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Manager Zdravoochranenia 2019 #7
Published: 2019-07-22
979
CONTENT OF THE ISSUE
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To the 10th anniversary of the health centers
The article analyzes the main performance indicators of health centers for the period 2014–2018. Shows the coverage of comprehensive surveys in health centers per 10000 population; distribution of citizens recognized as healthy and with risk factors; presents indicators characterizing preventive work with the surveyed citizens. In the context of Federal districts and subjects of the Russian Federation, indicators for the last two years – 2017 and 2018 were analyzed. According to the provided results, conclusions are drawn about the absence of significant positive dynamics of the indicators characterizing the activities of health centers over the past 5 years. Thus essential divergences of indicators at the level of Federal districts and subjects of the Russian Federation are revealed. Analysis of indicators of activities of health centers indicates the lack of a unified organizational methodology of their activities. Improvement of organizational processes in health centers should go in parallel with the improvement of accounting and reporting documentation, these processes should be inextricably linked and aimed at solving the strategic problem – ensuring the quality of preventive work with the population, including the formation of management decisions based on them.
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Performance optimization of the operating unit in conditions of high patient turnover using economical technologies
Proposed methods for optimizing the work of the receiving department. The efficiency and validity of the implementation
of these methods in the work of the receiving department has been shown. Analyzed the effectiveness of
innovations. An assessment of the result is given. -
Improving the system of organizing the psychiatric aid of the megapolis
Abstract. Currently, a restructuring of the psychiatric service is carried out in Moscow. The changes are implemented accordingto the concept of socially-oriented psychiatry based on a biopsychosocial approach. Reforms include the reductionof inpatient and the development of an outpatient unit of the psychiatric service. Psychiatric hospitals were merged with outpatient units on a territorial basis.
The aim of the study was a comprehensive analysis of the psychiatric service functioning in Moscow during the period of
its restructuring.
A retrospective analysis of the demographic characteristics of the Moscow population and clinical and epidemiological
indicators characterizing the incidence of mental disorders, as well as an analysis of the functioning of inpatient and
outpatient units of the Moscow psychiatric service and its staff, was made. The evaluation of the conversion efficiency
indicators was made. A sociological survey about the reforms (questionnaire) of specialists and relatives of persons with mental disorders being carried out through questionnaires was also conducted.
During the transformation of the psychiatric service, the incidence of mental disorders, hospital mortality and the number of cases of disability decreased. The provision of the population with places in day hospitals, the number of places in day hospitals and patients who received assistance in day hospitals, the staffing level of outpatient rates, and the number of visits to district psychiatrists increased. The share of persons involuntarily examined and recognized as in need of inpatient treatment increased from 70% to 100%. According to a sociological survey, most of the heads of structural units of the psychiatric service, psychiatrists, and users of the service positively assess the reforms that have been carried out.
For a large city, the cluster-modular system of psychiatric service, currently organized in Moscow, is a priority.
Results of this work have found application in the organization of psychiatric care in Moscow, Vladimir, and Tula regions
and the city of Sevastopol, and can be put into practice in other major cities of the Russian Federation. -
Improvement of information support and organizational and managerial aspects of the chief doctors of Central district hospitals
Annotation. The article presents the results of the study of the organization of work of chief physicians of Central district hospitals and their deputies in the Republic of Dagestan. The content of 918 administrative acts issued at the level of the Ministry of health of the Republic of Dagestan and basic CRH for the last 5 years is analyzed. Studied information provision CRH chief doctors and their deputies.
It is established that opinion acts of management are executed partially or aren’t executed at all. Of the 436 orders of the Ministry of health of the Republic of Dagestan executed 70.6% of 482 orders of chief physicians CRH – 64.2%. About
half (48.6%) of management decisions fall on personnel issues, 17.5% – on the organization of medical and preventive
care, 7.1% – on the development of material and technical base. On the basis of research materials recommendations
on improvement of information support and organizational and administrative aspects of activity of the chief physicians of the Central regional patients are developed. -
Hospital replacement technologies in dermatovenereology
The Program of State Guarantees provided for a decrease of almost 20% in the volume of inpatient care due to the development of hospital-substituting forms. The efficiency of day hospitals is higher than hospitals by 1.5–3 times, which is associated with work in 2 shifts. The economic effect of the activity of DS according to the results of research works of a number of authors reaches 70%.
At the same time, the rate of introduction of day hospitals (DS) remains unreasonably low, and core day hospitals are not sufficiently developed, including in dermatology.
