the functioning of the health personnel system.

1.2. Principles for the formation of personnel policy

Prospects for the development of healthcare in the Russian Federation largely depend on the state of the professional level and the quality of training of medical and pharmaceutical personnel as the main resource for healthcare.

The concept of personnel policy in the health care of the Russian Federation determines the main content of the personnel policy in the health care of the Russian Federation:

priorities in the formation of personnel work in the industry in accordance with the directions of its reform;
principles of planning and use of human resources for health care based on the improvement of the range of specialties and the system of certification of specialists;
a strategy for the intensive development of human resources in healthcare based on the optimization of the system of medical and pharmaceutical education in accordance with the requirements of practical healthcare, medical science and sectoral management;
new principles of the system of remuneration of workers in the industry;
new principles for the development of social partnership, involvement of public medical and pharmaceutical organizations in healthcare management 12 .

Thus, the personnel policy of any healthcare institution should be based on the following general principles:

formation in all services and divisions of the hospital of a highly qualified, reliable and loyal staff (creation of a cohesive, responsible and highly productive team), striving to work efficiently and efficiently in order to achieve the main goal of the institution - the provision of highly qualified medical services;
preservation, strengthening and development of human capital;
ensuring equal opportunities for professional and personal self-realization for each employee;
support of labor and social life personnel in strict accordance with the Labor Code of the Russian Federation, legislative acts, local regulations, Collective agreement.
creation of a personnel management system based on economic incentives and social guarantees that contribute to a harmonious combination of interests of both the employer and the employee.

Formation of personnel policy in a medical institution

To form a personnel policy, it is necessary to analyze the factors of the external and internal environment of a medical institution.

External factors:

features of legislative regulation labor relations;
the situation on the labor market in the field of medicine;
relations with professional and public associations;

Internal factors:

the goals of the medical institution, their development in time and perspective;
the style of management enshrined in the structure of the organization;
working conditions;
qualitative characteristics of the workforce;
methods of working with personnel 13 .

In the course of the formation of personnel policy, some aspects should be coordinated:

development general principles personnel policy and the definition of common goals, that is, their priorities;
organizational and staffing policy -development of a needs planning policy workforce, the formation of the structure and staff, reserve, relocation, appointment;
creation of an information policy and a traffic support system personnel information;
creation of a financial policy for the distribution of funds for the personnel management program;
creation of personnel development policy –providing a development program, career guidance and adaptation of employees, planning of individual promotion, team building, professional training and advanced training;
creation of a performance evaluation policy- analysis of the compliance of the personnel policy and the organization's strategy, identification of problems in personnel work, assessment of human resources (assessment center and other methods for assessing performance).

The main characteristics of an ideal personnel policy in an institution:

Link to strategy.
Orientation to long-term planning.
The importance of the role of personnel in the organization.
The philosophy of the medical institution in relation to its staff.
A system of interrelated functions and procedures for working with personnel 14 .

1.3. Types of personnel policy

An analysis of the existing personnel policy in specific organizations allows us to identify at least two reasons for their grouping. The first reason is related to the level of awareness of those rules and norms that underlie personnel activities. On this basis, the following types of personnel policy can be distinguished:

Passive;

Reactive;

preventive;

Active.

The second basis for differentiation of personnel policy may be the degree of openness of the organization in relation to the external environment in the formation of personnel, its fundamental orientation to internal or external sources acquisition. On this basis, two types of personnel policy are traditionally distinguished - open and closed. 15 .

Let us consider in more detail each of the mentioned options for personnel policy.

Passive and reactive personnel policy

The very phrase "passive policy" at first glance seems illogical. However, there are often situations in which the management of the organization does not have a pronounced program of action in relation to its own personnel, and personnel work is reduced to routine functioning or the elimination of "unforeseen and out of nowhere fallen negative consequences". Such an organization is characterized by the absence of a forecast of personnel needs, means of assessing labor and personnel, and diagnosing the personnel situation as a whole. Management is most often forced to work in an emergency response mode to emerging conflict situations, which it seeks to extinguish by any means, often not having time to understand the causes of events and their possible consequences.

