Manager Zdravoochranenia 2021 #1
CONTENT OF THE ISSUE
There are defined winners in nominees of Publishing House «Manager of Health Care»
Environment and Public Health: Actual Issues of Health Care Organization and Medical Education
The priorities of scientific and technological development of the Russian Federation, established by Decree of
the President of the Russian Federation № 642 of 01.12.2016, provide for the improvement of health-saving technologies, which in this article have been considered from the standpoint of their focusing on reducing health risks caused by the adverse impact of environmental factors, including by increasing the functional and adaptive reserves of the body.
The article analyzes in order to improve regulatory legal documents in the field of improving the prevention of chronic
non-communicable diseases, the formation of a healthy lifestyle and hygienic education of the population. Also, a critical
analysis of the state of educational activities provided at the state level in the field of higher professional education and
postgraduate training of medical workers in the direction (specialties): medical and preventive care, medical care, public
health and healthcare.
Concluded that to ensure scientific and technological development of the country's need to expand educational and
enlightening activities on issues of ensuring sanitary and epidemiological welfare of the population, hygiene, public
health and organization of health care in health care organizations, and also outside in all major sectors of economy
and business, in the sphere of organized tourism and recreation, SPA, fitness centers, educational organizations, sports,
social welfare and life of the population, especially in terms of prevention, that in accordance with Federal Law № 323 of
21.11.2011 "On the basics of protecting the health of citizens in the Russian Federation" provides for measures to eliminate the harmful influence of environmental factors. Proposals and additions to the relevant state regulatory documents of the Russian Federation that have already been approved and are currently under development are given.
Process-oriented management and project management as tools for the public health organization efficiency improvement
Medical services implementation schemes, based on the optimization of the flow of patient created values, are
proposed. Changes appearing in certain performance indicators of the medical organization during the process of new
management model introduction are analyzed. Aim. Creation of a management model for a state medical organization
in the basis of which are the modern methods based on a process-oriented approach to the separation of management
functions. Relevance. The work of healthcare organizations in a highly competitive environment requires more flexibility
and mobility, thus the primary task is to create new management models of the organization, taking into account industry characteristics and consumer needs. Materials and Methods. The work uses the published results of the analysis of structural changes in organizational activity by other authors. The study was carried out on the basis of internal documents of the FSFI FSRCC FMBA of Russia on the creation of a new management structure focused on the development of an organization in the conditions of the market of medical services. Analytical and descriptive methods and sociological survey were used. Results and Discussion. Changes in the indicators for service provision for compulsory medical insurance and the volume of medical care provided as a result of the reforms carried out by the management of the healthcare organization of the FSRCC for four years have been analyzed. There was an increase in the number of patients seeking medical services at the FSRCC, who want to receive information/assistance quickly, in accordance with the adopted concept of a client-oriented marketing strategy, which required the development of “short” routes for patients, especially in conditions of increased service. By the joint efforts of marketers and specialist doctors, using design technologies, self-supporting Centres are being formed, which are virtual subdivisions that bring together highly qualified doctors to address the specific needs of patients. The “short” path scheme is based on the adoption of the definition of “medical service” as a unit of measurement of the complexity of the process of “medical care” provision. Conclusions. An increase in the number of visits at the outpatient-polyclinic stage of medical care provision (diagnostics, consultations) over five years doubles the achievement of the goals set for the medical organization, considered as an economic entity of a market economy.
Applying lean manufacturing technologies to optimize ambulance operations amid the spread of COVID‑19
The pandemic of new coronavirus infection COVID‑19 has become a serious challenge for the national health
systems, including Russia, setting ambitious goals aimed at preventing the spread of infection and maintaining the availability of medical care in environment of increasing pressure. The aim of the study was to develop, based on the principles of lean production, a set of measures to increase the availability of emergency medical services for patients diagnosed with or suspected of a new coronavirus infection COVID‑19 in the Tomsk Region. Standard tools of lean manufacturing are applied to the work process of the admission department of the respiratory center in RSBHI «Medical sanitary station № 2». As a result of implementation of target state map, which provides for the optimization of process of transferring a patient diagnosed or suspected of a new coronavirus infection COVID‑19 to admission department, a positive dynamics of local (5.4 times increase in the proportion of calls completed within 15 minutes after the patient was delivered to the admission department) and system (an increase of 1.3 times in the proportion of calls with the time the ambulance team reaches the patient within 20 minutes) indicators of the ambulance service was achieved. The study confirms the effectiveness of lean manufacturing tools for optimizing the work of ambulance and allows us to recommend them for use in a pandemic and other risks of emergency.
