The article presents the results of applying modern strategies for the development of inpatient care as part of the modernization of a federal specialized multidisciplinary clinic. Problems of healthcare development are discussed Russian Federation and possible ways to solve them at the level of medical institutions in order to improve the quality and accessibility of medical care. Current areas are the development of human resources, the introduction of modern medical and management technologies. The use of information and organizational technologies: the principle of a single doctor, the institute of freelance chief specialists, rotation of specialists, a quality management system, marketing and others - contributed to increasing the efficiency of using the clinic’s resources. An integrated approach to reforming a medical institution based on new medical, organizational, structural, and information technologies made it possible to meet the target performance indicators of health care institutions for 2018 ahead of schedule.

reforming a multidisciplinary clinic

health care management

health care organization

healthcare development strategies

1. The concept of long-term socio-economic development of the Russian Federation. Order of the Government of the Russian Federation of November 17, 2008 No. 1662–r. [Electronic resource]. – Access mode: http://goverment.consultant.ru/page.aspx?986081

2. Order of the Government of the Russian Federation of December 28, 2012 No. 2599-r On the action plan (“road map”) “Changes in sectors of the social sphere aimed at increasing the efficiency of healthcare” [Electronic resource]. – Access mode: http://government.consultant.ru/page.aspx?1648191

3. Siburina T.A. Healthcare development strategies implemented in the world / T.A. Siburina, O.S. Mishina // Social aspects of public health. – 2011. – No. 2 (18) [Electronic resource]. – Access mode: http://vestnik.madnet.ru/content/view/278/30/lang,ru

4. Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” dated November 21, 2011 No. 323-FZ / “Rossiyskaya Gazeta” – Federal Issue No. 5639 (263) – November 21, 2011

5. Federal Law “On Compulsory Health Insurance in the Russian Federation” dated November 29, 2010 No. 326-FZ. / “Rossiyskaya Gazeta” – Federal issue No. 5353 – December 3, 2010

6. Khabriev R.U., Vorobyov P.A., Yuryev A.S., Nikonov E.L., Avksentieva M.V. Indicators of service quality medical care(regional level) // Problems of standardization in healthcare. – 2005. – Issue. 10. – pp. 54-63.

Russian healthcare is going through a difficult period. In conditions of chronic underfunding, aging personnel, lack of professional standards The work of doctors is under the close attention of society and the demands on our industry are increasing many times over. Required terms are the quality of medical services provided and efficient use resources.

IN last years Our country is modernizing its healthcare system. Adopted federal laws and documents, such as: Concept of long-term socio-economic development of the Russian Federation, Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation”, Federal Law of November 21, 2011 No. 323- The Federal Law “On the fundamentals of protecting the health of citizens in the Russian Federation” is intended to legislatively ensure the rights of citizens to receive quality medical care.

The Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the FMBA of Russia (FSC FMBA of Russia) includes: research institutes, experimental laboratories, a multidisciplinary hospital with 810 beds, and a consultative and diagnostic center. The following was chosen as a global strategy for the development of a medical institution: the creation, based on systemic transformations, of a modern specialized scientific and practical complex that unites wide range inpatient, outpatient and emergency medical care with the formation of conditions for scientific and pedagogical activities on the development and implementation of new medical technologies through the intensive development of the diagnostic and treatment base, the introduction of organizational and management changes. Thus, the main goals of the planned strategic development of the Federal Scientific Research Center FMBA of Russia included:

1. Increasing the competitiveness of the institution by ensuring a high level of quality and accessibility of specialized medical care, the use of unique diagnostic and treatment technologies.
2. Providing the assigned contingent with types and volumes of medical care, developing high-tech types of medical care, expanding opportunities for servicing patients on a contractual basis.
3. Providing integrated medical care to patients in accordance with the principle of a “closed loop” and under a single professional leadership.
4. Innovative development of the institution.
5. Increasing the competence level of employees in professional and legal aspects.
6. Ensuring effective management of the medical and business activities of the institution based on the optimal development and rational use of resources, the introduction of modern management technologies.

Scheme 1. Strategies for modernizing the activities of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia for the period 2008-2011.

The implementation of the selected strategies was carried out on the basis of a systematic approach using the principles of strategic management, including the priority of selected areas, justification of mechanisms for solving problems, systematic resource provision, planned implementation of planned activities, the team principle of management, attracting and increasing the initiative of the entire team to rationalize the process of their own work, constant informing the team about the results of transformations, as well as providing external conditions for carrying out transformations based on strengthening interaction with governing bodies (FMBA), departmental enterprises, patients and funding organizations.