With a reactive personnel policy, the management of a medical institution monitors the symptoms of a negative state in working with personnel, makes attempts to analyze their causes and monitors the emergence of conflict situations. The subject of special attention of the management is the monitoring of a qualified workforce and the motivation of personnel for highly productive work. In addition, certain measures are being taken in healthcare institutions to localize crisis phenomena, actions are being taken aimed at understanding the reasons that led to the emergence of personnel problems. The personnel services of such organizations, as a rule, have the means to diagnose the existing situation and provide adequate emergency assistance. At the same time, despite the fact that personnel problems are singled out and considered specifically in the programs for the development of institutions, the main difficulties in using a reactive personnel policy arise for the organization in medium-term forecasting.

Preventive and active personnel policy

In the true sense of the word, one can speak of a preventive personnel policy only when the management of a healthcare institution has reasonable forecasts for the development of the situation. At the same time, an organization characterized by the presence of a preventive personnel policy does not have the means to influence the situation. Employees of the personnel service of such institutions have both the means of diagnosing personnel and the methodology for predicting the personnel situation for the medium term. The organization's development program is based on short-term and medium-term forecasts of the need for personnel, both in qualitative and quantitative terms. It also usually presents tasks for staff development. The main problem of such organizations is the development of targeted personnel programs.

If the management has not only a forecast, but also means of influencing the situation, and the personnel department is able to develop targeted personnel programs, as well as regularly monitor the situation and adjust the execution of programs in accordance with the parameters of the external and internal environment, then we can talk about the presence in this organization active personnel policy.

From the point of view of the mechanisms that are used by the management of the organization, two types of active personnel policy can be distinguished - rational and adventurous. 16 .

With a rational personnel policy, the management of the enterprise has both a qualitative diagnosis and a reasonable forecast for the development of the situation and has the means to influence it. The personnel department of the enterprise has not only personnel diagnostic tools, but also methods for predicting the personnel situation for the medium and long term. The development programs of the organization contain short-term, medium-term and long-term forecasts of the need for personnel (qualitative and quantitative). In addition, an integral part of the plan is a program of personnel work with options for its implementation.

A rational personnel policy involves:

1) the possibility of implementing a mobile strategy for personnel management within the organization, taking into account the implementation of several projects or activities.

2) flexible forms of inclusion of specialists to solve those tasks specific to a certain stage of project implementation, which these specialists can solve as efficiently as possible.

This approach involves a constant change in the composition of performers, which depends on the transition of the organization from one stage of development to another, and allows you to build long-term career trajectories for employees 17 .

With an adventurous personnel policy, the management of the enterprise does not have a qualitative diagnosis, a reasonable forecast for the development of the situation, but seeks to influence it. The personnel department of an institution, as a rule, does not have the means to predict the personnel situation and diagnose personnel, however, the organization's development program includes personnel work plans, often focused on achieving goals that are important for the development of the enterprise, but not analyzed from the point of view of changing the situation. In this case, the plan for working with personnel is based on a rather emotional, poorly reasoned, albeit true idea of the goals of working with personnel. Problems in the implementation of such a personnel policy may arise if the influence of factors that were not previously included in consideration increases, which will lead to a sharp change in the situation, for example, with a significant change in the market, the emergence of a new product that can replace the current one from the organization.

Open and closed personnel policy

An open personnel policy is characterized by the fact that the organization is transparent to potential employees at any structural level. A new employee can start working both from the lowest position, and from a position at the senior management level. In the extreme case, such an organization is ready to hire any specialist, if he has the appropriate qualifications, without taking into account work experience in this or related organizations. This type of personnel policy is typical for modern telecommunications companies or automobile concerns, which are ready to "buy" people for any job levels, regardless of whether they previously worked in such organizations. Personnel policy open type may be adequate for new organizations pursuing an aggressive policy of conquering the market, focused on rapid growth and a rapid entry into the forefront of their industry.

