Standards for accountants in health care. Lack of regulatory support for a number of departments of healthcare facilities, individual positions. Economic groundlessness of new labor standards
- in institutions with up to 100 beds;
- in institutions assigned to groups I - II in terms of remuneration of managers
- in maternity hospitals with antenatal clinics with less than 5 medical positions and a hospital with 100-180 beds; 1 position:
- in regional, regional, republican, district hospitals;
- Narcological and neuropsychiatric dispensaries of republican, district, regional, city (cities with a population of over 800 thousand) subordination; skin and venereal dispensaries of urban subordination, serving at least 200 thousand people; in the absence of a psycho-neurological dispensary, this position is established in one of the psychiatric hospitals that have a dispensary department;
- in central district and central city hospitals in rural areas and cities with a population of over 25 thousand people;
- in city hospitals with 360 or more beds;
- in children's city hospitals, the polyclinic of which serves 15 thousand or more children. When serving a smaller number of children, the specified position is introduced at the rate of 15 thousand children;
- in maternity hospitals, in antenatal clinics, in which there are 5 or more medical positions. In cases where there are fewer medical positions in the antenatal clinic, this position is introduced if there are at least 190 beds in the hospital
| N p / p | Job title | Number of positions |
| 1 | 2 | 3 |
| 1.6.1. | manager | 1 position in each institution. In pharmacies serving up to 150 beds, the position of the head is established instead of 1 position of a pharmacist, over 150 to 250 beds - instead of 0.5 of the position of a pharmacist. In control and analytical laboratories assigned to group V in terms of remuneration of managers, the position of head is established instead of 1 position of a pharmacist, in laboratories assigned to group IV - instead of 0.5 positions of a pharmacist |
| 1.6.2. | Chief Accountant | 1 position in institutions assigned to groups I - III in terms of remuneration of managers |
| 1.6.3. | Accountant | 0.5 positions in pharmacies assigned to group V in terms of remuneration of managers; in control and analytical laboratories and centers for quality control and certification of medicines assigned to groups IV - V in terms of remuneration of managers; 1 position in pharmacies assigned to III-IV groups in terms of remuneration of managers; in control and analytical laboratories and centers for quality control and certification of medicines classified as group III in terms of remuneration of managers; 2 positions in pharmacies assigned to group II in terms of remuneration of managers; control and analytical laboratories and centers for quality control and certification of medicines assigned to groups I - II in terms of remuneration of managers; 3 positions in pharmacies assigned to group I in terms of remuneration of managers |
| 1.6.3. | Head of economic department | 1 position in institutions assigned to groups I - II in terms of remuneration of managers |
| 1.6.4. | Head of the household | 1 position in institutions assigned to groups III - V in terms of remuneration of managers |
2.1. Positions of employees
| N p / p | Job title | Number of positions |
| 1 | 2 | 3 |
| 2.1.1. | Deputy Head of Technology | 1 position in medical and preventive institutions assigned to groups I - II in terms of remuneration of managers, equipped with complex medical and other equipment, apparatus and facilities |
| 2.1.2. | Chief mechanical engineer | 1st position: - medical and preventive institutions with a bed capacity, assigned to groups I - II in terms of remuneration of managers, in which the positions of heads of services are not introduced, except for the head of the repair service; - blood transfusion stations assigned to group I in terms of remuneration of managers |
| 2.1.3. | Chief Power Engineer | 1 position: - medical and preventive institutions with a bed fund, referred to group I in terms of remuneration of managers in the presence of an energy sector; - blood transfusion stations classified as group I in terms of remuneration of managers, in the presence of an energy economy |
| 2.1.4. | Chief technologist | 1 position: - blood transfusion stations assigned to group I in terms of remuneration of managers |
| 2.1.5. | Heads of services: plumbing, gas, elevator, air conditioning and heating, energy | Treatment-and-prophylactic institutions assigned to I-IV groups according to the remuneration of managers. At the same time, one position of the head of each service can be introduced: - water supply and sewerage - with an average daily supply of water and an average daily amount of liquid discharged through the sewer network of at least 4 thousand cubic meters. m; - gas - with the volume of work of the gas economy over 500 conventional units; - elevator - if there are at least 45 elevators; - air conditioning and heating - in the presence of central and autonomous air conditioners and ventilation facilities; - energy - in hospitals with energy facilities. In cases where it is inappropriate to introduce the positions of chiefs for individual services, positions of chiefs for joint services may be introduced. |
| 2.1.6. | Head of repair service | 1 position in medical institutions classified as group I in terms of remuneration of managers, in which positions of heads of services are not introduced |
| 2.1.7. | Head of technical department | 1 position in medical and preventive institutions assigned to III-IV groups for the remuneration of managers, equipped with complex medical and other equipment, apparatus and facilities: - blood transfusion stations assigned to groups II - IV in terms of remuneration of managers; - ambulance stations with a number of visits per year of at least 50 thousand, with radiotelephone communication |
| 2.1.8. | Head of Logistics Department | 1 position: - in the institutions provided for in paragraphs 1.1 and 1.2, assigned to groups I - IV in terms of remuneration of managers; - in blood transfusion stations that process 15 thousand or more liters of plasma per year in the production of plasma protein fractionation |
| 2.1.9. | Central warehouse manager | 1 position in institutions where a central warehouse is organized - instead of the position of a warehouse manager |
| 2.1.10. | Engineer | 1 position in republican, district, regional, regional hospitals - to ensure all the necessary work on the introduction of office equipment, small-scale mechanization, etc. if it is impossible to perform it by the available engineering and technical personnel |
| 2.1.11. | Metrology engineer | 1 position in medical and preventive institutions assigned to groups I - II in terms of remuneration of managers. If the healthcare system of the constituent entities of the Russian Federation has two or more regional, regional, republican multidisciplinary hospitals, the position of a metrology engineer is introduced in one of them |
| 2.1.12. | Engineers and technicians of boiler houses, pumping stations and other special installations, structures and industries | All institutions - according to the relevant inter-industry and industry standards and labor standards |
| 2.1.13. | Engineers and technicians of services: plumbing, gas, elevator, air conditioning and heating, repair, energy | All institutions - according to the relevant intersectoral and sectoral norms and labor standards. In cases where it is inexpedient to introduce positions of engineering and technical workers of individual services, positions of engineers and technicians for joint services may be introduced. |
| 2.1.14. | Programmer | In institutions that have computers on their balance sheet, if there is a volume of work |
| 2.1.15. | Employees of motor transport units (garages) | Establishments with more than 50 units of rolling stock (cars, tractors, road and other machines), except for electric and car trucks, etc. funds, - according to the standards for employees of motor transport enterprises |
| 2.1.16. | Employees for servicing electronic computers, special sea and river vessels, meteorological stations and posts, vivariums, as well as for the manufacture of koumiss | Institutions with relevant units and equipment - according to the standards in force in the relevant sectors of the economy |
At the same time, the names of positions of employees and professions of workers must correspond to their names provided for in the current staffing standards, tariff and qualification characteristics for industry-wide positions of employees and professions of workers approved by the Ministry of Labor of Russia. The names of the professions of workers that are not provided for by the tariff and qualification characteristics for industry-wide professions of workers are established in accordance with the names contained in the Unified Tariff and Qualification Directory of Works and Occupations of Workers (ETKS).
In the staff list of the institution, vacant positions are indicated by their basic name, for example, accountant, economist, engineer.
The names of positions occupied by specific employees are determined based on the compliance of their qualifications with the requirements provided for by the tariff and qualification characteristics for industry-wide positions of employees, for example, a specialist (economist, accountant, engineer) with a higher professional education and 4 years of experience as an economist, in the staff list of the institution, the position will be called an economist of the II category, etc.
3. Integer or 0.25, 0.5 and 0.75 positions (units) can be entered into the staffing tables, when calculating them, the final figures less than 0.13 are discarded, the figures 0.13 - 0.37 are rounded up to 0.25, figures 0.38 - 0.62 are rounded up to 0.5, figures 0.63 - 0.87 are rounded up to 0.75, and more than 0.87 - to one. If for several titles 0.25, 0.5 or 0.75 positions (units) are formed, they may be combined by categories of personnel (employees, workers) under one of the combined titles with the performance of functions in all the combined positions (professions).
Appendix No. 2
STAFF STANDARDS OF EMPLOYEES OF CENTRALIZED ACCOUNTING AT STATE AND MUNICIPAL HEALTH INSTITUTIONS1. The position of the chief accountant is established in each accounting department.
2. The positions of deputy chief accountants are established in the accounting department, which is subject to paragraphs 4 - 8 of these staff standards:
From 5 to 10 positions of accountants - 1 position;
From 11 and above positions of accountants - 2 positions.
2.1. Additionally, the position of deputy chief accountant may be introduced at the expense of one of the positions of group leaders in centralized accounting departments with a total number of beds over 2100 and the number of medical positions over 420 in the serviced institutions.
2.2. Additionally, the position of deputy chief accountant may be introduced in institutions that carry out tax and statistical accounting operations.
3. The position of the head of the accounting group is established for each functional group, which, according to paragraphs 4 - 8 of these staff standards, is entitled to at least 6 positions of accountants, instead of one of them.
4. The positions of accountants for accounting and costing food products are established at the rate of 1 position for 300 beds in medical institutions with a bed fund, and places in orphanages.
5. The positions of accountants for accounting of material assets are established at the rate of 1 position for:
300 beds in medical and preventive institutions with bed capacity and places in orphanages;
100 medical positions in institutions without beds.
6. The positions of accountants for settlements with workers and employees are established at the rate of 1 position per 200 full-time positions in the serviced institutions.
7. The positions of accountants in financial accounting are established at the rate of 1 position for:
150 positions of doctors in serviced institutions.
Additionally, the positions of accountants in financial accounting are established:
7.1. 1 position in the execution of cash transactions through the treasury system.
7.2. 1 position to work with funds: compulsory health insurance, pension and social development.
7.3. At the rate of 1 position per 1000 beds and 200 positions of doctors in serviced institutions operating in the compulsory health insurance system.
7.4. 1 position in servicing blood transfusion stations assigned to groups III - IV, and 2 positions - to groups I - II for the remuneration of managers.
