2022 № 4 Features of the formation of the labor rationing system in medical organizations providing primary health care
Labor rationing has a number of potential opportunities, with the competent implementation of which it is possible to solve many urgent management tasks, including stimulating employees.
The purpose of the study is to evaluate the principles of the formation of the remuneration system through the applied elements of labor rationing for various categories of medical workers providing primary health care, taking into account the specialty of the medical worker and his activities.
Materials and methods. A mechanism has been developed for the introduction of a remuneration system (an effective contract) through labor rationing in compliance with labor legislation and other regulatory documents based on the timing of the performance of the labor function (manipulation, procedure, examination, etc.), its quantitative and qualitative characteristics.
Results. During the development of the labor rationing system in the polyclinic, timekeeping tables for load accounting were developed for all departments. Based on these data, the optimal accounting unit of labor costs was established and the required number of points was determined, which guarantees the receipt of an official salary with a full worked rate of hours per month. For each employee, the form “Performance of the load per month” was filled out, where the indicators “Number of patients/days per month” and “Average load per day” were calculated. Summary evaluation data were entered into labor passports, which reflected the rate of points per day, the actual number of points scored, the difference between the actual number and the norm, the percentage of the surcharge. As an example, several developed methods are presented for the development of criteria and the establishment of additional payments to polyclinic medical workers within the framework of an effective contract.
Findings. Determining the workload of medical workers based on the study of labor processes and the cost of working time to perform various jobs, and then rationing their labor, in general, makes the requirements for the volume of work performed transparent, reasonable and understandable for the staff of medical organizations.
2023 № 3 The wage system as an instrument of influence on the quality of primary health care.
Qualified and motivated employees of a medical organization are a necessary component that ensures the provision of medical care of appropriate quality One of the motivating factors of medical workers for high-quality and efficient work is wages.
The purpose of the study. To analyze and evaluate the impact of the remuneration system of medical workers based on labor rationing on the quality of primary health care (PHC) on the example of the state district polyclinics of St. Petersburg. Materials and methods. Based on the reporting data of polyclinics selected by the research bases, the following were studied: the dynamics of the number and staffing of medical workers from 2018 to 2021; the percentage and structure of reasons for refusal to pay for cases of medical care in 2010–2018 and 2020–2021; the dynamics of the detection of malignant neoplasms in the early stages. The results of the patient survey were analyzed in order to assess changes in the quality of primary health care for the adult population after the introduction of a system of remuneration for medical workers based on labor rationing.
Results. After the introduction of a new wage system based on its rationing, a number of general positive trends were identified for the studied polyclinics, such as: an increase in staffing of medical personnel in general by 3.5%–8.7%, district internists by 4.6%–42.7%, specialist doctors by 2.8%–12.4%, average medical personnel by 4.5%–17.7%; increase in the proportion of oncological pathology detected at early stages by 13.5%–20.1%; decrease in the share of refusals to pay for medical care cases by 9.3%–32.9%; a decrease in the total number of citizens’ complaints in the form of complaints by 6.0–58.0%, including justified ones.
Findings. The introduction of a wage system based on labor rationing has increased the economic and medico-social efficiency of the polyclinics under study, as well as the motivation of medical workers to provide medical care of appropriate quality.