A closed personnel policy is characterized by the fact that the organization focuses on the inclusion of new personnel in its composition only from the lowest official level, and the vacancies of higher positions are filled only from among the employees of the organization. A closed-type personnel policy is typical for companies focused on creating a certain corporate atmosphere, creating a special spirit of involvement, and also, possibly, working in conditions of a shortage of human resources.

Features of the implementation of personnel processes in the open and closed personnel policy

Personnel process	Type of personnel policy
	open	Closed
Recruitment	The situation of high competition in the labor market	Labor shortage situation
Staff adaptation	Possibility of quick inclusion in competitive relations, introduction of new approaches for the organization proposed by newcomers	Effective adaptation due to the institution of mentors (“guardians”), high team cohesion, inclusion in traditional approaches
Personnel training and development	Often held in external centers, promotes the borrowing of new experience	Often held in intra-corporate centers, it contributes to the formation of a unified view, following common technology adapted to the specifics of the organization
Staff promotion	On the one hand, the possibility of growth is hindered due to the constant influx of new personnel, and on the other hand, a “dizzying career” is quite likely due to the high mobility of personnel	Priority in appointment to higher positions is always given to honored employees of the company, career planning is carried out
Motivation and stimulation	Preference is given to labor stimulation (primarily material)	Preference is given to motivation (meeting the need for stability, security, social acceptance)
Implementation of innovations	Constant innovative impact on the part of new employees, the main mechanism of innovation is the contract, the definition of the responsibility of the employee and the organization	Innovative behavior must either be specially initiated, or it is the result of an employee's awareness of the commonality of his fate with the fate of the organization.

Chapter 2 Analysis and improvement of the personnel management system in the MUSIC _________ Central Regional Hospital of the Volgograd Region

2.1. General information about the activities of the MUZ _________ Central District Hospital

Aya CRH is a municipal health care institution. Address: Volgograd region, _________ district, r. n., hospital town,
st. Mira, 1. Tel, fax: E-mail :, official site –. The capacity of the hospital is 280 beds, a multidisciplinary facility with 7 specialized departments. The hospital serves a population of 33.4 thousand people.

There are 61 doctors and 290 paramedical workers in the health care facility. Provision with doctors 19.5/10,000 population. All heads of departments have the highest qualification category 18 .

The _________ CBR currently employs:

61 doctors;
290 paramedical workers;
293 junior workers and AHS;
The highest qualification category has - 24 doctors - 39.3%;
The first qualification category has - 15 doctors - 24.6%;
The second qualification category has - 1 doctor - 1.6%;
1 Honored Doctor of the RSFRS - 1.6%;
Excellence in health care - 7 people - 11.5%;
certificate of honor MHSD have 10 people - 16.4.

Personnel structure by level of education

9.5% of the employees of the _________ Central Regional Hospital have a higher medical education.

Gender composition of healthcare workers

Gender analysis of the employees of the MHI _________ CRH shows that in a health care institution, in percentage terms, 34% are men and 66% are women.

2.2. Analysis of the ongoing personnel policy in the MEI _________ Central District Hospital

Let's evaluate the personnel policy pursued at the _________ Central Regional Hospital according to the main indicators:

Information on the number of dismissed and accepted medical personnel

	2011	year 2012	year 2013	year 2014
Accepted
Dismissed

Personnel information for 2011-2014

	2011	year 2012	year 2013	year 2014
Doctors
Nursing staff
AHS and junior medical staff

Consider the overall turnover rate of medical workers (doctors and m/s) for 2013:

Kobor \u003d (Chp + Chu) / Chsh100

Kobor = (34+56)/(64+290)x100 = 25.4%

The overall range of personnel movement in 2013 amounted to 25.4%.

Calculate partial turnover rates:

Cop \u003d 34/354x100 \u003d 9.6%

Kou \u003d 56/354x100 \u003d 15.8%

The turnover rate in the hospital in 2013 is 15.8%.

