Manager Zdravoochranenia 2019 #9

Published: 2019-11-15



    Focus of the problem
  • To the question of training of medical workers within internal control of quality and safety of medical activity

    Changes in the legislation concerning the organization of internal control of quality and safety of medical activity put forward new requirements to training of medical workers. These requirements concern the mandatory training on early detection of cancer, ensuring the provision of medical assistance to citizens in emergency form, the use and operation of medical devices. The article deals with the practical implementation of these requirements at the level of the medical organization.

    Authors: Piven D. V. [59] Kitsul I. S. [59]

    Tags: internal control of quality and safety of medical activity1 medical activity5 medical care13 medical organization53 medical worker3 training4

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  • Management in healthcare
  • Modern approaches to the analysis of emergency medical care for children

    112 936 cases of 24-hour emergency medical care in a children’s clinic for 2018 were analyzed. The meth¬ods of multivariate statistical analysis and theory of time series are used. It has been established that about 30% of the challenges occur in children of the first year of life. From January to March and from June to October, there is an increase in the number of calls. The days with the most calls are the 12th, 19th and 26th of the month. Almost a quarter of weekly calls fall on Monday. The resulting model of the call service duration structure allows you to evaluate changes in the work of the emergency service in different periods and proves the need for round-the-clock work.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3] Tricomenas N. N. [3]

    Tags: emergency medical care2 factor analysis1 markov chains with estimates1 medical care for children4 time series1

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  • Restructuring of a regional system of rendering stationary medical care on the basis of means of tool benchmarking

    In work approach to justification of management decisions on restructuring of a regional system of rendering stationary medical care with use of means of tool benchmarking is considered. Results of activity of hospitals were measured by calculation of an indicator of technical efficiency on the basis of a method of the analysis of the environment of functioning. Specialization of hospitals was measured by means of the index of the theory of information constructed on the basis of data on the clinic-statistical groups used in hospitals. The dependence between the index of specialization of hospitals and efficiency of activity of hospitals when rendering medical services on the basis of which a set of scenarios of restructuring of a regional system of rendering stationary medical care is formulated is revealed.

    Authors: Danilov A. V. [2]

    Tags: diagnosis related group1 efficiency indicators2 information theory index1 medical organizations23 scenarios of restructuring1

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  • Application of lean management in medical examination of children in Tomsk region

    The object of the study is the process of preventive medical examination of children of the first year of life, which can be improved on the basis of the principles of lean production. As part of a joint project of the Ministry of health of Russia and Rosatom state Corporation “Lean clinic”, which is designed to improve the efficiency of medical organizations and the availability of their assistance by introducing elements of lean production in public health institutions on a systematic basis, in the Tomsk region on the basis of a pilot medical organization – children’s clinic – a project was implemented to introduce lean technologies in the process of preventive examination of children of the first year of life, in order to minimize the loss of time when receiving medical services by the patient. The main directions of optimization: improving the productivity of the process using the mapping method; increasing the productivity of a single workplace using the 5C technique; increasing the productivity of the movement of medical staff using the Spaghetti diagram. During the project, the logistics scheme of patients and staff movement was significantly improved, and a route map was developed, which was issued to the parents of patients in the registry of the medical organization. In addition, in order to assess the effectiveness of the developed measures before the project and after its implementation, a sociological survey was conducted among the parents of children undergoing pre¬ventive medical examination, which allowed to assess the level of their satisfaction with the assistance provided. As a result of the implementation of the project on the introduction of lean technologies, it was possible to achieve the goals, in particular, to reduce by almost 3.5 times the time spent by patients on the passage of a full cycle of preventive examination, to reduce to 2 number of visits to the clinic, as well as to increase comfort of staying in the institution of patients and their parents.

    Authors: Shibalkov I. P. [8] Boykov V. A. [7] Kobyakova O. S. [16] Deev I. A. [9] Kanonerker L. M. [1] Kulikov E. S. [2] Novikova I. Y. [1] Osihov I. A. [1] Sivolobova T. V. [1] Taranov A. A. [2] Titova M. A. [1]

    Tags: 5s methodology.1 children’s hospital1 lean  production6 mapping method1 prophylactic medical examination1

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  • Economic efficiency of application of methods of mass-spectrometrically identification of microorganisms in a large general surgical hospital

    Bacterial complications, seen in the prism of health care-related infections, have very tangible socio-economic conse¬quences on the part of the patient, insurance companies, medical institutions, and on the part of the state as a whole. The pur¬pose of this study was to perform an economic analysis of the introduction of innovative technology for the diagnosis of bacterial infections, based on mass spectrometric technologies.