The disadvantage of the healthcare system in Russia and dermatovenerologic care in particular is the lack of economic incentives in favor of choosing less expensive technologies, their parameters are shifted towards hospital provision. Over the past decade, the numberof research papers on the activities of CPs has significantly decreased, an economic financing mechanismhas not been developed that stimulates the development of these forms of work. -
The main trends of the incidence in girls of 15–17 years on the background of high level of chronic pathology
The health condition of the Russian Federation children, including adolescents, has been characterized by negative trends in the past thirty years. The aim of the study is to identify the main trends in the total and for the first time in the life registered incidence in girls 15–17 years old in the Russian Federation, as well as to track the quantity and dynamics of the indicator of chronicity of diseases. The data of form N12 of the federal statistical observation for the period 2000–2017 are analyzed, using the method of descriptive statistics. A significant increase was revealed both in the total incidence of girls (by 56.9%) and for the first time in the life registered incidence (by 63.0%). The maximum increase in total incidence is observed for the most classes of diseases, for example: neoplasms (2.4 times), injuries, poisoning and some other consequences of external causes (2.4 times), congenital anomalies (malformations) (2.3 times), cardiovascular system diseases (2 times), diseases of the musculoskeletal system and connective tissue (2 times). The growth for the first time in life registered incidence was revealed for the overwhelming majority of classes of diseases, for example: injuries, poisoning and some other consequences of exposure to external causes (2.5 times), diseases of the nervous system (2.2 times), cardiovascular system diseases (2 times), neoplasms (2 times), diseases of the ear and mastoid process (2 times), diseases of the musculoskeletal system and connective tissue (1.9 times). High figures of the chronicity index aggregative for all classes of diseases reflect the initially high level of chronic pathology in girls 15–17 years old, what is an unfavorable characteristic of their health condition. An analysis of the chronization index of the diseases among girls aged 15–17 years over the study period revealed its maximum growth for classes of congenital anomalies (malformations) (by 31.1%) and tumors (for 23.0%), and for certain nosologies: menstrual disorders (5.8 times) and renal failure (4.2 times). The health of children, and especially adolescents, determines the health of the nation in the nearest future; therefore, the issues of its preservation and improvement require thorough attention.
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The role of communicative activity of the quality manager inspection body in improving the functioning of the quality management system
Abstract. The role of the communicative activity of the quality manager of the inspection body in the functioning of the
quality management system was investigated with the aim of developing and proposing measures to stimulate the communicative
activities of managers. A survey of 258 employees of the inspection body on a specially developed by the authors
questionnaire. Reliability of differences was assessed using nonparametric statistics, relative and average indicators, representativeness
errors, relative risk and its confidence interval were calculated. The communication of the communicative
activity of the quality manager with the involvement of the personnel of the inspection body in the functioning of the quality
management system has been revealed. The lack of theoretical knowledge of quality management among managers of
structural divisions about the functions and role of a manager in a team creates risks of insufficient awareness of inspection
body staff about the goals and objectives of the implemented quality management system, failure to understand its
documented procedures and non-compliance with its requirements. It was proposed to introduce mandatory external
and additional internal training of quality managers to quality assurance in accordance with the requirements of ISO/
IEC17020:2012 «Requirements for the operation of various types of bodies performing inspection
(IDT)» and ISO 9000 series standards. It is proposed to introduce a cascade method for internal staff training in order to
minimize time and material costs. It is recommended that in terms of combining the functions of a manager with the main
professional activity of employees, to provide material incentives to managers. The need to develop a mentoring system in
the establishment of newly hired employees to the principles and requirements of the quality management system implemented
in the organization prior to the implementation of independent practical activities has been identified. -
Pre-trial settlement of disputes in the compulsory medical insurance system: effective expert activity and protection of the rights and legitimate interests of the patient in the framework of the National Healthcare project
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Some approaches to the labor normalization in the laboratory diagnostics
The laboratory service is one of the most difficult from the point of view of labor normalization, which is determined,
first of all, by the many and ever-increasing number of studies, the variety of equipment used, etc. Laboratory
labor standards were developed more than 20 years ago. They relate primarily to non-automated techniques and do not
reflect the modern organization of labor, new laboratory technologies, etc. Due to the lack of centrally developed labor
standards, medical organizations are forced to determine the load indicators, the number of necessary laboratory workers
mainly by expert means, or try to independently develop labor standards. In these conditions, it is necessary to determine
the main approaches to the implementation of labor standards in the laboratory service, to develop normalization methods
for various research groups. The authors' suggestions were the result of joint research by Federal Research Institute for
Health Organization and Informatics of Ministry of Health of the Russian Federation (Moscow) and St. Petersburg State
Budgetary Healthcare Institution Consultative and Diagnostic Center for Children (St. Petersburg).