Let's calculate the level of turnover of medical personnel in 2013 and 2014:

Kt2013g \u003d (Chus + Chup) / Chsh100 \u003d (56 + 0) / 354x100 \u003d 15.8%

Kt2014 \u003d (58 + 0) / 351x100 \u003d 16.5%

The calculated level of turnover of medical personnel in 2014 compared to 2013 increased by 0.7%, which indicates a negative trend, and this causes economic and social losses and, accordingly, affects the quality of medical services provided to the population.

Calculate the staff stability coefficient in 2014:

(1-58/351+36)x100% = 85.1%

This coefficient indicates an insufficiently high level of organization of the management of the institution. Ideally, the frame stability ratio should be close to 90-95% 19 .

Just like in any organization, the health care institution I am considering has a personnel policy. All three important parts that make up the personnel policy are taken into account: the concept of development of the medical services provided, their improvement; financial concept - rational distribution of income and expenses; social concept - the prospect of development of each medical worker and the team, in general. But, unfortunately, all these three parts in this organization are considered and implemented separately, independently of each other. Medical staff and, above all, doctors are the most significant and most valuable part of the internal resources of the hospital, they ensure the effectiveness of their activities. And this performance will be high only if:

1. requirements for personnel will be precisely regulated and communicated to the personnel;
2. personnel planning for medical workers will be carried out based on the needs of the organization;
3. control over the reduction and increase in staff will be carried out;
4. personnel will be trained;
5. control over the quality of medical services provided by medical personnel will be carried out;
6. The policy of stimulating employees will be implemented.

Thanks to the ongoing reforms in the field of healthcare, which did not bypass the organization I am considering, the current personnel policy has risen to a higher level, although, as before, there are many problems and shortcomings in it. First, let's talk about the requirements for staff. On a theoretical level, everything looks just perfect. In this medical institution, there are special directories that describe in detail all job descriptions, clearly regulate the duties of an employee of each profession. But due to the lack of medical personnel, as well as due to not very high discipline, it often happens quite differently. So, due to the lack of time for a doctor, part of his duties is taken over by a nurse, which cannot but affect the quality of medical care, since she does not have certain skills and abilities, the required qualification level.

Planning the number of medical personnel is also one of the main tasks of the personnel policy of a medical institution. The personnel service calculates the minimum required number of posts to perform all the functions assigned to the institution through established standards.

It is impossible not to touch on the issue of staff turnover. Staffing in the _________ CRH is achieved through the combination of positions, which is detrimental to the health of medical personnel, reduces the quality of work and the effectiveness of medical care, or labor productivity. A fairly high level of staff turnover is due to low wages and poor incentive policies.

Very important place in the personnel policy of the hospital is the evaluation of the effectiveness of the staff and control of its activities. Appraisal is a process of evaluating the effectiveness of an employee's performance of their duties, carried out directly by the manager. It includes the following aspects: determination of the service suitability of a medical worker for his position; identifying the prospects for using the potential abilities and capabilities of a medical worker; stimulation professional competence medical worker; determination of areas for advanced training, professional training or retraining of a medical worker; making proposals for the transfer of medical personnel, the release of a medical worker from his post, as well as the transfer to a more (or less) qualified job.

It has already been said that the health care institution under consideration does not have a clearly coordinated personnel policy plan, which makes it more difficult to control its implementation. The financial policy of the organization, affecting personnel issues, is more related to the remuneration of medical workers.

2.3. Features of the existing system of personnel management and personnel policy in the MEI _________ Central District Hospital

Modern healthcare systems, which unite hundreds and thousands of people, operate in a constantly changing and complex environment, with constant exposure to interference that is difficult to foresee and take into account. All this puts forward high demands on those involved in management, and the problem of recruiting personnel for work in health management bodies in general, and in the hospital I am considering in particular, becomes one of the most important.

