2019 № 2 Health resourcing of traumatologic-orthopedic service in the subject of the Russian Federation amidst realization of grant program “Zemsky doctor
Medical staff are one of the crucial factors, which guarantee health care service efficiency. However, Russian national traumatologic-orthopedic service exists under the lack of significant lack of staff. Grant program “Zemsky doctor” became one of the problem solving ways.
Purpose. To evaluate Health resourcing of traumatologic-orthopedic service, and to examine results in completing staff jobs of trauma orthopaedists in medical organization in the subject of the Russian Federation achieved due to “Zemsky doctor” program realization.
Approaches: analytical, statistical.
Results. The research is conducted within Stavropol region. It showed that in 5 municipal districts of 36 trauma orthopedist jobs were either not specificated or completed, 6 of 36 had no traumatologic beds. Within the period 2011–2016 we registered negative dynamics of trauma orthopedists completeness from 94,4% to 88,9%. Comparing to 2011, when excluded trauma orthopedists were 23,3% of the general number of fired and hired, in 2016 they were 42,8%. The most active medical staff change is in town medical organizations. Within the period of 2012 to 2016 in terms of “Zemsky doctor” program 12 trauma orthopedists were hired in Stavropol region, which is 1,9% of all signed contracts under this program and 9,2% of all hired within this time trauma orthopedists.
Conclusion. We revealed significant disproportion of health resourcing in health service centres in the subject of the Russian Federation, which limits traumatologic-orthopedic care accessibility. Despite “Zemsky doctor” program being implemented, the strong deficiency of trauma orthopedists still exists, whereas its efficiency decrease the number of licenses for institutional traumatologic-orthopaedical care in rural areas.
2019 № 7 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
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.
2019 № 6 Management in modern management in foreign health care systems(scientific literature review)
This science literature review was conducted for five-year period. It has been established that the process of improvement by lean management has more than 50 years history in industry, and the experience is best carried out, in primary health care; the main of lean management introduction in healthcare is to ensure optimal participation of medical staff in the changes; the concept of medical care in the first place has the aim of improving the quality and availability of healthcare processes; mapping is a basic tool allows to visualize the process of changes and evaluate progress; project management is a method of comprehensive changes in healthcare in which the elements of lean management are also used to ensure general increase in the efficiency of transformations. Lean management is becoming increasingly scientific and practical tool in health management nowadays.