    Tags: antibiotic resistance.1 bacterial infections1 clinical and economic analysis1 innovative technologies1

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  • Population and health
  • The dynamics of the components of the changes in the life expectancy of the population of the Krasnoyarsk territory

    The aim of the study was a component analysis of mortality in the Krasnoyarsk region for the period from 1999 to 2017. To conduct a component analysis, we used depersonalized databases of all registered deaths in the Krasnoyarsk region from 1999 to 2017 and data on the average annual population for this period. E. M. Andreeva and E. E. Arriaga methods were used as a methodology of component analysis. The results of the component analysis allowed to establish a positive contribution of mortality changes in the dynamics of life expectancy of the population of the Krasnoyarsk territory in almost all age groups, with the exception of women in the age group 35–39, where there was a slight negative contri¬bution. For the period from 1999 to 2017 negative contribution to the dynamics of life expectancy has made changes in mortality from such causes as: diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism diseases of the nervous system and diseases of the digestive system, and diseases of the skin and subcuta¬neous tissue. At the same time, the greatest negative contribution among all categories of the population was made by the change in mortality from diseases of the nervous system. The results can be used in the formation of short-term health development programs to increase life expectancy.

    Authors: Kurbanismailov R. B. [3] Narkevich A. N. [3] Vinogradov K. A. [3] Mironova A. A. [2] Paraskevopulo K. M. [1]

    Tags: causes of death1 component analysis1 life expectancy1 mortality21 priority direction1

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  • Features of the medical and demographic process in the Kostroma region as a region of Central Russia

    Based on the official statistics from Rosstat, the article presents the results of the analysis of the medical and demographic process using the example of the Kostroma region taking into account the general trend in the constituent entities of the Russian Federation, including the dynamics of the population, the main demographic indicators of mortality and fertility, and indicators of natural population movement.

    Authors: Mingazova E. N. [30] Schepin V. O. [1] Zhelezova P. V. [3]

    Tags: medical-demographic process1 population birth rate1 population depopulation1 population mortality.1

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  • Personnel management
  • The problem of personnel shortage of the doctors for medical prevention

    The Federal Law of November 21, 2011 № 323-FL «About the basis of the protection of public health in the Russian Federation» defined the priority of prevention in the field of health protection (Article 12). However, a number of problems in staffing of the system of medical prevention remain. Aim: to investigate the dynamics of the number of posts for doctors for medical prevention (positions, occupied positions, individuals), as well as their staffing level and combination rate for the period from 2014 until 2017 in the Russian Federation and its regions. Methods: based on the data of the Federal Statistic (form № 30), the article presents a statistic analysis of the number of posts for doctors for medical prevention for the period from 2014 until 2017 in the Russian Federation and its regions. Results: There is a low staffing level for doctors for medical prevention in the Russian Federation, which decreased even more over the study period: from 73.2% to 64.0% (by 12.5%). This is explained both by an increase in the staff positions of these doctors in the country from 1031 to 1526 (by 48.0%), while the number of occupied posts increased only by 29.50% (from 754.25 to 976.75), and by a simultaneous decrease in the part-time combination rate from 2.1 to 1.7 (19.0%), which continues to be high. At the same time, the num¬ber of regions with 100.0% staffing level of these personnel decreased by 76.9% (from 13 to 3). Conclusion: The low staffing level (64.0%) and the high part-time combination rate of doctors for medical prevention (1.7) in the Russian Federation in 2017 indicate a shortage of individuals for doctors for medical prevention – the main workers in the occupied positions and their replacement by doctors – co-workers of other specialties. This largely takes place due to the absence of the specialty «medical prevention», which necessity of the introduction needs to be discussed by the medical community.

    Authors: Banteva M. N. [9] Manoshkina E. M. [7] Kukushkin S. K. [1]

    Tags: combination rate.1 doctor for medical prevention1 doctor position1 staffing level1

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  • Special opinion
  • Examination of the quality of medical care in the system of compulsory medical insurance: Procrustean bed?

    Authors: Starchenko A. A. [34]

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  • Manager of health care consults
  • Work with appeals of citizens and satisfaction of separate requirements of the consumer: what to consider medical organizations

    The article deaths with the features of working with citizens and to meet the individual requirements of the consumer, which are required to know medical organizations. The authors show and justify under what conditions the consumer’s demand is a citizen’s appeal, as well as how the terms of consideration of citizens ‘ appeals and the terms of satisfaction of individual consumer requirements are correlated with each other. In the article it is noted that in the medical organization work with citizens‘ appeals should be an integral component of ensuring and controlling the quality and safety of medical activities.

    Authors: Piven D. V. [59] Kitsul I. S. [59] Ivanov I. V. [30]

    Tags: citizens‘ appeals1 consumer requirements1 control issues1 medical organization53 quality  control  and  safety  of  medical  activities4

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