The basis of the modern personnel management system at the _________ Central Regional Hospital is made up of employees with certain work experience, qualifications, and a high level of training. But most of these skills they achieved in the process of work. A feature of this management system is that the personnel for working with the hospital staff must have not only an economic education, but also the basics of a medical one, since it is very important to know the problems of the hospital from the inside, to understand their intricacies. Therefore, when selecting personnel, the problem of possible training of an employee in the governing body, the degree of his learning ability, must also be solved. But the difficult, time-consuming and responsible task of recruiting personnel, unfortunately, is not solved effectively due to the lack of scientific criteria and methods for hospital personnel management.

In general, the personnel management system of the MUS _________ CRH is a personnel department. But the scope of the human resources department is much narrower than the responsibilities that the personnel management system should perform. The personnel department mainly performs the functions of a technical and information and accounting nature. The hospital lacks a clear personnel policy plan. One of the most important tasks of medical personnel management is the scientific organization of the work of medical workers. Experience has shown that no means of organizational computer technology, no organizational forms and labor methods will not give the desired effect if the time and effort of the employee are spent on performing functions that are not characteristic of him 20 . Therefore, a clear distribution of functions between health workers is the main task. In fact, the hospital has all the necessary job descriptions, which clearly regulate the rights and obligations of each health worker, but due to poor staffing, medical workers sometimes have to combine their work with another that is not characteristic of them. Another reason not to follow job descriptions is bad discipline. Violation of the balance of duties and rights leads to insufficient performance of each employee and the entire management apparatus as a whole.

The effectiveness of work with personnel is determined by the quality of work of each employee of the medical personnel management system. The formation of a psycho-physiological attitude to the work performed or the position held is developed in a person under the influence of a number of factors, including social ones (the content of the work; the assessment given by the employee to the work performed by him; career advancement; remuneration for work; confidence in the stability of the position held; labor organization, etc.) 21 . The data obtained indicate that, unfortunately, there is still a place for the impact of social order factors in the personnel management bodies that form a negative attitude of the employee to the position held. Among them, one should point out, first of all, the lack of a scientific organization of labor, the predominance of “clerical” work associated with the need to process a large flow of information, fuzziness, vagueness in the distribution of rights and duties, etc. In the medical personnel management bodies, there is an extremely limited promotion of workers in service. It should also be said that the means of moral stimulation in the form of gratitude, awarding with diplomas, valuable gifts, badges, etc. are also not used enough.

In order to improve the efficiency of the functioning of health authorities, the selection and training of personnel should be carried out on the basis of deep scientific research.

Thus, summing up the analysis of the personnel situation in the _________ Central Regional Hospital, a number of problems :

there is a high percentage of part-time medical and secondary medical positions;
there is a low level of average wages and living conditions of medical personnel;
the problem of providing housing for young professionals remains;
in some departments, there is an unsatisfactory material and technical base, low equipment with modern medical equipment;
there is no system of state distribution of graduates of medical institutions.

In connection with the above,measures aimed at improving the personnel policy in the hospitalmay be the following:

- development of a system of municipal orders for the volume and structure of training of medical personnel, primary specialization of graduates of medical academies based on a thorough analysis of the composition of personnel and its movement;
- development of the issue of restoring the state distribution of students studying at the expense of the budgets of the healthcare system, the development of a contract form of training specialists;
– purposeful work of the public health authorities of the Volgograd region with the Administration of the _________ municipal district to assess the overall need for medical personnel, develop opportunities for attracting young professionals and monitoring the implementation of social guarantees for medical workers, enshrined in federal and regional legislation;
– interaction with educational institutions in order to provide specialists working in healthcare institutions with postgraduate education in accordance with the needs of the industry;
– improvement of the monitoring system, regular analysis and forecast of the development of medical personnel;
- increasing the level of salaries for medical workers;
– increasing the role of the local administration in solving personnel problems (target recruitment, inviting doctors on individual contracts, building housing on preferential terms, etc.).