Identification of patients as a safety in providing medical care (practical experience)
Patient safety is one of the priorities in medical care. The leading place in it is occupied by “correct patient
identification”. According to research by experts from the World Health Organization (WHO), “misidentification of a patient is the cause of many errors.” The purpose of this work is to assess the implementation of a patient identification system using bracelets in a multidisciplinary hospital. The main idea of the project is based on the use of personal identifiers, made in the form of a disposable white bracelet worn on the patient’s arm, as well as the use of color-coded bracelets (red, yellow, red-yellow), which allows identifying patients at risk of developing life-threatening conditions: high risk falling of the patient and the presence of an allergological history. The introduction of identification bracelets with patient data and a barcode on them increased the percentage of identification performance increased from 67% to 89%. After the introduction of the system of prevention of falls and color identification by bracelets, the number of falls of patients decreased by more than 4 times. Successful integration of the automatic identification system into the workflow of a multidisciplinary hospital significantly reduces the influence of the human factor on the number of medical errors and related preventable consequences for patient health.
Activity of daily stay oncological hospitals in the Russian Federation and its regions for 2010–2019
Relevance. Oncological diseases both in our country and in other countries of the world make a significant
negative contribution to the overall mortality and disability of the population. Moreover, in the last decade, oncopathology is significantly more often affects the younger, employable population. One of the factors improving medical care is the provision of the population with specialists and hospital beds of oncological profile, including day care, where patients with this class of diseases could undergo a full course of pre-treatment, treatment, rehabilitation and recovery.
Aim. To identify the dynamics of the main activity indicators of daily stay oncological hospitals of the public health sector in the Russian Federation, federal districts and regions of the Russian Federation for 2010–2019.
Materials and methods. Using the data of federal statistical observation (form № 14DS) by the method of descriptive
statistics, the main activity indicators of daily stay oncological hospitals in the Russian Federation, federal districts and
regions of the Russian Federation in dynamics for 2010–2019 were analyzed.
Results and discussion. In General, in the Russian Federation, the absolute number of oncologic hospital beds in daily
stay hospitals of medical organizations providing inpatient care for the period from 2010 to 2019 increased by 3,5 times
(from 1,448 to 5,013 beds), in daily stay hospitals of medical organizations providing outpatient care for the period from
2014 to 2019 by 67,1% (from 2,465 to 4,120 beds). At the same time the number of patients treated in oncological hospital beds in inpatient daily stay hospitals for the period 2010–2019 increased by 405,245 (from 78,120 to 483,365 people), and in outpatient daily stay hospitals for the period from 2014 to 2017 increased by 93939 (from 218,502 to 312,441 people). The average occupancy of an oncological hospital bed per year and the average duration of treatment in Russia in inpatient daily stay hospitals decreased from 409 days in 2010 to 380 days in 2019 and from 7,7 to 5,6 days, respectively, in outpatient daily stay hospitals from 407 days in 2014 to 386 days in 2017 and from 4,7 to 4,6 days, respectively.
Conclusion. The expansion of the bed fund of daily stay hospitals of oncological profile is timely and justified, but its
development in different regions of the Russian Federation is characterized by a pronounced disproportion. At present
there are all the necessary reserves to continue the active development of the network of daily stay hospitals of this profile.
