Manager Zdravoochranenia 2019 #10
CONTENT OF THE ISSUE
Traditional nominees of «Manager of Health Care» Publishing House for the best publications in 2019 year
Requirements to internal control of quality and safety of medical activity according to the Оrder of Ministry of health of the Russian Federation of 07.06.2019 № 381n: how to ensure coordination of work of system on internal control and the medical commission
In the article the authors emphasize the importance of the Requirements for the organization and conduct of internal control of quality and safety of medical activities, approved by the order of the Ministry of health of the Russian Federation of 07.06.2009 № 381n, in terms of ensuring continuity between the content of internal control of quality and safety of medical activities, on the one hand, and the directions of state and departmental control of quality and safety of medical activities, on the other hand. The publication details and substantiates the mechanisms of interaction on internal control between the Commission (service) on internal control and the medical Commission of the medical organization.
Patient-centeredness in the provision of medical services to the population as a value and principle of activity
The article correlates the principles of patient-orientation (PO) and patient-centeredness (PC) in the provision of medical care, gives a normative basis for the implementation of these principles, defines the characteristics of a value-oriented healthcare, presents the features of the implementation of the patient-centered principle in the provision of paid medical services.
Medication and medical product procurement regulations in a multidisciplinary healthcare institution
Relevance. The process of organization of medication and medical product supply in conditions of the day hospital and inpatient care, that are part of the health insurance system, is assigned to the authority of the Ministry of Health of the constituent territory of the Russian Federation. However, the need to determine the quotas for medications and medical products from other sources of funding (federal budget, extrabudgetary activity) falls within the competence of a healthcare institution.
Aim. To propose tools and regulations that allow to plan volume and range of medications and medical products for health¬care institutions that provide medical services, both through compulsory medical insurance and on an extrabudgetary basis.
Materials and methods. The materials studied were the legislative and regulatory framework governing the medication supply of healthcare institutions of the Russian Federation and the Krasnoyarsk Territory; internal regulations of the FSFI FSRCC under the FMBA of Russia, a healthcare institution subordinate to the Federal Medical-Biological Agency. Mathe¬matical, analytical and descriptive methods were used in this work.
Results and discussion. Particular problems in determination of the volume and range of medications for the institutions providing medical services on an off-budget basis are associated with the impossibility of accurate planning concerning medication type and volume. The FSRCC uses a retrospective analysis of requests for each type and number of medical services using a technical medical service worksheet. Application of the designed and approved procurement regulations allows to plan future expenses the most optimal way for the uninterrupted high-quality routine medical care provision not only at the expense of compulsory medical insurance but also as a part of extrabudgetary activity.
Conclusions. The proposed algorithm for work with the regulations is recommended for the use in multidisciplinary health-care institutions in order to optimize procurement activity.
Perinatal monitoring system in Krasnoyarsk region
Successful functioning of information software systems that provide automation of monitoring of pregnant women at the regional level is possible only if there is, as well as continuous improvement of the organizational system. The lack of a well-established organizational system does not allow to use the capabilities of these complexes and often leads to their asynchronous work.
The aim of the study was to form a scheme of perinatal care in the Krasnoyarsk region using the perinatal monitoring system and its evaluation using the methodology of system analysis. Data on 122 250 cases of pregnancy in the period from 2014 to 2017, the degree of risk of women, as well as the outcomes of these cases of pregnancy were used to analyze the work of perinatal monitoring of the Krasnoyarsk territory. All pregnancy outcomes were divided into 2 groups: cases of pregnancy with adverse outcomes and favorable outcomes.
Despite the rather long-term work of perinatal monitoring in the Krasnoyarsk region, the analysis of the existing system revealed a number of significant shortcomings that limit its effectiveness, functioning and management of this system. The lack of management of women’s consultations as the level of management of the system of perinatal care in the Krasnoyarsk region, the imperfection of the system of assessing the degree of perinatal risk, the lack of information in the existing reporting forms and information on the outcomes of completed pregnancy cases in the database of the system were noted as shortcomings.