7.5. Based on 1 position per 100,000 visits per year in serviced ambulance stations.
7.6. 0.5 positions in servicing the centers of the state sanitary and epidemiological supervision, assigned to groups III - IV, and 1 position - to groups I - II for the remuneration of managers.
7.7. At the rate of 1 position for 60 medical positions in the service of the forensic medical examination bureau.
7.8. 0.5 positions in servicing dairy kitchens with a daily throughput of 1 to 5 thousand servings, 1 position - over 5 to 7 thousand servings and 1.5 positions - over 7 thousand servings.
8. The positions of accountants-auditors are established:
8.1. 1 position - when servicing less than 10 institutions with more than 300 beds (in total) and (or) 60 doctor positions (in total).
2 positions - at least 15 institutions with more than 750 beds (in total) and (or) 150 doctor positions (in total).
8.2. 1 position - when servicing ambulance stations with more than 100 thousand visits per year.
8.3. 1 position in the presence of centers of state sanitary and epidemiological surveillance with a population of more than 1 million people served.
8.4. 1 position when servicing blood transfusion stations with the amount of plasma harvested at least 10 thousand liters per year or processing at least 40 thousand liters of plasma per year.
8.5. 1 position in the service of the Bureau of Forensic Medical Examination with more than 60 medical positions.
9. The position of a senior cashier is established in the accounting department serving more than 1000 employees (physical eggs), instead of one cashier position, which is due under paragraph 10 of these staff standards.
10. The position of the cashier is established in each accounting department. When the accounting department directly conducts cash settlements with the population, additional positions of cashiers are established in its staff:
10.1. 0.5 positions in the presence of a dairy kitchen with a daily throughput of up to 2 thousand servings; 1 position - over 2 thousand servings.
10.2. 0.5 positions in the presence of a prosthetic department with the number of positions of dentists-orthopedists 5 or more.
10.3. 0.5 positions in the presence of a blood transfusion department with a procurement of at least 2 thousand liters of blood from regular donors.
10.4. 0.5 positions in the presence of a department of preventive disinfection with a staff of 10 or more positions of medical disinfectors for paid work on preventive disinfection, disinfestation and deratization.
10.5. 1 position for other paid medical services.
11. The position of an economist for financial work is established:
11.1. At the rate of 1 position for 200 beds and 50 medical positions, with the number of beds in serviced institutions over 300 (in total) and over 60 medical positions (in total).
11.2. Based on 1 position per 100,000 visits per year at ambulance stations.
11.3. At the rate of 1 position for 60 medical positions in the Bureau of Forensic Medical Examination.
11.4. 1 position in servicing the centers of state sanitary and epidemiological surveillance and blood transfusion stations assigned to groups III - IV, and 2 positions - to groups I - II for the remuneration of managers.
12. 0.5 - 1.0 the position of a typist is established in each accounting department.
Notes. 1. Economic maintenance of the centralized accounting department (cleaning and repair of premises, current monitoring of equipment and apparatus, etc.) is carried out by the personnel of the institution in which the centralized accounting department is organized.
The positions of employees and professions of workers of centralized accounting departments located in separate premises, as well as those employed in the technological process, are established according to the standards of the relevant employees provided for medical institutions.
2. Integer or 0.25, 0.5 and 0.75 positions (units) can be entered into the staffing tables, when calculating them, the final figures less than 0.13 are discarded, the figures 0.13 - 0.37 are rounded up to 0.25, figures 0.38 - 0.62 are rounded up to 0.5, figures 0.63 - 0.87 are rounded up to 0.75, and more than 0.87 - to one. If 0.25, 0.5 or 0.75 positions (units) are formed for several items, they can be combined by categories of personnel (employees, workers) for one of the combined items with the performance of a function for all the combined positions (professions).
3. The formation of functional groups and the determination of the number of accounting and accounting personnel in each group is determined by the chief accountant within the limits of the number of positions that are due to centralized accounting for these model states.
4. When calculating the positions of accountants-auditors, economists for financial work in the number of beds and the number of positions of doctors
Notes. 1. When determining the number of employees in structural subdivisions for mobilization work and civil defense (individual employees as part of other subdivisions) in organizations with hospitals, the number of patients being treated (according to the number of estimated beds) is taken into account.
2. In medical institutions that have departments for non-transportable patients for a special period, instead of the position of a civil defense specialist, the position of head of the department may be introduced.
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Appendix No. 2
to the Regulations on the organization of the provision
primary health care
adult population approved
by order of the Ministry
health and social
development of the Russian Federation
private healthcare organization.
Name
posts
Number of positions
1. Chief physician 1 position
2. Manager
therapeutic
department
with the number of positions of general practitioners
all titles (including doctors-
adolescent therapists in the absence
department) 6.5 - 9 -
instead of 0.5 doctor positions;
if the number of specified positions is more than 9 -
beyond these positions
3. Manager
surgical department
1 position:
with the number of positions of surgeons and
traumatologists-orthopedists (with
lack of position in the institution
head of traumatology and orthopedics
department) 5 - 8 - instead of 0.5 positions
if the number of specified positions is more than 8 -
beyond these positions
4. Manager
traumatological
orthopedic
department<1>
1 position for 8 or more medical
posts
5. Head of department
medical prevention
1 position in the staff of the polyclinic,
serving at least 25 thousand adults
population, instead of 0.5 doctor positions
medical prevention room
6. Head of department
otorhinolaryngological,
ophthalmic,
neurological
1 position in each of the departments
the specified profile with the number of positions
doctors of the corresponding names are not
less than 3.5 - instead of 0.5 of the position of a doctor
7. Deputy Chief
expert doctor
temporal
disability
1 position - with the number of positions of doctors
outpatient reception at least 25
8. Home medical
1 position
9. Head of the office
medical statistics
10. Deputy Chief
medical doctor
It is established with the number of medical
positions (including the position of chief
doctor) at least 40
11. District general practitioner 1 position per 1700 adults
population aged 18 years and older. Surgeon 0.65 positions per 10,000 people
adult population attached to
polyclinic
13. Traumatologist-orthopedist 1 position for conducting adult appointments
patients with injuries and diseases
musculoskeletal system by 20 500
adult population;
1 position for 20 beds per shift
traumatology and orthopedic department;
1 24/7 post per 100,000
attached population to provide
24-hour outpatient
trauma care
14. Urologist 1 position per 20,000 people
attached population
15. Otorhinolaryngologist 1 position per 20,000 people
attached population
16. Ophthalmologist 0.6 positions per 10,000 people
attached population
17. Neurologist 1 position per 20,000 people
attached population
18. Cardiologist 1 position per 20,000 people
attached population
19. Endocrinologist (doctor-
diabetologist)
1 position per 20,000 people
attached population
20. Infectious disease doctor 1 position per 50,000 people
attached population
21. Allergist-
immunologist
1 position per 100,000 adults
population
22. Rheumatologist 1 position per 30,000 people
attached population
23. Doctor (paramedic) cabinet
medical prevention
population<2>
24. Head of the office
medical care for
smoking cessation
1 position instead of 0.5 positions
head of medical office
prevention<3>
25. Clinical doctor
laboratory diagnostics
additional 0.25 positions if available
allergy room
26. Radiologist 1 position for 25 positions of doctors,
leading outpatient reception
27. Physiotherapist depending on the number of positions of doctors
outpatient clinic reception:
from 15 to 30 - 0.5 positions;
over 30 to 50 - 1 position;
over 50 - 1 position and additionally
0.5 positions for every subsequent 25
positions of doctors leading outpatient
reception (over 50)
28. Medical Doctor
physical education
1 position for 40 positions of doctors,
leading outpatient reception, but not less than 1
jobs at the clinic
29. Physician-methodologist 1 position in the staff of one of the polyclinics
Cities with a population of 200,000 or more
30. Functional doctor
diagnostics
Depending on the number of positions of doctors
outpatient appointment:
from 20 to 50 - 0.5 positions;
over 50 - 1 position
31. Psychotherapist 1 position per 25,000 attached
population
32. Oncologist or doctor-
specialist who passed
oncology training
1 position per 500 people of the contingent
dispensary cancer patients
33. Psychiatrist-narcologist 1 position per 30,000 attached
population
34. Gastroenterologist 1 position per 50,000 adults
35. Coloproctologist 1 position per 100,000 population36. Epidemiologist 1 position in polyclinics over 300
visits
37. Nurse
precinct
1.5 positions for each position
local general practitioner
38. Nurse 2 positions for each position of a doctor-
surgeon, traumatologist-orthopedist, doctor-
endocrinologist (diabetologist);
1 position for each doctor position,
leading outpatient reception;
1 position per shift for 24/7
trauma center in the presence of the amount of work on
plaster casts
1 position for each doctor position
functional diagnostics
39. Nurse
departments (office)
medical prevention
(to provide
pre-medical appointment,
history taking and
organization
dynamic observation
for people with high
risk of chronic
non-infectious
diseases)
0.5 positions per 5 thousand adults
population
40. Nurse
physiotherapy
1 position per 15 thousand conditional
physiotherapy units per year
41. Medical Instructor
physical education
1 position for 25 positions of doctors,
leading outpatient reception, and
as part of the traumatology polyclinic
orthopedic department
42. Laboratory assistant 1 position for 8 positions of doctors,
leading outpatient reception
43. X-ray laboratory assistant According to the positions of doctors-
radiologists and additionally 1 position
in the presence of a polyclinic
traumatology and orthopedic department
44. Nurse by
leading outpatient reception, and
additional 0.5 positions if available
polyclinic of traumatology and orthopedic
branches
45. Nurse
procedural
1 position for 10 positions of doctors,
leading outpatient reception
46. Senior operating room
nurse
Installed in the state of the clinic with
the number of positions of surgeons and
at least 4 traumatologists-orthopedists
Instead of one medical post
47. Senior Medical
receptionist nurse
Installed in the clinic with a number
positions of medical registrars
48. Senior Medical
branch sister
According to the positions of managers
departments<4>
49. Medical registrar 1.1 posts for 5 posts of doctors,
leading outpatient reception;
1 position for the X-ray room archive
(departments) of polyclinics with the number
positions of outpatient physicians are not
less than 100;
for maintaining medical examination records -
at the rate of 1 position per 20 thousand people
specified cards
50. Medical statistician Installed in polyclinics with the number
medical positions (all):
up to 20 - 0.5 positions;
over 20 to 40 - 1 position;
over 40 to 60 - 1.5 positions; over 60 - 2 positions<5>
51. Assistant epidemiologist 1 position in polyclinics with the number
visits up to 300;
1 position (together with a doctor-
epidemiologist) in polyclinics with a number
visits over 700
52. Sister-mistress 1 position
53. Nurse 1 position:
for each medical specialist position
(surgeon, traumatologist-orthopedist,
infectious disease specialist, coloproctologist);
for every two positions of other doctors,
leading outpatient reception;
for every 4 positions of laboratory doctors and
laboratory assistants;
for every 2 positions of nurses
in physiotherapy, and in the presence of water
mud-peat-ozokerite-paraffin treatment -
for every nursing position,
busy with the leave of the said procedures;
for each operating position
nurse;
for every nursing position
treatment room, but not more than 1
office positions per shift;
to the x-ray room per shift;
to the registry in shift
54. Medical psychologist
psychotherapists
55. Social worker
psychotherapists
<1>The branch is organized in cities with a population of over 400 thousand people in
the composition of organizations providing traumatological and orthopedic medical care.