Experience in using the staff management structure in a redesigned infectious diseases hospital to provide medical care to patients with a new coronavirus infection
The article presents the experience of using the staff management structure in the conditions of redesigning
a multi-specialty hospital into an infectious hospital for providing medical care to patients with a new coronavirus infection. For example, one of the largest hospitals providing specialized medical care during coronavirus infection, proven effectiveness staff management structure as the most optimal for the purposes of redesigning and further use against the growing epidemic Covid‑19.
The role of local governments in solving the problems of providing primary health care personnel
The problem of staffing in healthcare remains relevant for a long time. The article considers the possibilities of participation of local self-government bodies in attracting and securing medical workers, primarily primary care. The
analysis of normative legal acts of the Federal level is presented. Amendments to Federal laws № 131-FZ and № 323-FZ related to specifying the powers of local self-government bodies in terms of health personnel are proposed. The necessity of a comprehensive assessment of the implemented measures of social support for medical workers to identify the most effective measures and select the best practices is justified.
Emotional burnout of a district doctor
Based on the results of assessments of the dependences of the level of psychoemotional load of a primary care
physician (PHC) (district physician) on medical and social problems related to the conditions of his activity, measures have been developed for stress resistance and health saving of a district physician (VTU). The Orenburg region with a population of almost 2 million people was the pilot territory (base) for the study. The region has 12 cities and 35 rural districts, the share of the rural population is 40.1%.
Research materials und methods: sociological, direct observation, statistical: 1014 questionnaires of survey of district
physicians (93% of the total number of VTU) were subjected to statistical processing. The study included 4 stages. At the first stage, sociological surveys of district physicians working in medical organizations located in urban and rural settlements were carried out (568 and 446 VTU, respectively). At the second stage of the study, the level of psychoemotional burnout was assessed using the modified method of V. V. Boyko (2010) “Diagnostics of the level of emotional burnout”. At the third stage of the study, we calculated the statistically significant correlation of the symptom of professional burnout (SPEV) with factors related to medical and social problems of the professional activity of the local GP. At the fourth stage of the study, a set of measures has been developed and is being implemented to increase emotional stability in the professional activity of the local GP.
Relevance. WHO classifies occupational stress as a disease of the twentieth century, which can manifest itself in any
profession and can reach the size of a “global epidemic”. The accumulation of negative emotions in the profession of a
doctor can lead to psycho-emotional exhaustion and the formation of the syndrome of “emotional burnout”. A necessary quality of a primary care physician is emotional stability. This is the ability to overcome a state of excessive emotional arousal. Of particular importance is the development of professional burnout and the assessment of professional stability for district physicians who make first contact with the patient.
Results. Measures have been developed to increase the effectiveness of emotional (professional) stability in the activities of VTU.
Conclusion: Emotional stability in the doctor’s work allows you to maintain and further increase the effectiveness of professional activities. The obtained research results were used for the development of the “program for the modernization of health care in the Orenburg region”. They were used in the development of the Software product of the Ministry of health of the Orenburg region.
Development of e-health as a mechanism for increasing labor productivity of midwifery specialists
E-health is technologies that allow bringing medical services closer to patients in accordance with the objectives
of state policy to level the staff shortage and remoteness of medical centers in rural areas. The established factors
that reduce the quality of working life by the example of a survey of 248 midwifery specialists working in rural areas were characterized by the territorial proximity of a medical organization to home (70.1 ± 5.8%), identified the 5th rank place in the structure of measures to increase satisfaction with the quality of work, creation of a unified information environment. Analysis of modern literature has revealed the main aspects of the need and benefits of introducing e-health, such as accessibility, acceptability and quality.
KADYROV TO FARIT NAKIPOVICH – 60 YEARS OLD
Financing of healthcare in 2021 from the federal budget: priorities within the national project “Healthcare” in the context of the fight against coronavirus infection Covid‑19
An analysis of the upcoming financing of healthcare from the Federal budget shows that in 2021–2022,
despite the difficult financial situation, the volume of financial support for the industry will continue to grow. These are all
the more important parameters because the upcoming budget in the period under review assumed a slight reduction in
funding compared to the approved figures of the Federal budget for 2020. This should help to ensure the stable functioning
of health care.
Management in healthcare
Manager of heath care consults