In the economic aspect, the improvement of the personnel management system and personnel policy should ensure the growth of efficiency on the basis of continuous technical and organizational improvement of the healthcare institution. In the social aspect, changes in personnel management and personnel policy should be aimed at maximizing the use and development of the abilities of the employees of the organization, as well as creating a favorable psychological atmosphere. These economic and social goals are closely interconnected, because the orientation towards the development of abilities and the creation of a favorable psychological atmosphere is essential condition creative activity that ensures the development of the organization itself. The initial stage of preparation for transformations should consist in creating a new system of values, ideology, organizational culture, changing management styles and principles of motivation. When developing the concept of personnel policy by a healthcare institution, first of all, it is advisable to focus on the discipline and professional skills of employees.

Conclusion

The personnel policy of a medical institution is aimed at bringing the personnel potential of the organization in line with the goals and strategy of its development.

From the point of view of the level of awareness of the rules and norms that underlie personnel activities, the personnel policy of an organization can be passive, reactive, preventive or active.

Depending on the factors external environment, as well as the characteristics of the corporate culture, either an open or closed personnel policy of a healthcare institution can be effective.

In the course of developing general principles for the formation of personnel policy, it is important to coordinate organizational, staffing, information, financial and personnel development policies 22 .

The stages of designing a personnel policy include rationing, programming and monitoring of medical personnel. To build an adequate personnel policy, it is important to proceed from the understanding of the goals, norms and methods of implementing personnel activities. The main mechanism for maintaining an adequate personnel policy is personnel monitoring.

The improvement of personnel management has become one of the practical tasks, factors, and economic success. It is designed to provide a favorable environment in which labor potential is realized, personal abilities develop, people receive satisfaction from the work performed and public recognition of their achievements.

Timely staffing of all municipal healthcare organizations becomes impossible without clear planning, development and implementation of personnel policy. Planning in personnel work is an integral part of the management of a healthcare institution as a whole, it involves tracking changes in the professional and qualification structure of personnel and is designed to identify trends in the development of the workforce, to determine the qualitative and quantitative requirements for it in a timely manner. All this significantly increases the efficiency of the use of human resources. The growing role of personnel services and the radical restructuring of their activities are caused by fundamental changes in the economic and social conditions in which municipal organizations, including healthcare facilities. Personnel management services should be staffed with specialists who can successfully solve a wide range of issues related to the activities of a medical institution and, together with other services, actively influence the efficiency of the hospital. Foreign experience shows that the head of the personnel management service of any medical institution is endowed with broad powers, actively influences the policy of the organization 23 .

The manager needs to know how to solve problems, how to skillfully and appropriately use the appropriate technologies and methods of personnel management. And if skillfulness implies the practical mastery of relevant skills, then relevance is understood as the adequacy of the method used in the situation in the organization. 24 .

The personnel management system at the MEI _________ CRH is a personnel service that conducts all work with personnel. Unfortunately, the scope of her work is too narrow and does not cover many different aspects related to personnel management. The current personnel policy is not clearly regulated, which complicates its "implementation".In the course of the analysis, an assessment was made of the state of personnel policy and personnel processes of a municipal healthcare institution: the lack of a formalized and systematic nature of personnel policy, which manifests itself in the underdevelopment or absence of a number of its areas, in the underdevelopment of the applied technologies and personnel management methods, and the use of outdated approaches.

One of the most important conditions for achieving high efficiency in the activities of a medical institution is the correct placement of personnel, from senior positions to junior staff. The scientifically substantiated placement of personnel provides for the planning of a service career, conditions and remuneration, and the systematic movement of personnel. management position the hospital should be occupied by a person well versed in matters of medicine 25 . It must be a medical specialist. Before taking up such a responsible position, he must have worked in this hospital for a sufficient time in another position in order to familiarize himself with the specifics of this particular hospital.
Very important issue is wages. It must provide a decent standard of living. In order for the quality of medical care provided to the population to be high, doctors must improve their qualifications and undergo certification every five years. Chief Physician MUZ _________ th Central District Hospital pays due attention to this issue, however, due to limited budget, basically, the entire material side of this issue falls on the shoulders of the main workers.