<2>For 25 thousand of the population, 2.5 rates of a doctor in a medical office are provided
prevention, instead of 0.5 rate of the doctor of the cabinet of medical prevention, 1 rate is introduced
head of the department of medical prevention (thus, in a polyclinic,
serving 25 thousand people, there will be a department of medical prevention, consisting of 2
offices headed by the head of the department).
<3>For 35 thousand population, 3.5 positions of a doctor in the medical office are provided.
prevention, instead of 0.5 of the position of a doctor in the medical prevention cabinet, 1
the office manager's rate for smoking cessation (thus, in
polyclinic serving 35 thousand people, a department consisting of 3
medical prevention rooms and 1 medical care room in case of refusal from
smoking).
<4>In departments where the position of head is introduced instead of 0.5 or 1 position
doctor, the position of the head nurse is established respectively instead of 0.5 and 1
positions of a medical (district medical) nurse.
<5>In a polyclinic that has a staff position as a methodologist, it may additionally
1 post of medical statistician is established.
Order of the Ministry of Health of the Russian Federation of June 9, 2003 N 230
"On approval of staffing standards for employees and workers of state and municipal health care institutions and employees of centralized accounting departments at state and municipal health care institutions"
According to the letter of the Ministry of Justice of the Russian Federation dated June 26, 2003 N 07 / 6476-YUD, this order is recognized as not requiring state registration (information published in the newspaper AKDI "Economics and Life", August 2003, N 31)
In order to improve the organization and standardization of work of employees of healthcare institutions and on the basis of the Decree of the Government of the Russian Federation of April 29, 2002 N 284 "On approval of the Regulations on the Ministry of Health of the Russian Federation" (Collected Legislation of the Russian Federation, 2002, N 18, Art. 1771) I order :
1. Approve the staffing standards for employees and workers of state and municipal healthcare institutions (Appendix N 1), staffing standards for employees of centralized accounting departments at state and municipal healthcare institutions (Appendix N 2) and staffing standards for structural units (employees) specially authorized to solve problems in areas of civil defense of state and municipal health care institutions (Appendix N 3).
2. Consider invalid the order of the Ministry of Health of Russia dated May 22, 2001 N 165 "On the approval of staff standards for employees and workers of health care institutions and employees of centralized accounting departments at health care institutions."
3. To impose control over the execution of this order on the First Deputy Minister of Health of the Russian Federation A.I. Vyalkov.
Minister Yu.L.Shevchenko
Appendix No. 1
Staff standards for employees and workers of state and municipal health care institutions
1. Positions of employees introduced by types of institutions
1.4. Blood transfusion stations, blood centers
|
NN p/n |
Job title |
Number of positions |
|
1.4.1. |
Head (chief doctor, director) | 1 position in each institution. In institutions assigned to group IV in terms of remuneration of managers, the position of head is introduced instead of 0.5 of the position of a doctor |
|
1.4.2. |
Deputy Head of Economic Affairs | |
|
1.4.3. |
Deputy Chief Physician for Economic Affairs | 1 position in institutions assigned to groups I-III in terms of remuneration of managers |
|
1.4.4. |
Head of economic department | 1 position in institutions assigned to group IV in terms of remuneration of managers |
|
1.4.5. |
Chief Accountant | 1 position in each accounting department. In an institution that is entitled to up to 3 positions of accountants, this position is introduced instead of the position of an accountant, more than 3 to 6 - instead of 0.5 of the position of an accountant |
|
1.4.6. |
Deputy chief accountant, accountant, accountant-auditor, senior cashier | According to staff standards of centralized accounting departments at budgetary healthcare institutions, based on the indicators of this institution |
|
1.4.7. |
Cashier | |
|
1.4.8. |
Deputy Chief Physician for Human Resources, Head of the Human Resources Department, Human Resources Specialist, Senior Inspector for Human Resources, Inspector for Human Resources, Typist | According to the standards provided for in paragraphs 1.1.10, 1.1.11, 1.1.12, 1.1.31, respectively |
|
1.1.10. |
Deputy Chief Physician for Human Resources | 1 position in institutions assigned to groups I-II in terms of remuneration of managers |
|
1.1.11. |
Head of Human Resources | 1 position in institutions assigned to groups I-II in terms of remuneration of managers; 1 position in institutions assigned to groups III-IV in terms of remuneration of managers - instead of one of the positions provided for in clause 1.1.12 |
|
1.1.12. |
Human Resources Specialist, Human Resources Inspector (Senior Inspector) | Based on 1 position for 150 positions, but not less than 1 position in the institution |
|
1.1.31. |
Typist | Based on 1 position per 8,000 typewritten sheets of service documentation per year |
|
1.4.9. |
Office manager | 1 position in institutions classified as group I in terms of remuneration of managers |
|
1.4.10. |
clerk | 0.5 positions in institutions assigned to group IV in terms of remuneration of managers. 1 position in institutions assigned to groups I-III in terms of remuneration of managers |
|
1.4.11. |
secretary typist | 1 position in each institution |
|
1.4.12. |
Economist | 1 position in institutions assigned to groups IV-III in terms of remuneration of managers. 2 positions in institutions classified in groups II-I in terms of remuneration of managers |
|
1.4.13. |
Economist for financial work | 0.5 positions in institutions not serviced by centralized accounting and assigned to group IV in terms of remuneration of managers. 1 position in institutions not serviced by centralized accounting and classified in groups I-III in terms of remuneration of managers. |
|
1.4.14. |
Engineer | 1 position in institutions assigned to groups I-III in terms of remuneration of managers and not having production facilities (laboratories) for plasma protein fractionation |
|
1.4.15. |
Technician | 1 position in institutions assigned to IV-V groups in terms of remuneration of managers and not having production facilities (laboratories) for plasma protein fractionation. |
|
1.4.16. |
Labor protection engineer | 1 position in institutions with more than 100 employees (individuals) and additionally - according to intersectoral standards for the number of employees of the labor protection service in organizations. |
|
1.4.18. |
Merchandiser | 1 position in facilities that process at least 10,000 liters of plasma per year in a plasma fractionation facility, and an additional 1 position when processing at least 20,000 liters of plasma per year. |
2. Positions of employees and professions of workers, introduced depending on the organizational and technical conditions for the functioning of institutions
2.1. Positions of employees
|
Job title |
Number of units |
Number of positions |
|
| Car driver | For a car of any type. For an ambulance - per shift | ||
| Motor vehicle driver | On a motorcycle, motor scooter, motor sled or other motor vehicle belonging to category "A" used for the transport of goods | ||
| Snowmobile driver | The time for which the driver of the snowmobile is provided is determined by the health authorities according to the subordination of the institution | ||
| Electric and truck driver | On the electric and auto truck used for the transport of goods | ||
| Carter | On a workhorse | ||
| Wardrobe attendant | At the rate of 1 per 150 rooms, but not less than 1 per shift. In the states of district hospitals with less than 25 beds, outpatient clinics with less than 10 medical positions (including those that are part of district hospitals), orphanages and dairy kitchens, a cloakroom attendant is not introduced . | ||
| Stoker | If there are stoves for the heating season | ||
| Mason | Based on 1 for: - 30 thousand sq.m. of the total area of brick buildings or 33,700 sq.m. of the total area of large-block and large-panel buildings operated up to 10 years; or 22500 sq.m. respectively, in these buildings, operated for more than 10 years. | ||
| Castellane | For an independent medical and preventive institution that does not have a bed fund, with the number of medical posts 25-75. For an outpatient department with a number of medical posts from 25 to 75, which is part of a medical facility and located in a separate room. | ||
| For an independent medical and preventive institution that does not have a bed fund, with a number of medical posts over 75. For an ambulance station with more than 10,000 visits per year. | |||
| To the blood transfusion station, assigned to the II-III groups for the remuneration of managers. | |||
| To the blood transfusion station, assigned to group I in terms of remuneration of managers. | |||
| Storekeeper | In institutions with 75-120 beds, and in central district hospitals - with 50-95 beds. At blood transfusion stations with the amount of blood harvested up to 3 thousand liters per year. At ambulance stations - with the number of visits per year from 20 to 40 thousand. In the bureau of forensic medical examination with the number of medical posts from 20 to 40. | ||
| In institutions for 125-200 beds (beds), and in central district hospitals - for 100-150 beds. In institutions over 200 (in central district hospitals - over 150) beds additionally at the rate of 1 position per 250 beds. At blood transfusion stations with the amount of blood harvested 3 or more thousand liters per year. At the ambulance stations with the number of visits per year 40 thousand or more. | |||
| Roofer | Based on 1 for: - 10300 sq.m. of steel roofing - 9200 sq.m. of rolled roofing (soft) - 11800 sq.m. of slate roofing - 16500 sqm of asbestos-cement roofing - 12400 sq.m. of tiled roof |
||
| lifter | On a freight elevator per shift | ||
| Painter and plasterer | In total, based on 1 for: - 20,000 sq.m. of total area in stone buildings operated up to 10 years; - 13,500 sq.m. in the said buildings, which have been in operation for over 10 years; - 16000 sq.m. of total area in wooden buildings - 1400 sq.m. of total area in other buildings |
||
| Operator of electronic computers and computing machines | |||
| Copier and duplicator operator | In institutions assigned to groups I-II in terms of remuneration of managers, if there is a volume of work | ||
| Operator of microfilming and copying machines | Depending on the scope of work according to technically sound standards, and in their absence - according to the standards developed by the institution using the experimental statistical method | ||
| Hairdresser | Based on 1 per 200 beds | ||
| Document Binder | According to standard norms of time for binding work | ||
| Furnace, green farm worker or gardener, territory cleaner and other workers engaged in sanitary maintenance of territories | All institutions - according to service standards for furnace work, according to standard service standards for workers engaged in work on the sanitary maintenance of households. | ||
| Construction carpenter and joiner | In total, based on 1 for: - 18,000 sq.m. of total area in stone buildings operated up to 10 years; - 11,000 sq.m. in these buildings, which have been in operation for over 10 years; - 8000 sq.m. of total area in wooden buildings; - 10000 sq.m. of total area in other buildings |
||
| floor polisher | According to standard norms of time for flooring work | ||
| support worker | All institutions in the presence of a volume of work not provided for in other professions of workers. In pharmacies assigned to groups I-IV in terms of remuneration of managers. |