Identification of the presented shortcomings allowed to form the offers allowing to increase efficiency, to expand opportunities, and also to create tools of management of routing of pregnant women in system of perinatal monitoring.
Professional standards as a tool to improve the efficiency of personnel management in medical institutions
The transformation of the sphere of employment and the labor market of hired personnel, training systems for specialists have identified the need for the development and implementation of professional standards. The article substantiates the main reasons for the demand for new regulatory documents to the challenges of the time, the relevance of the competency-based approach at all stages of the implementation of professional standards in the healthcare system. The implementation of professional standards requires large-scale processing by the personnel department of organizational and structural documents; adaptation to new per-sonnel management tools, while taking into account the interests of employers, workers, educational organizations engaged in the training of specialists; additional costs for retraining workers. The main problems of the implementation of professional standards in the healthcare system are related to the renaming of posts and the transfer of employees to less qualified posts, which affects the level of wages and benefits, provokes conflict situations in the team, and creates the conditions for professional burnout.
The article shows the practice of implementing professional standards, implementation problems and ways to solve them using the example of a medical institution, considers changes in the training system, reflecting the dynamics of the formation of professional competencies in the face of uncertain changes. Particular attention is paid to the problems associated with the implementation of professional standards in healthcare.
On the development of the information system for evaluating the severity of hiv infection in prisoners
Nowadays one of the most important issue is the prediction of HIV and AIDS development. The ability to evaluate in numbers the outcome of the disease (in particular the AIDS development) is of great interest. It depends on a number of systematically taken medical indicators of an HIV infected person. For to create the information system for evaluating the severity of hiv infection in prisoners it is necessary, first of all, to evaluate the link between those indicators of the patient’s condition and the development of the disease itself. The article is focused on the possibility of using correlation analysis to identify the link between the develoopment of HIV and the data of the main medical indicators, which is regularly monitored in the penitentiary system. For to achieve this goal it was formed a sample based on the data of the Russian penitentiary system.
Overview of interdepartmental programs for public health care
“In the Decree of the President of the Russian Federation of 07.05.2018 No. 204 “About the national purposes and strategic problems of development of the Russian Federation until 2024” achievement of the following target indica¬tors is established: increase by 2024 in the expected life expectancy at the birth till 78 flyings and till 80 flyings by 2030)”. Prevention of noninfectious diseases on an interdepartmental basis is necessary for achievement of such indicators. We carried out the overview of federal orders, resolutions, a regulatory framework and interdepartmental programs for public health care. The analysis of literature showed that in the Russian Federation development and realization of the strategy, projects and programs directed to prevention of noninfectious diseases and forming of commitment of the population to a healthy lifestyle is conducted many of which are between sectoral and use the principles of “Health in all strategy”.
Surgery – a zone of professional and legal risk: legal nihilism and ignoring the rights and legitimate interests of the patient
The main contours of the next reform of sectoral wage system in public health
The special attention paid to staffing is not accidental – it is a natural reaction of the state to the deterioration of the situation with the number of medical workers in state (municipal) institutions. In turn, the personnel deficit has increased due to the fact that in difficult economic conditions, many institutions have taken the path of reducing workers in order to increase the wages of the remaining. These steps directly contradicted the logic of the "May" presidential Decrees of 2012, but simplified the task of achieving the salaries of medical workers at the level stipulated by these Decrees. Therefore, a number of documents reflecting the strategy of development of health care, as well as the Instructions of the President contain measures aimed at correcting the situation, including by reforming the system of remuneration of employees of state (municipal) health care institutions. At the same time, it is important not just to implement the measures provided for in these documents, but also a specific implementation mechanism. Therefore, the article analyzes the possible positive and negative consequences of various options for the implementation of measures provided for by the Instructions and other documents.
Some questions about provision of paid medical services
Focus of problem
Manager of health care consults
Questions and answers