It is possible to propose a number of measures aimed at achieving the greatest efficiency of the personnel management system, which is implemented through the personnel policy in a healthcare institution:
1. high-quality training of personnel service specialists;
2. strict regulation of the duties of the personnel department;
2. increase in wages;
3. clear regulation of the duties of medical personnel;
4. planning the number of medical personnel, based not only on staffing standards, but also on the specific conditions of the hospital;
5. professional development of specialists with higher and secondary medical education;
6. ensuring a decent standard of living for workers;
7. restoration of the state distribution of students studying at the expense of the budgets of the health care system.

In conclusion, it should be noted that interest in the problem of improving personnel policy in order to form a personnel management system corresponding to the development of healthcare institutions is increasing. The future development of medical institutions and the healthcare industry as a whole depends on how effectively the implementation of personnel policy directions, and, therefore, personnel management in an organization, will be carried out. The need to continue research on personnel policy in municipal health care institutions is obvious.

Bibliography

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1 Ivanova C.B. Functions of managing the health care reform process // Issues of Economics and Management for Healthcare Leaders. 2003. No. 3. pp. 14-15.

2 Arseniev Yu.N. Personnel Management. Management models. Tutorial. - M.: UNITI-DANA, 2005. - 107p.

3 Vikhansky O.S., Naumov A.I. Management: Textbook. – M.: Gardariki, 2006.

4 Maly I. Economic aspects of healthcare // Health Management. 2005. No. 1-2.

5 The concept of personnel policy in the health care of the Russian Federation dated 03.07.2002 No. 210.

6 Letter of the Ministry of Health and Social Development of the Russian Federation dated March 19, 2001 No. 15-12 / 200 "On the direction of the concept of personnel policy in the healthcare of the Russian Federation"

7 The concept of personnel policy in the health care of the Russian Federation dated 03.07.2002 No. 210.

8 Parshin M.M. Certification of personnel in the healthcare system of the Russian Federation. M.: Intern. center of fin.-econ. Development, 1999. 336 p.85,86.87,8889,90,91

9 Ermakov V. Manager in health care// Doctor. 1998. No. 8. pp.37-51.

10 Doroshenko G.V., Litvinova N.I. Management in health care: Proc. allowance. M.: FORUM: INFRA-M, 2005. 96 p.

11 Elovikov L.A., Polezhaev K.L. Changes in the nature and content of labor in health care institutions and their influence on the management of the population's health protection system. Bulletin of the Omsk University. Issue 2. 2001. S. 81-84.

12 The concept of personnel policy in the health care of the Russian Federation dated 03.07.2002 No. 210.

13 Blokhin A.B. On the problems of the effectiveness of management of medical and preventive institutions // Zdravookhranenie RF. 2005. S.24-27

14 Armstrong M.S. The Practice of Human Resource Management. 8th ed. / Per. from English. ed. S.K. Mordovin. - St. Petersburg: Peter, 2007 - 103 p.

15 Goncharov V.V. In Search of Management Excellence: A Guide for Senior Management. - M.: MNIIPU, 2005

16 Kravchenko K.A. Organizational building and personnel management of a large company. - M.: Academic Project, 2005. - 206s.

17 Kibanov A.Ya. Fundamentals of personnel management: Textbook. - M.: INFRA-M, 2006. - 239 p.

18 www.e

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21 Shapiro S.A. Fundamentals of personnel management in modern organizations: a unique approach that ensures the effective operation of the company. − M.: GrossMedia, 2005.

22 Alekseev V.A., Shurandina I.S. Elements of the technology of professional activity of the personnel service of a healthcare institution // Zdravookhranenie.2001. No. 7. pp. 147-154.

23 Ivanova C.B. Functions of managing the health care reform process // Issues of Economics and Management for Healthcare Leaders. 2003. No. 3.

24 Blinov A.O., Vasilevskaya O.V. The art of personnel management: Proc. settlement M.: GELAN, 2004.

25 Ermakov V. Manager in health care// Doctor. 1998. No. 8.

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