||
| Gold receiver of dental institutions (divisions) | - up to 15 kg; - over 15 kg. |
||
| Integrated building maintenance worker | It is introduced instead of the professions of workers (stoker, bricklayer, roofer, painter, plasterer, floor polisher, carpenter, carpenter, installer of internal sanitary systems and equipment, glass cleaner, electrician), when, according to the standards stipulated for each profession, workers of the specified professions by individual names | ||
| Workers of motor transport units (garages) | Institutions with up to 50 units of rolling stock (cars, tractors, road and other machines), except for electric and car trucks, etc. vehicles - according to the standards for motor transport workers | ||
| Laundry workers (operator for washing and repairing overalls, washing machine operator, ironer, etc.) | Occupations of laundry workers are introduced according to the labor costs of laundry workers, depending on the amount of work. | ||
| Workers of boiler houses, pumping stations and other special installations, structures and industries | All institutions - according to the relevant intersectoral norms and labor standards | ||
| plumber | Depending on the scope of work according to technically sound standards, and in their absence - according to the standards developed by the institution using the experimental statistical method | ||
| glass cleaner | According to the standard time standards for glass wiping work | ||
| carpenter | Depending on the scope of work according to technically sound standards, and in their absence - according to the standards developed by the institution using the experimental statistical method | ||
| Watchman (watchman) | Depending on the scope of work according to intersectoral and sectoral norms and standards | ||
| Local telephone operator | per switch per shift | ||
| Industrial and office cleaner | Based on 1 for: - 250 sq.m. wooden floors; - 350 sq.m. of floors covered with ceramic tiles; - 425 sq.m. of floors covered with linoleum; - 550 sq.m. of passages and tunnels connecting the building |
||
| Seamstress | Based on 1 per 300 beds (places) | ||
| Communication electromechanic | Institutions with automatic telephone exchanges - according to the standards of communications workers | ||
| Electrician for repair and maintenance of electrical equipment | Depending on the scope of work according to technically sound standards, and in their absence - according to the standards developed by the institution using the experimental statistical method |
Notes:
1. The title of the position of the head of the institution is established in accordance with the profile of the institution headed, for example: hospital, polyclinic - chief physician; hospital - chief; sanatorium, center - head physician, director; pharmacy - manager, etc.
In the staffing table of the institution, the position of the head is taken into account in the general institution staff.
The position of director, replaced by specialists who do not have a medical education, is established in sanatorium-and-spa institutions assigned to groups I-IV in terms of remuneration of managers. In this case, the position of director as deputy head of the institution is not introduced.
2. The head of the institution, based on production needs, has the right to strengthen individual structural units or introduce positions (professions of workers) not provided for by these staffing standards, at the expense of positions of other structural units within the limits of the wage fund established by the institution.
The introduction of additional positions in excess of the current staff standards is allowed only if there is a job description on the functional duties of an employee additionally introduced into the staff of the institution, and an economic justification for the expediency of introducing the specified position.
At the same time, the names of positions of employees and professions of workers must correspond to their names provided for in the current staffing standards, Tariff and qualification characteristics for industry-wide positions of employees and professions of workers approved by the Ministry of Labor of Russia. The names of the professions of workers that are not provided for by the Tariff and qualification characteristics for industry-wide professions of workers are established in accordance with the names contained in the Unified Tariff and Qualification Directory of Works and Professions of Workers (ETKS).
In the staff list of the institution, vacant positions are indicated by their basic name, for example, accountant, economist, engineer.
The names of positions occupied by specific employees are determined based on the compliance of their qualifications with the requirements provided for by the tariff and qualification characteristics for industry-wide positions of employees, for example, a specialist (economist, accountant, engineer) with a higher professional education and 4 years of experience as an economist, in in the staff list of the institution, the position will be called an economist of the II category, etc.
3. Integer or 0.25, 0.5 and 0.75 positions (units) can be entered into the staffing tables, when calculating them, the final figures less than 0.13 are discarded, the figures 0.13-0.37 are rounded up to 0.25, figures 0.38-0.62 are rounded up to 0.5, figures 0.63-0.87 are rounded up to 0.75, and over 0.87 - to one. If several titles form 0.25, 0.5 or 0.75 positions (units) each, they may be combined by categories of personnel (employees, workers) under one of the combined titles with the performance of functions in all the combined positions (professions).
Appendix No. 2
Staffing standards for employees of centralized accounting departments at state and municipal healthcare institutions
(approved by order of the Ministry of Health of the Russian Federation of June 9, 2003 N 230)
1. The position of the chief accountant is established in each accounting department.
2. The positions of deputy chief accountants are established in the accounting department, which relies on paragraphs. 4-8 of these staff standards:
- from 5 to 10 positions of accountants - 1 position;
- from 11 and above positions of accountants - 2 positions.
2.1. Additionally, the position of deputy chief accountant may be introduced at the expense of one of the positions of group leaders in centralized accounting departments with a total number of beds over 2100 and the number of medical positions over 420 in serviced institutions;
2.2. Additionally, the position of deputy chief accountant may be introduced in institutions that carry out tax and statistical accounting operations.
3. The position of the head of the accounting group is established for each functional group, which, according to paragraphs. 4-8 of these staff standards, at least 6 positions of accountants are required, instead of one of them.
4. The positions of accountants for accounting and costing of food products are established at the rate of 1 position for 300 beds in medical institutions with a bed fund, and places in orphanages.
5. The positions of accountants for accounting of material assets are established at the rate of 1 position for:
- 300 beds in medical institutions with bed capacity, and places in children's homes;
- 100 medical positions in institutions without beds.
6. The positions of accountants for settlements with workers and employees are established at the rate of 1 position per 200 full-time positions in the serviced institutions.
7. The positions of accountants in financial accounting are established at the rate of 1 position for:
- 750 beds;
-150 positions of doctors in serviced institutions. Additionally, the positions of accountants in financial accounting are established:
7.1. 1 position in the execution of cash transactions through the treasury system;
7.2. 1 position to work with funds: compulsory health insurance, pension and social development;
7.3. at the rate of 1 position per 1000 beds and 200 positions of doctors in serviced institutions operating in the system of compulsory health insurance;
7.4. 1 position in the service of blood transfusion stations assigned to groups III - IV and 2 positions - to groups I-II for the remuneration of managers;
7.5. at the rate of 1 position per 100 thousand visits per year in serviced ambulance stations;
7.6. 0.5 positions in the service of the centers of state sanitary and epidemiological supervision assigned to groups III - IV and 1 position to groups I - II for the remuneration of managers;
7.7. at the rate of 1 position for 60 medical positions in the service of the forensic medical examination bureau;
7.8. 0.5 positions in servicing dairy kitchens with a daily throughput of 1 to 5 thousand servings, 1 position - over 5 to 7 thousand servings and 1.5 positions - over 7 thousand servings.
8. The positions of accountants-auditors are established:
8.1. 1 position - when servicing less than 10 institutions with more than 300 beds (in total) and (or) 60 doctor positions (in total);
2 positions - at least 15 institutions with more than 750 beds (in total) and (or) 150 doctor positions (in total);
8.2. 1 position - when servicing ambulance stations with more than 100 thousand visits per year;
8.3. 1 position in the presence of centers of state sanitary and epidemiological surveillance with a population of more than 1 million people served;
8.4. 1 position in servicing blood transfusion stations with the amount of plasma harvested at least 10,000 liters per year or processing at least 40,000 liters of plasma per year;
8.5. 1 position in the service of the Bureau of Forensic Medical Examination with more than 60 medical positions.
9. The position of a senior cashier is established in the accounting department serving more than 1000 employees (individuals) instead of one cashier position, which is due under clause 10 of these staff standards.
10. The position of the cashier is established in each accounting department. When the accounting department directly conducts cash settlements with the population, additional positions of cashiers are established in its staff:
10.1. 0.5 positions in the presence of a dairy kitchen with a daily throughput of up to 2 thousand servings; 1 position - over 2 thousand servings;
10.2. 0.5 positions in the presence of a prosthetic department with the number of positions of orthopedic dentists 5 or more;
10.3. 0.5 positions in the presence of a blood transfusion department with a procurement of at least 2 thousand liters of blood from paid donors;
10.4. 0.5 positions in the presence of a department of preventive disinfection with a staff of 10 or more positions of medical disinfectors for paid work on preventive disinfection, disinfestation and deratization;
10.5. 1 position for other paid medical services.
11. The position of an economist for financial work is established:
11.1. at the rate of 1 position for 200 beds and 50 medical positions with the number of beds in serviced institutions over 300 (in total) and over 60 medical positions (in total);
11.2. at the rate of 1 position per 100,000 visits per year at ambulance stations;
11.3. at the rate of 1 position for 60 medical positions in the Bureau of Forensic Medical Examination;
11.4. 1 position in servicing the centers of state sanitary and epidemiological supervision and blood transfusion stations assigned to groups III-IV and 2 positions - to groups I-II for the remuneration of managers.
12. 0.5-1.0 the position of a typist is established in each accounting department.
Notes:
1. Economic maintenance of the centralized accounting department (cleaning and repair of premises, current monitoring of equipment and apparatus, etc.) is carried out by the personnel of the institution in which the centralized accounting department is organized.
