Manager Zdravoochranenia 2020 #2
CONTENT OF THE ISSUE
Phenomena of formation and functioning of modern managers in russian healthcare
The article considers a number of phenomena that determine the features of the formation of the professional trajectory of modern managers in health care. The analysis of factors that determine the appointment of managers to positions, as well as environmental, market, personal, educational, political and other factors that accompany the activities of management personnel in health care is presented.
Dynamics of indicators of the hospital bed fund of round-the-clock and daily stay in the Russian Federation
For the period 2010–2018 the number of hospitals in the Russian Federation decreased from 5705 to 4323
(by 24.2%), both due to the reduction in the number of beds and in connection with the unification of medical organizations.
The number of beds of round-the-clock stay decreased from 1250120 to 1044875 (by 16.4%); the following
indicators decreased: provision with these beds (from 87.5 to 71.1 per 1000 population – by 18.7%), the average treatment
duration (from 12.6 days to 10.7 – by 15.1%) and, unfortunately, average bed occupancy per year (from 325 to
313 days – by 3.7%). In 2018, the extreme values of the indicator of hospitalization rate for 24-hour hospital beds in
the regions of the Russian Federation differ 1.8 times, provision with hospital beds – 2.9 times, average bed occupancy
per year – 1.2 times, average treatment duration – 1.8 times. The revealed differences are significant, what indicates
the imbalance of the ongoing structural transformations. The overall hospital mortality rate in the Russian Federation increased:
from 1.5% in 2010 to 1.9% in 2018 (by 28.4%), similar dynamics – in all Federal Districts. The provision of the
population of the Russian Federation with places in day time hospitals increased from 15.4 per 10 000 in 2010 to 17.0
in 2018 (by 10.7%). Multidirectional tendencies are noted, both toward increasing and decreasing the number of places
in day hospitals both in the Federal Districts and in the regions of the country; the extreme values of the indicator of the
provision of places for day hospitals in the constituent regions of the Russian Federation differ by 30 times, what reflects the
disproportionate organization of the network of day time hospitals in the country’s regions. During the observation period
in the Russian Federation the level of hospitalization in round-the-clock hospitals decreased from 222.0 to 203.5 per 1000
population (–8.3%), while the level of hospitalization in day time hospitals steadily increased from 26.4 to 35.0 per 1000
population (by 32.8%), what indicates the implementation of the expected hospital-replacing function of day time hospitals
in the country. The issue of further structural and functional optimization of the bed fund of the country remains relevant.
Оrganization of extracorporeal care in a multidisciplinary medical institution
Organization of round-the-clock extracorporeal (EC) treatment in required volumes and options is one of the
most important tasks of a modern surgical hospital. The annual volume of extracorporeal procedures at the B. V. Petrovsky
National Research Center for Surgery (NRCS) is 1.5–2.0 thousand. The most significant methods are transfusiological blood
saving, high-volume plasmapheresis, and renal replacement therapy. Doctors of various specialties are traditionally engaged
in conducting EC procedures: resuscitators, nephrologists, transfusiologists. In modern medicine, EC hemocorrection
methods are in wide demand. Their effectiveness can be determined by the start time of the procedure. Therefore, roundthe-
clock access to all the necessary manipulations is important. In the absence of specialized departments of extracorporeal
treatment with around-the-clock working schedule the implementation of the necessary extracorporeal procedures is
possible in close contact with resuscitators, nephrologists, transfusiologists, in collaboration with the doctor of the clinical
diagnostic laboratory. The quality of providing high-tech extracorporeal care depends on the adequacy of the treatment
process management in a particular medical institution. Collegial performance of EC procedures for one patient by specialists
of various profiles – resuscitators, nephrologists, transfusiologists – gives a high clinical result.
Evaluation of the organization and transport accessibility of medical care to rural residents
The basis of the study was the Orenburg region. According to the MIAC health care in the Orenburg region
in 2015, the number of rural settlements was 1036, and the number of FAPs was 945. Sociological studies were conducted
in three pilot rural areas with different populations and distances from the regional center: Abdulinsky, Orenburg, Svetlinsky.