The positions of employees and professions of workers of centralized accounting departments located in separate premises, as well as those employed in the technological process, are established according to the standards of the relevant employees provided for medical institutions.
2. Integer or 0.25, 0.5 and 0.75 positions (units) can be entered into the staff lists, when calculating them, the final figures less than 0.13 are discarded, the figures 0.13-0.37 are rounded up to 0.25, figures 0.38-0.62 are rounded up to 0.5, figures 0.63-0.87 are rounded up to 0.75, and over 0.87 - to one. If several titles form 0.25, 0.5 or 0.75 positions (units) each, they may be combined by categories of personnel (employees, workers) under one of the combined titles with the performance of functions in all the combined positions (professions).
3. The formation of functional groups and the determination of the number of accounting and accounting personnel in each group is determined by the chief accountant within the limits of the number of posts that are due to centralized accounting for these model states.
4. When calculating the positions of accountants-auditors, economists for financial work, the number of beds and the number of positions of outpatient doctors include the indicated indicators only for those institutions that are financed through centralized accounting.
Appendix No. 3
Staff standards of structural units (employees) specially authorized to solve problems in the field of civil defense, state and municipal health care institutions (approved by order of the Ministry of Health of June 9, 2003 N 230)
|
Number of employees in the healthcare facility |
Job titles |
|
| Up to 500 people | 1 position of Deputy Chief Physician (Director, Head, Head) for the Medical Department (for mobilization work and civil defense) | |
| From 500 to 2000 people | 1 position of Deputy Chief Physician (Director, Head, Head) for the medical department (for mobilization work and civil defense); 1-2 positions of civil defense specialists | |
| From 2000 to 5000 people | 1 position of Deputy Chief Physician (Director, Head, Head) for the medical department (for mobilization work and civil defense); 2-3 positions of civil defense specialists | |
| Over 5000 people | 1 position of Deputy Chief Physician (Director, Head, Head) for the Medical Department (for mobilization work and civil defense); 4-5 positions of civil defense specialists |
In institutions, organizations and enterprises that are not classified as civil defense, with the number of employees over 200 people, 1 position of deputy chief physician (director, head, head) for the medical unit (for mobilization work and civil defense) is introduced.
Notes:
1. When determining the number of employees in structural subdivisions for mobilization work and civil defense (individual employees as part of other subdivisions) in organizations with hospitals, the number of patients being treated (according to the number of estimated beds) is taken into account.
2. In medical institutions that have departments for non-transportable patients for a special period, instead of the position of a civil defense specialist, the position of head of the department may be introduced.
The positions of specialists of paraclinical units are established in the presence of appropriate medical equipment and technology, depending on the amount of work performed and the current estimated time norms according to the tariff set of services, but at least 1 position per shift for healthcare organizations providing inpatient care, in accordance with Appendix 5 to these Model States and staffing standards of healthcare organizations.
When calculating the required number of specialists, it should be taken into account that the working time utilization rate is 0.85 for urban and 0.75 for rural medical organizations.
The position of the head is established instead of one position of the doctor of the paraclinic department.
The position of a senior paramedic (nurse, laboratory assistant) is established according to the position of the head instead of one position of a paramedic (nurse, laboratory assistant).
^
§ 10. Staffing standards of the department of radiation diagnostics
The positions of X-ray laboratory assistants are established according to the positions of radiologists.
The positions of medical registrars for the x-ray archive (computer x-ray archive) are established at the rate of 1 position per shift for hospitals and 1 position per polyclinic.
The positions of nurses of the X-ray department (office) are established in accordance with the positions of doctors.
The positions of radiologists are established at the rate of 1 position per 60 thousand of the population attached for preventive fluorographic examination of the chest organs.
The positions of X-ray laboratory assistants are established at the rate of 1 position per 30 thousand of the population attached for preventive fluorographic examination of the chest organs.
The positions of medical registrars are established at the rate of 1 position per 30,000 population. In areas with a population of 15 thousand people, 0.5 positions of an X-ray laboratory assistant are provided.
On mobile units, the staff is provided: 1 radiologist, 1 x-ray laboratory assistant, 1 driver.
Positions of X-ray laboratory assistants for computed tomography are established at the rate of 2 positions of X-ray laboratory assistant per shift.
The position of a procedural nurse is established at the rate of 0.5 positions per CT scan room per shift.
The positions of nurses in the CT room are set at the rate of 0.5 positions per CT room per shift.
The positions of computed tomography engineers are established at the rate of 1 position for two or more installations and equipment per shift.
The positions of an anesthetist nurse are established according to the positions of anesthesiologists.
Complex angiographic and X-ray television equipment is serviced by a specialist - engineer: 1 engineer position for two or more installations and equipment.
The number of X-ray surgical interventions cannot exceed 4 per week.
The calculation norms of studies include the time for preparatory work, the study itself or medical intervention.
^
§ 11. Staffing standards of the department of ultrasound diagnostics
The positions of a nurse are established according to the positions of ultrasound diagnostic doctors, including the position of the head.
The positions of nurses are established at the rate of 0.5 positions per one position of an ultrasound diagnostics doctor, including the position of a head, but not less than 1 position.
Engineering support of the equipment of departments (rooms) of radiation diagnostics is carried out by personnel in accordance with the staff of managers, specialists, employees and workers of healthcare organizations.
^
§ 12. Staff standards of the laboratory of radioisotope diagnostics
The estimated time norms include the time for the direct conduct of the study, for preparatory and final work, documentation and other activities related to the direct conduct of the study, including the processing of information on a computer.
Engineering support of radiodiagnostic (radiometric) installations of radioisotope diagnostics laboratories is carried out by the personnel of the radiological department, and in the case of organizing a laboratory in an organization that does not have a radiological department, by personnel whose positions are provided for in the standard staffing of administrative and managerial and housekeeping personnel of a healthcare organization.
The positions of nurses are established at the rate of 0.5 positions per one position of a radiologist, including the position of the head, but not less than 1 position.
^
§ 13. Staff standards of the clinical diagnostic laboratory
The positions of laboratory nurses are established at the rate of 1 position for 4 positions of laboratory doctors, paramedical laboratory assistants and laboratory assistants. In the staff of the laboratory where the mediation is carried out, additional positions of nurses are established depending on the amount of work.
^
§ 14. Staff standards for immunological and serological laboratories
Positions of laboratory doctors are established at the rate of 1 position for every 150 sera tested per working day, but not less than 1 position per laboratory.
Positions of laboratory assistants are established at the rate of 1 position for every 75 sera tested per working day.
The positions of the staff of immunological and serological laboratories as part of clinical diagnostic laboratories are adjusted based on the time standards for performing studies.
^
§ 15. Regular standards of a bacteriological laboratory
The positions of the staff of bacteriological laboratories as part of clinical diagnostic laboratories are established based on the amount of work and time standards for performing research according to the tariff for services. In the absence of time standards, staff positions (1 bacteriologist, 2 paramedics, 1 nurse for media preparation in self-preparation of media, 1 cleaning nurse) are established at the rate of 1 brigade for 3334 analyzes per year.
^
§ 16. Regular standards of the cytological laboratory
The diagnostic work of clinical cytology includes all types of cytological studies in a hospital, clinic, examination rooms, during preventive and diagnostic examinations of the population with the establishment of a morphological diagnosis.
In the absence of established standards for conducting research (according to the tariff for services), the following standards are established:
when conducting preventive examinations for 40,000 cytological studies per year, the positions of doctors, cytotechnicians and orderlies are established at the rate of one doctor, 3 cytotechnicians and 1 orderly;
for diagnostic studies, the standards are set at the rate of 4,000 studies per year per team: 1 post of doctor, 1 post of cytotechnician and 1 nurse;
for hormonal studies (determination of the hormonal profile by vaginal smears, the study of sex chromatin), the standards are set at the rate of 2500 studies per year for a team of 1 doctor, 1 cytotechnician, 1 orderly;
if a cytologist makes a set of material, then his load is 10 punctures per day, 2300 studies per year per rate;
with an increase in the load of cytological laboratories, the staff is increased due to the rates of the serviced healthcare organizations;
if there are 6 or more positions of doctors and cytotechnicians in the staff of cytological laboratories, the heads of the laboratory are exempted by 0.5 rates from performing the work of a doctor, 12 or more positions - completely from the direct technical performance of the work of a doctor;
taking into account the structure, volume and nature of the work of the cytological laboratory, if there are at least 15 positions of doctors, laboratory assistants (cytotechnologists) and orderlies in the state, the positions of a released senior laboratory assistant, medical registrar and housewife are introduced in the existing positions;
if there are special electronic installations in the cytological laboratory (electronic computer, complex optical devices with electronic equipment - a microscope, etc.), the position of an engineer is included in its staffing table.
^
§ 17. Staff standards of the endoscopy department
To perform endoscopic operations, the following standards are established:
Hemicolectomy, gastric resection, gastrectomy 360 minutes per operation;
On the organs of the chest cavity 360 minutes for the operation;
On the pelvic organs 210 minutes per operation;
Retroperitoneal space 210 minutes per operation;
Mediastinum 210 minutes per operation;
Skulls 210 minutes per operation.
Estimated time limits for endoscopic operations are intended for endoscopists performing these surgical interventions.
The positions of nurses are established according to the positions of doctors - endoscopists, including the position of head of the endoscopic department.
The positions of nurses are established at the rate of 0.5 positions for 1 position of an endoscopist, including the position of the head of the endoscopic department, but not less than 1 position.
^
§ 18. Staff standards of the department of physiotherapy and exercise therapy
Positions of physiotherapy nurses are established at the rate of 1 position per 10,000 conditional physiotherapeutic units per year.
The positions of massage nurses are established in the staff of the physiotherapy department (office) from the standards for massage.
Positions of instructors in physical therapy are established at the rate of 1 position for 150 beds and an additional 1 position for every 20 beds for patients with polio; 0.5-1 position for each orthopedic, traumatological, neurological, tuberculosis department for patients with osteoarticular tuberculosis.
The positions of nurses in the physiotherapy department (office) are established at the rate of 1 position for 2 positions of physiotherapy nurses, exercise therapy instructors and massage therapists, and when conducting water-mud-peat-ozocerite-paraffin treatment - for 1 position of a nurse engaged in vacation of these procedures.
For one conditional physiotherapeutic unit, work is taken, the execution and preparation of which takes 8 minutes.
One massage unit is considered to be a work lasting 10 minutes (taking into account the preparatory and final time, the need for documentation and a short rest).
^
§ 19. Staffing standards for the staff of the department (office) of functional diagnostics
The positions of nurses in the functional diagnostics office are established in accordance with the positions of functional diagnostics doctors, but not less than 1 position in the presence of the specified office.
The positions of nurses of the department (office) are established according to the positions of doctors of functional diagnostics, but not less than 1 position in the presence of the specified office.
The estimated load rate for a doctor and nurse of the department (office) of functional diagnostics is calculated from the standard of 33 conventional units for a 6.5 hour working day (1 unit - 10 minutes).
^
§ 20. Regular standards of the pathoanatomical department
Positions of laboratory assistants are established at the rate of 1.5 positions for each position of a pathologist.
The positions of orderlies of the histological laboratory are established at the rate of 1 position for each position of a pathologist, but not less than one position per department.
The positions of orderlies of the mortuary are established 1 position for each position of a pathologist, but not less than one position for the department.
If it is necessary to receive deceased patients during the day from other medical organizations, positions of nurses may be additionally established to ensure the specified work in the evening and at night, on generally established weekends and holidays.
^
§ 21. Staff standards of the pharmacy of healthcare organizations
Pharmacy staff positions are established in healthcare organizations with 100 or more beds.
The position of the head of the pharmacy - pharmacist is established in the pharmacy of each hospital (as the head of the hospital department).
The position of deputy head of a pharmacy - pharmacist is established in pharmacies of hospitals with 400 or more beds (as a deputy head of a hospital department).
The positions of pharmacists-technologists are established in:
Hospital pharmacies with more than 200 beds - 1 additional post for every next 100 beds;
Pharmacies of hospitals with 500 beds or more - an additional 0.5 posts for every next 100 beds.
The positions of pharmacists-analysts are established in the pharmacies of hospitals:
From 200 to 500 beds - 1 position;
Over 500 beds - an additional 0.5 posts for every next 200 beds, but not more than 2.
The positions of pharmacists are established in the pharmacies of hospitals based on:
Additional 1 post for every 100 beds (in hospitals from 200 to 500 beds);
Additional 0.5 posts for every 100 beds in hospitals over 500).
Positions of packers in pharmacies of hospitals are established on the basis of:
Additional 0.5 posts for every 100 beds (over 200).
The position of a nurse is established in the amount of 40% of the total staff of pharmacists-technologists and pharmacists, but not less than 1 position.
The position of the worker is established in the pharmacy of each hospital.
The office cleaner position is established in the pharmacy of each hospital.
In pharmacies of hospitals that do not have pharmacists-technologists and pharmacists on staff due to the small hospital bed capacity, their duties are performed by the head of the pharmacy.
In the case of a hospital being serviced by an interhospital pharmacy, in the state of the hospital for 200 or more beds, 1 position of a pharmacist-technologist or pharmacist is established.
In the pharmacies of infectious diseases hospitals, an additional 1 position of a cleaning nurse for every 200 beds is established.
^
§ 22. Staffing standards for emergency departments (air ambulance)
The positions of the personnel of the department of emergency and planned advisory assistance are established according to the following staffing standards:
head of the department - general practitioner - 1 position;
doctors to provide emergency care to the adult population at the rate of 0.8 positions (in total) per 100,000 population;
paramedic - 6 positions;
nurse - 2 positions.
^
§ 23. Staffing standards for organizational and methodological departments and medical statistics offices
The positions of personnel of organizational and methodological departments are established depending on the population, according to the following standards: for up to 1 million people, 2 positions of a methodologist, 2 positions of a paramedic, over 1 million people - 3 positions of a methodologist, 3 positions of a paramedic, over 1.5 million people - 3.5 positions of a methodologist, 3.5 positions of a paramedic.
^
§ 24. Cabinet of medical statistics
The position of a medical statistician is set for 36-50 retired patients per day, but not less than one position per hospital.
The position of a medical statistician is established for 2 positions of medical statisticians, but not less than one position.
The position of the head of the medical statistics office is established in each hospital.
§ 25. Teaching staff of medical organizations for children
The positions of educators are established at the rate of 1 position for:
25 children of preschool age in anti-tuberculosis departments for patients with osteoarticular tuberculosis.
The positions of teachers are established in the staff of anti-tuberculosis hospitals (dispensaries), specialized sanatorium-improving and rehabilitation organizations (centers) depending on the number of classes and the curriculum.
The classes provide for at least 4 and no more than 20 students. If there are not enough contingents of children to complete the classes, group classes for students can be organized.
Teacher positions are established by the staff of TB hospitals, depending on the number of classes for children with TB and the curriculum. Classes must have at least 10 and no more than 20 students. If there are not enough contingents of children with tuberculosis, group classes for students can be organized to complete the class.
The position of the head of the educational unit is established at the rate of 1 position.
In the hospital for 200 beds, 1 position of a psychologist is established.
The positions of speech therapists are established according to the standards of speech therapy rooms.
§ 26 Other positions
The position of deputy chief physician for medical affairs is established in a hospital with 250 or more beds.
The position of deputy chief physician for obstetric and gynecological care is established in a hospital with over 200 obstetric and gynecological beds.
The position of Deputy Chief Physician for Surgical Care may be established in a hospital with at least 200 surgical beds. At the same time, obstetric and gynecological beds are included in the number of beds in the surgical cycle if the position of the deputy chief physician for obstetric and gynecological care is not established in the hospital staff.
The position of deputy chief physician for organizational and methodological work is established 1 unit per hospital (hospital, clinic, dispensary).
The position of chief nurse or deputy head of nursing is established in each hospital.
The position of the archive registrar is established by 1 position for 200 beds, at least 1 position for a hospital (hospital, clinic, dispensary).
The current stage of development of labor rationing in healthcare is characterized by two opposite trends:
- at the intersectoral level, a number of decisions are made aimed at creating a system of labor rationing, including in healthcare institutions; in one of the research institutes of the Ministry of Health of Russia, a division for the regulation of the work of medical workers was opened;
- The Ministry of Health of Russia approves legal documents on labor that contain a lot of erroneous provisions that are both editorial and semantic in nature and do not correspond to the theory and practice of labor rationing.
1. Organizational technologies of labor rationing
As positive measures to create a labor rationing system, one should recognize the approval of the Orders of the Ministry of Labor of Russia: dated May 31, 2013 No. 235 “On approval of guidelines for federal executive authorities on the development of standard industry labor standards” and dated September 30, 2013 No. 504 “On approval of methodological recommendations on the development of labor rationing systems in state (municipal) institutions”.
Order No. 235 contains:
- conditions and terms for the revision of standard industry labor standards;
- normative factors;
- methods of labor rationing;
- labor intensity;
- stages of normative research work.
The appendix to the order provides statistical tools for the development of standard industry labor standards.
The main provisions of the order coincide with the methodological materials on labor rationing in the healthcare sector [ Shipova V.M. Fundamentals of labor rationing in health care (textbook) Edited by Academician of the Russian Academy of Medical Sciences O P. Shchepin: - M .: GRANT Publishing House, 1998. - 320 p.; Labor rationing in health care, lectures No. 1-No. 10 M .: RIO FGBU "TsNIIOIZ", 2013-2017. ]. However, when applying Order No. 235, the specifics of the work of medical workers should be taken into account. Recently, there has been an increased interest of the heads of medical organizations in the development of local labor standards, including timing. In the process of timing, an examination of the volume and quality of work is carried out, an assessment of the compliance of medical and diagnostic measures with the diagnosis and state of health of the patient, and medical prescriptions. This work can only be carried out by an appropriate specialist who knows the technology of the diagnostic and treatment process well. It is a mistake to involve economists, personnel department employees, commissions in timing the activities of medical workers, since, firstly, these workers not only cannot conduct an expert assessment, but even accurately determine the name of the labor operation, and, secondly, the presence of persons who do not have a medical education is unacceptable when contacting a medical worker and a patient.
Order No. 504 defines the types of labor standards and establishes a connection between them. These provisions are of great importance to healthcare organizers and to all healthcare professionals. The fact is that the issues of labor rationing are still not included in the program of diploma and postgraduate training of doctors and paramedical workers, these issues are not considered in textbooks on public health.
Order No. 504 contains certain innovations in organizational technologies for labor rationing. The document provides recommendations for state (municipal) institutions on the development of the Regulations on the labor rationing system, which is either approved by the local regulatory act of the institution, taking into account the opinion of the representative body of workers, or included as a separate section in the collective agreement.
- labor standards applied in the institution;
- the procedure for implementing labor standards;
- the procedure for organizing the replacement and revision of labor standards;
- measures aimed at compliance with established labor standards.
The most important for medical organizations, taking into account the existing regulatory framework for labor in the field of healthcare, is the first section, in the annexes to which the following data is indicated:
- references to standard labor standards used in determining labor standards;
- the applied methods for determining the population rate based on the typical time rate, the number rate based on the typical service rate and the service rate based on the typical time rate (if calculations were made);
- calculation of the correction of standard labor standards, taking into account the organizational and technical conditions for the implementation of technological (labor) processes in the institution (if a correction was carried out);
- methods and means of establishing labor standards for individual positions (professions of workers), types of work (functions) for which there are no standard labor standards.
Order No. 504 also defines the circle of persons who should be involved in the development of a labor rationing system in an institution.
Taking into account the number of employees and the specifics of the activities of the institution for the performance of work related to labor rationing, it is recommended to create a specialized structural unit (service) for labor rationing in the institution. In its absence, the performance of work related to the regulation of labor may be entrusted to a structural unit (employee), which is in charge of staffing the activities of the institution, organization of labor and wages.
The implementation of these recommendations in medical organizations should be addressed, in our opinion, as follows. Taking into account the fact that medical workers do not possess, as indicated, the necessary knowledge and skills in labor rationing, the deputy chief physician for economic issues should be responsible for organizing labor rationing in medical organizations. In the absence of this position, the organization of labor rationing can be entrusted to the personnel department, accounting staff, while it should be emphasized that it is organization regulation of labor.