The total number of adults in the three districts is 19,356. The results of a sociological survey indicate a low availability of medical assistance to rural residents, the lack of a preventive focus among doctors on the prevention of exacerbations of chronic pathology, primarily of villagers living in localities attached to FAP. The need to improve the organizational forms of the work of medical organizations in the countryside, the development of mobile field complexes and general medical (family) practices, the development of medical and social assistance in rural areas is determined.
Improving the quality of organization and provision of medical care for children with injuries in order to reduce their disability
Children’s disability is an urgent medical and social problem of modern society, one of the main characteristics
of public health and social well-being of the country. This article provides additional data on the main trends in primary
childhood disability, depending on the age and type of injury, type of injury and a damaging factor; presents a medium-
term prognosis of primary childhood disability due to injuries for the Kursk region. The types of psychological status of a
family with a child with an injury are determined, and their effect on the implementation of measures for its rehabilitation in
various types of injuries is studied. The results obtained indicate the importance of an individual approach to each specific
family with a child with an injury, and the need for work aimed at achieving optimal treatment outcomes and preventing
the formation of disability. A scheme has been developed for the interaction of various organizations and departments
involved in the prevention of childhood injuries and the comprehensive rehabilitation of children with the consequences of
injuries. A scheme of the relationship between the types of rehabilitation and the level of adaptation (somatic, psychological,
socio-environmental) of children with the consequences of injuries under the age of 12 years is proposed.
The clinical significance of the relationship between doctor and patient (literature review)
This literature review collects research, laws, and various models of physician-patient interaction in the health
care system. The question of the patient’s adherence to treatment based on the level of trust in the doctor is considered in
detail, the analysis of the concepts of different models of interaction is carried out, and their specific conditions are defined,
presented in the scientific literature by the authors of the CIS and Europe. The purpose of the review was based on the
analysis of various options aimed at the development of the doctor-patient relationship in health care. Based on the data,
the authors suggested that it is necessary to search for new approaches to increase the legal, economic responsibility of
the patient, both for the performance of medical appointments and for their own health.
Technical equipment of departments of anesthesiology and reanimation of the Russian Federation
Renders hardware of offices of anesthesiology and resuscitation on quality of delivery of health care and safety of patients of a surgical profile and the persons which are in critical condition. The analysis of security of these offices with the equipment and equipment in the Russian Federation, federal districts, subjects for 2015–2018 is presented in this article. Now the park of the equipment for these offices became morally outdated, security with this equipment on subjects is presented unevenly.
Competency model based human resources assessment in medical organization
The article considers main types of personnel assessment on the example of a large specialized hospital, analyzes
the features of the assessment of medical personnel. As an example of the system of personnel assessment, personnel
assessment is given according to the competency model of a large medical organization with consideration of practical
examples of the use of personnel assessment results in the development of the clinic. The model of personnel rating based
on the given competency model is presented.
The Main approaches to the evaluation of the effectiveness of the implementation of the “effective contract” in health care
The upcoming reform of the wage system involves a more detailed analysis of not only the advantages and disadvantages of the existing system (as well as previous ones), but also the practice of its application. The most obvious criterion for evaluating the effectiveness of the current wage system is to assess how well it has enabled the implementation of an effective contract and the tasks assigned to it. At the same time, it is necessary to analyze what were the problems of introducing an effective contract that are not directly related to a specific wage system.
One of the main methodological problems with the introduction of an effective contract is that the recommendations for its introduction, developed at the preliminary stage, were not revised following the evaluation of the implementation of an effective contract and its results. Best practices and mistakes were not taken into account, which made it impossible to adjust and specify approaches to the introduction of an effective contract.
In many ways, this is why many institutions have approached the introduction of an effective contract quite formally.
The proposed article is devoted to the criteria for evaluating the success of implementing an effective contract in state (municipal) health care institutions.
The transition to electronic work book
Medical errors: a new stage of discussion
Focus of problem
Management in health care
Manager of health care consults
Questions and answers