The direct development and establishment of labor standards on the basis of standard norms approved at the federal level, or in the absence of such, is carried out by the heads of structural medical and diagnostic units, chief and senior nurses, taking into account the specifics of the specific conditions of labor organization.
2. Analysis of the modern regulatory framework for labor in the healthcare sector
The labor standards of medical workers have been set out in recent years in the following departmental legal documents:
- orders of the Ministry of Health of Russia on the procedures for the provision of medical care;
- letters from the Ministry of Health of Russia on the formation and economic justification of the territorial program of state guarantees of free provision of medical care to citizens for the corresponding financial year and planning period (hereinafter referred to as the territorial program);
- letters of the Ministry of Health of Russia, FFOMS "On methodological recommendations on how to pay for medical care at the expense of compulsory medical insurance" (labor standards for dentistry).
The mass approval of the orders of the Russian Ministry of Health on the procedures for providing medical care, of which the recommended staffing standards are an integral part, began in 2009 and, after a short break in 2014, continues to this day. To date, there are 67 orders. Unfortunately, the erroneous provisions of the labor standards given in these documents, as a rule, are not corrected during the revision, and in some cases new errors are added to them.
The systemic erroneous provisions of modern legal documents on labor are as follows.
2.1. Erroneous application of different types of labor standards
In health care, the following types of labor standards are used: norms of time, workload (service), number. The values of these indicators are presented in the methodological materials on labor rationing in health care and, as indicated, in Order No. 504 of the Ministry of Labor.
Time standards in health care are expressed in minutes, conventional units, conventional units of labor intensity (UUT), load (service) norms - in the number of visits per hour, year, patients per day, number of examinations, procedures per day, year or for any other period of time .
The size standards are presented in terms of the population or its contingents, the number of beds or round-the-clock posts per 1 medical position, the volume of a particular work.
In the orders for the procedures approved before 2012, the norms of time for visits in certain specialties were cited, erroneously called the norms of workload or workload. When reviewing such orders, these data are not indicated. However, in the current order for coloproctology (dated April 2, 2010 No. 206n), the time standards for a diagnostic and treatment appointment are given, called the load rate.
In the territorial programs, starting from 2008 and up to the present, a table is provided, the title of which indicates "the load indicator for 1 position of a doctor (middle medical worker)", and the content of the table shows the number of beds per 1 medical position and the number of beds per 1 post of nurses, i.e. population standards.
2.2. Unjustified change in the format of presentation of labor standards
The standards for the number of personnel in health care institutions are determined by the staffing standards used for medical workers, and the standard staff used to standardize the work of employees and workers of a medical organization. The difference between these documents is that staffing standards are set based on some indicator, for example, at the rate of 1 position of a general practitioner for 25 beds. The vast majority of typical states do not require such a calculation, and one or another position is established on the basis of the presence or a certain capacity of an institution, unit, for example, the position of deputy chief physician for economic issues is established in a medical facility with 100 or more beds and including outpatient clinics. divisions.
The recommended staffing standards given in the Orders on Orders are modeled on standard staffing that do not provide for calculation and are used for non-medical personnel. With the transition to this new form of population norms, i.e. the use of model states instead of staff standards, the words so necessary for staff standards have also disappeared: “the position is established on the basis of ...”, which can lead to different workloads for medical workers with the same amount of work. For example, if the position of a doctor is set as “1 for 20 beds”, this leads to the fact that only one position can be established for 20 beds, and for 30, and for 35 beds, which obviously leads to a different workload for the doctor. If the position was established “based on 20 beds”, as is customary in staffing standards, then 1.5 positions can be installed for 30 beds (30: 20 = 1.5), and 1.75 positions for 35 beds ( 35:20=1.75).
Only in two orders (dated November 15, 2012 No. 923n "Procedure for the provision of medical care in the field of "neurosurgery"" and dated November 15, 2012 No. 918n "Procedure for the provision of medical care to patients with cardiovascular diseases") and only in hospital departments of the position of medical workers are established "at the rate of 30 beds".
2.3. Violations of the nomenclature of medical organizations, specialties and positions of medical workers, hospital beds
Currently, the following legal documents on nomenclatures are in force:
- Order of the Ministry of Health of Russia dated 08/06/2013 No. 529n "Nomenclature of medical organizations";
- Order of the Ministry of Health of Russia dated 07.10.2015 No. 700n "Nomenclature of specialties of specialists with higher medical and pharmaceutical education" with additions made by order of the Ministry of Health of Russia dated 11.10.2016 No. 771n;
- Order of the Ministry of Health and Social Development of the Russian Federation dated April 16, 2008 No. 176n with subsequent additions “Nomenclature of specialties for specialists with secondary medical and pharmaceutical education in the healthcare sector of the Russian Federation”;
- Order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n “Nomenclature of positions of medical and pharmaceutical workers”;
- Order of the Ministry of Health of Russia dated 08.10.2015 No. 707n “Qualification requirements for medical and pharmaceutical workers with higher education in the direction of training “Health care and medical sciences””;
- Order of the Ministry of Health of Russia dated 10.02. 2016 No. 83n "Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education";
- Order of the Ministry of Health and Social Development of the Russian Federation of May 17, 2012 No. 555n "Nomenclature of the bed fund according to the profiles of medical care."
Compliance with these nomenclatures is mandatory for medical organizations. Incorrect names of positions and specialties in the staffing tables of medical organizations lead to complications in the provision of pensions for employees, the establishment of a work and rest regime, wages, and so on. Moreover, such violations are unacceptable in legal documents. However, in almost every order on orders there are names of positions and specialties that do not correspond to the current nomenclatures. So, for example, in orders on orders, the positions of a gynecologist are given instead of the position of an obstetrician-gynecologist, a dermatologist instead of a dermatovenereologist, a traumatologist instead of an orthopedic traumatologist, a neuropathologist instead of a neurologist, a laboratory assistant instead of a clinical laboratory diagnostics doctor, a ward nurse instead of a ward nurse (guard), a bacteriologist instead of a bacteriologist, a massage therapist instead of a massage nurse, etc., as well as positions that are not in the nomenclature, for example, a microbiologist, a senior laboratory assistant, a senior radiologist, etc.
When applying orders on the nomenclature, one should keep in mind a number of existing contradictions between the nomenclature of positions, the nomenclature of specialties and qualification requirements. A number of medical positions indicated in the nomenclature of positions are not included in the nomenclature of specialties. These positions include: a diabetes doctor, a medical prevention doctor, a clinical mycologist, a laboratory mycologist, a palliative care doctor, a medical rehabilitation doctor. These positions are also absent in order No. 707n on qualification requirements, although for most of these positions there are labor standards defined in the relevant orders on procedures.
The order of the Ministry of Health of Russia dated October 11, 2016 No. 771n made its "mite" to the incompatibility of orders on the nomenclature of specialties, positions and qualification requirements, which included a number of specialties as an addition to the nomenclature of specialties of specialists with higher medical and pharmaceutical education.
These changes in the nomenclature of specialties are not accompanied by changes in either the nomenclature of positions or in the document on qualification requirements.
2.4. Erroneous data on the number of posts to ensure round-the-clock work
The organization of the activities of medical organizations involves different modes of operation of units and relevant positions for their functioning. So, for example, an ambulance station (department) operates around the clock; in a hospital to ensure round-the-clock provision of medical and diagnostic medical care, round-the-clock posts of middle and junior medical workers, a number of positions of doctors are established. The orders on procedures indicate the specific number of posts to ensure round-the-clock work: from 1 to 5.7 posts.
The number of posts to ensure round-the-clock work depends on two main groups of data:
- the number of working days and pre-holiday days in a year in which there are reductions in working hours;
- mode of work and rest positions.
The number of working and pre-holiday days in which there is a reduction in working hours changes annually.
The regime of work and rest differs not only in the names of positions, but even in the same position, but working in medical organizations in different regions of the country, for example, in an institution in the Central Strip of Russia and in the regions of the Far North due to different vacation duration.
Therefore, it is not a different number of posts to ensure round-the-clock work, specified in orders on procedures, that is erroneous, but the very indication in the normative record of this number of posts. The normative record on the staffing of round-the-clock work should contain only the number of beds for organizing this mode of operation, or a certain amount of work, for example, the number of emergency calls and, consequently, the number of teams. The specific number of positions must be calculated in a medical organization annually, depending on the mode of work and rest of the position and the number of working and pre-holiday days in the year in which the reduction of working time occurs.
2.5. Unreasonable introduction of new indicators for labor rationing
When choosing an indicator for labor rationing, the following requirements must be observed:
- taking into account the current level of development and organization of medical care, labor organization, equipment, compliance with the relevant technologies of the treatment and diagnostic process;
- compliance with the degree of integration of the indicator to the conditions and nature of the work of a particular type of institution, ensuring the necessary accuracy in setting staffing standards; the influence of the main norm-forming factors and the need to take them into account in the normative indicator;
- coverage of the most common options for performing work, convenience for calculating staffing standards;
- the specific content of normative indicators, the possibility of establishing their quantitative value.
The following indicators meet these requirements:
- the number of the population or its individual contingents to establish the positions of outpatient doctors;
- the number of beds to establish the positions of medical workers in hospitals;
- the number of outpatient doctors and the number of beds or the amount of work to establish the positions of medical personnel of the auxiliary medical diagnostic service, most of the positions of middle and junior medical workers.
An unreasonable change in these indicators for the normalization of labor in the absence of their value fixed by statistics makes these data very manageable and leads to the possibility of an unjustified increase or decrease in the number of employees. An example of the erroneous introduction of a new labor indicator is the establishment in orders of orders of the position of an anesthesiologist-resuscitator for the number of workplaces of operating tables.
It is quite obvious that the number of workplaces, operating tables does not indicate the volume of work of the personnel, in this case it is necessary to determine at least the number of surgical interventions on one operating table, or the hours of operation of the operating table, and so on. According to earlier orders of the USSR Ministry of Health, the standard number of these doctors was set to the number of surgical beds, and, in our opinion, there are no grounds for changing this indicator.
Another example of changing the indicator for labor rationing is to establish the standard number of nurse positions per office. In fact, the number of offices, as premises for the work of a doctor, is not in the statistics, and the indicator for the standard for the number of positions of a nurse should be the number of positions of a doctor of a particular specialty.
Another "novelty" of orders on orders is the change in the normative indicator for the position of chief physician, head of the department. Thus, the number of these positions in the children's polyclinic, according to the relevant order (dated April 16, 2012 No. 363n), is set for 10 thousand attached population. If we follow the "letter" of this order, then in a children's polyclinic serving 20,000 children, it is possible to establish 2 positions of chief physician, and 30,000 - 3 chief physicians, which is contrary to public health practice.
2.6. Lack of regulatory support for a number of departments of healthcare facilities, individual positions
In a number of modern legal documents, positions or entire divisions are “missing”. Thus, the order on the order in the inpatient department of traumatology and orthopedics (dated March 31, 2010 No. 201n) did not provide for the positions of a dressing and operating room nurse. When this document was revised (No. 901n dated November 12, 2012), the position of a dressing nurse was introduced into the structure of this unit, and the position of an operating room nurse is still missing. In the staffing standards of the dermatovenerologic dispensary, there is no staffing of medical workers in the admissions department, in the staffing standards of the children's polyclinic - the security of the registry, etc.
2.7. Erroneous wording of the standard for the position of the head of the department
In the staff list of a medical organization, the position of the head can be established only in the form of one position, although the procedure for establishing this position may be different: instead of the whole or part of the position of a doctor or in addition to medical positions. At the same time, the position of the head in outpatient departments is established by the number of positions of outpatient doctors of the corresponding specialty, in hospital departments - by the number of beds. In orders on orders, in some cases it is recommended to establish a fractional number of posts: 0.25; 0.5 or 0.75 posts.
The position of the head of the hospital department in a number of cases is established, as indicated, "based on 30 beds." Such a record is quite acceptable for most positions, but these positions include the head of the department. At the same time, the question of the number of positions of managers in a department of a different capacity, for example, in a department with 45 or 50 beds, remains open. Following the specified standard, in a department with 45 beds, 1.5 positions of the head can be established (45:30 = 1.5), and in a department with 50 beds - 1.75 (50:30 = 1.667, rounded 1.75). Thus, the presented establishment of the positions of heads of departments is contrary to public health practice.
2.8. Inconsistency in the values of labor standards in different, simultaneously valid documents
In simultaneously acting orders on orders, a different standard is indicated for the same position. For example, the position of a surgeon, according to one of the orders, is set as 1 position per 10.0 thousand of the adult population, according to another - 0.65 positions. It is quite characteristic that both of these orders were approved in 2012 and entered into force almost simultaneously - in November-December 2012. The standard for the position of a pediatric urologist-andrologist has a two-fold difference: according to one of the orders on orders, this position is set for 10.0 thousand of the attached child population, according to another - for 20.0 thousand.
In addition to orders on orders, labor standards are also indicated in territorial programs, while for a number of profiles there is a discrepancy between these values and orders on orders. So, for otorhinolaryngology, according to the territorial program for 2016, a standard is set equal to 12 beds per 1 doctor's position, and according to the order on order - for 20 beds, for nephrology - for 12 and 15 beds, respectively, and so on.
There are no coincidences indicated in the territorial program and in the orders of the Ministry of Health, in terms of the standard labor costs for a visit: according to the order approved in mid-2015, the following typical time standards for a visit were established: for a district general practitioner - 15 minutes, for a general practitioner (family doctor) - 18 min. The territorial program for 2016 states the following: “The recommended time limit for 1 visit to a district therapist, general practitioner, district pediatrician is an average of 20 minutes.”
Such conflicting data on the value of standard labor indicators specified in simultaneously valid legal documents approved by the same department require urgent action at the federal level of health management.
2.9. Recommendations for the use of one indicator out of several given in the standard
In staff standards, the establishment of a particular position is possible for several indicators. In these cases, the number of posts is calculated for each indicator, and then the calculated number of posts is summed up. In the orders on procedures approved in 2016 (dated March 1, 2016 No. 134n, dated March 24, 2016 No. 179n), the union "or" is included in the normative entry. This union is used in Russian to connect two or more sentences, as well as homogeneous members of a sentence that exclude each other. Thus, the normative record with the union "or" suggests that you need to choose only one of the given indicators. However, the logic and practice of applying labor standards suggests that if a position in one of the medical organizations is set for one of the indicated indicators, for example, in one of the medical and physical education dispensaries for the number of people involved in sports, and in another - for another indicator, for example, on the urban population living on the territory of the dispensary, this will lead to a different standard number of positions that does not reflect the full scope of work and the load on servicing all the contingents of the population and athletes indicated in the document.
2.10. Economic groundlessness of new labor standards
All the shortcomings of regulatory documents indicated in the previous paragraphs can be considered as editorial, although they are unacceptable in documents of this kind. If desired, erroneous provisions can be corrected: you can introduce a calculation method for the formation of labor standards, bring the names of positions and specialties into line with the nomenclatures, change the normative records for establishing the positions of heads of departments, set the required indicator for round-the-clock work, eliminate contradictions in simultaneously acting normative and legal documents and so on.
The medical and economic assessment of modern labor standards was carried out according to the methodology of labor rationing in healthcare. Within the framework of this publication, it is not possible to describe all the methodological approaches used, they are presented in sufficient detail in the relevant literature and are used in medical organizations in the economic analysis of the activities of medical workers and departments.
Carrying out calculations of the normative number of medical positions only according to orders approved over the past two years (except order No. 134n), showed that over 30 thousand additional positions are needed for their implementation, including the need to increase the positions of narcologists by more than 3 times compared to their actual number, geriatricians - 10 times and so on. Moreover, the calculations were carried out only on those indicators that have statistical security.
A striking example of the economic unreasonability of labor standards is Order No. 134n “On approval of the procedure for organizing the provision of medical care to persons involved in physical culture and sports (including the preparation and conduct of physical culture and sports events), including the procedure for medical examination of persons wishing to undergo sports training , engage in physical culture and sports in organizations and (or) fulfill the test standards (tests) of the All-Russian Physical Culture and Sports Complex "Ready for Labor and Defense"".
If, when calculating the normative number of medical positions, only one indicator is used: the number of people involved in sports and health clubs, organizations and groups, which is currently 39071.4 thousand people [ Healthcare in Russia, 2015: Stat. Collection / Rosstat. - M., 2015. - 174 p.], i.e., contrary to common sense, to use the word “or” indicated in the regulatory record, it turns out that in order to implement only this provision of the order, the number of medical positions is required that exceeds the actual number of all doctors in the country. For comparison, we note that the previous order (dated August 9, 2010 No. 613n) established the standard number of doctors in sports medicine and physiotherapy equal to more than 25 thousand positions, and the actual number of these doctors is 3.9 thousand positions. Moreover, these positions include not only doctors working in medical and physical education dispensaries, but also in hospitals, sanatoriums, and clinics. Under these conditions, with such a lack of staff standards of the current order, the very decision to revise the regulatory document is erroneous.
With regard to the standard number of middle and junior medical workers, a different trend is revealed: a decrease in the number of average medical personnel and the disappearance of the standard for the number of junior medical workers. In accordance with the new order (dated 05.05.2016 No. 279n), the standard for the positions of paramedical workers in sanatorium-resort organizations has been reduced tenfold compared to the previously existing ones, and the standard for the position of a ward nurse (according to the nomenclature in force during the period of approval of this standard) or the standard for junior there is no nurse to care for the sick (according to the current nomenclature) at all.
The introduction of order No. 279n of the Ministry of Health of Russia into healthcare practice does not allow organizing the work of a sanatorium for children with less than 250 beds and a sanatorium for adults with less than 500 beds, primarily because of such a reduction in the standard number of middle and junior medical workers and the impossibility of their round-the-clock work. In sanatoriums of greater capacity, the reduction in the number of round-the-clock posts of ward nurses (guards) and the complete lack of standard provision of junior medical workers will lead to significant difficulties in organizing the provision of medical care.
There are no standards for the positions of orderlies in the recommended staffing standards for the department (office) of medical prevention for adults (dated September 30, 2015 No. 683n), the audiology room (dated April 9, 2015 No. 178n), the geriatric department and the geriatric office (order No. 38 dated January 29, 2016). ) etc.
The reduction in the actual number of junior medical personnel in medical organizations is due to an attempt in this way to fulfill the May 2012 decrees of the President of Russia. In medical organizations, the positions of nurses are being transferred to the positions of cleaners, i.e., these positions are being excluded from the number of medical workers, and for several months of 2016, according to Rosstat, about 50 thousand nurses quit [ Chief Nurse, 2016. - No. 10. - P.8.]. It should be noted that such a transfer is not always justified, since in a number of cases the nurse performs not only the functions of a cleaner, but also takes part in providing medical care to the patient to a certain extent, i.e., performs the functions of a junior nurse to care for the sick, especially in the provision of hospital and sanatorium care. But in this case, we are talking about the standard provision of junior medical personnel, and in order to transfer the positions of nurses to the positions of cleaners, it is necessary to have a standard for the position of a nurse. In this regard, we consider it erroneous to exclude the positions of junior medical personnel from staff standards.
Conclusion
The current stage in the development of labor rationing can be viewed as a transition to the creation of a system of labor rationing. The measures taken to create this system are apparently not enough, since legal documents containing such obvious errors are still being approved.
The critical mass of erroneous provisions of orders on procedures in terms of labor standards, the main of which is economic unreasonableness, determines the need to revise these legal documents. In modern conditions of organizing labor rationing and functioning in one of the research institutes of the Ministry of Health of Russia, the labor rationing unit, all documents of this kind should be developed jointly with labor rationing specialists, or at least undergo an appropriate expert assessment before they are approved. Such work is partially carried out, but, in our opinion, it should be extended to all draft legal documents on labor standards.
In order to improve the development of labor standards, it is necessary to include labor rationing issues in the training program for doctors and paramedical personnel and postgraduate training in the specialty "Organization of health care and public health", "Organization of nursing", holding seminars, lectures on this topic, and, first turn, for the developers of labor standards and specialists who approve these standards.
For chief physicians, heads of departments of medical organizations, representatives of ministries and departments in the field of healthcare: we suggest that you familiarize yourself with the program of the symposium, which will be held on August 21 - 25, 2017 "Management of a medical institution in modern conditions".
We invite you to take part in the International Conference for Private Clinics , where you will get the tools to create a positive image of your clinic, which will increase the demand for medical services and increase profits. Take the first step towards the development of your clinic.
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