During the study, a structural reorganization of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia was carried out, including the following activities:

• While maintaining the total number of beds in the hospital (810), the structure of the bed fund was significantly changed (up to 10% per year) in accordance with the results of an analysis of the assessment of demand for various medical areas (analysis of waiting times for hospitalization, the structure of inpatients by nosology, a survey of medical and sanitary units and insurance companies), 19 new divisions were created, including a consultative and diagnostic center, an emergency department, a marketing service, legal department etc.
• The reorganization of the laboratory service, including the centralization of activities, re-equipment, optimization of the processes of collecting biological material, informatization of the process and documentation, made it possible to introduce 72 new laboratory techniques during the reform period; establish a research quality control system; increase the efficiency of equipment use; reduce the share of manual research methods from 90% to 30%; increase the volume of diagnostic studies by 1.52 times in 2011 compared to 2007.
• Increasing the availability of highly qualified assistance from specialized specialists and specialized outpatient treatment and diagnostic care was achieved by the creation of a consultative and diagnostic center (CDC), whose tasks also include the selection of patients for hospitalization, pre-hospital examination, pre-operative preparation, follow-up treatment of patients after hospital treatment, provision of medical preventive examinations and medical examinations of clinic staff, and performing in-depth medical examinations of athletes. As a result of the organization of the CDC, the volume of advisory assistance per year increased in 2011 compared to 2007 by 5.9 times, and the volume of diagnostic assistance to outpatients increased: laboratory tests - 1.9 times, radiological tests - 1.9 times , incl. according to CT - 1.7 times, according to MRI - 2.7 times, ultrasound - 1.6 times, endoscopic - 2.7 times.

As part of the optimization of personnel policy, the mechanisms of employee motivation related to the optimization of wages (the introduction of new system wages), providing social package, creating conditions for continuous training of personnel, stimulating professional growth. Indicators and coefficients of quantitative and qualitative criteria for incentive payments of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia have been developed and implemented.

One of the main directions of the research was the implementation of the strategy for developing the innovative potential of the institution, which included:

• introducing our own original developments, attracting new specialists to the institution who know new methods or are their developers, training our specialists, exchanging experience with the world's leading clinics, purchasing and mastering new equipment (193 new medical technologies were introduced in 2008-2011);
• provision of high-tech assistance in 13 profiles;
• participation in international clinical trials medicines, testing of medical equipment and consumables, which allowed to increase the number of new technologies introduced into clinical practice;
• holding scientific conferences, incl. international;
• Since 2010, the publication of its own journal “Clinical Practice”, dedicated to the description and analysis of cases of complex and rare diseases in patients treated in clinics of the Federal Medical and Biological Agency of Russia.

A set of measures to improve the efficiency of the management system when modernizing the clinic included the use of modern organizational technologies and optimization of the adoption process management decisions.

As organizational and management technologies, elements of a quality management system were introduced into the work of the institution, and a division was organized marketing activities, a system of rotation of specialists, changes were made to the organization of the work of the emergency department, to the operating hours of the hospital (transfer to round-the-clock operation), the organization of sanitary and epidemiological care, the drug supply system, and the KOTEM information system was created. The rotation of qualified specialists and unified management at the outpatient and inpatient stages made it possible from 2007 to 2012 to reduce the average length of a hospital bed-day by 30.6% and increase the number of outpatient consultations by 6.6 times.

The set of measures related to increasing the efficiency of the management system included the creation of a local regulatory framework that determines the work of the institution and departments, the use of modern organizational technologies, optimization of the management decision-making process, including using information technologies. The introduction of the COTEM medical information system into the practice of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia made it possible to automate the maintenance of electronic medical records; reduce the processing time of medical documentation and provide prompt access to medical information patients and medical staff; carry out full-fledged maintenance of statistical, financial accounting and analysis of services; optimize planning and use of resources (control of bed capacity, hospitalization plan, discharge plan, scheduling of doctors’ work, schedules for the use of premises and equipment, scheduling patients’ appointments with a doctor or undergoing a procedure, etc.); generate reporting and analytical documentation on the entire database of available data to make timely management decisions.

In conclusion, it is important to note that the strategic development of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia was carried out within the framework of the main directions of state policy to improve the quality and accessibility of medical care, innovative development therapeutic, diagnostic and management processes based on new clinical, organizational, structural and organizational and managerial methods and technologies. The measures taken made it possible in 2012 to fulfill the target indicators for the use of beds of the Road Map for 2018, the average length of stay in a bed in the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia was 10.7, and the bed occupancy was 344 (planned indicators of the Road Map for 2018 11 ,7 and 331 respectively).

The comprehensive nature of the reorganization of the activities of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia made it possible to provide a solution to the accumulated problems of rationalizing the use of the institution’s resources, increasing its resource potential in terms of strengthening the material and technical base, developing personnel, and ensuring sustainable financing.

Reviewers:

Bushmanov A.Yu., Doctor of Medical Sciences, Professor, First Deputy general director FSBI State Scientific Center FMBC named after. A.I. Burnazyan, Moscow.

Shchukin A.I., Doctor of Medical Sciences, Deputy Chief Physician for Clinical Expert Work, Federal State Budgetary Institution State Scientific Center FMBC named after. A.I. Burnazyan, Moscow.

Bibliographic link

Collection output:

CONDITIONS FOR EFFECTIVE QUALITY MANAGEMENT OF THE ACTIVITY OF THE ADMISSION DEPARTMENT

Podgorbunskikh Elena Ivanovna

Ph.D. honey. Sciences, methodologist "City Clinic No. 115 DZM" branch of State Enterprise No. 79, applicant for the Department of Public Health and Healthcare of the State Budgetary Educational Institution of Higher Professional Education MGMSU named after. A.AND. EvdokimovaMinistry of HealthRussia

Email:

CONDITIONS FOR EFFECTIVE MANAGEMENT OF QUALITY OF ADMISSIONS OFFICE ACTIONS

Podgorbunskikh Elena

candidate of Medical Science, doctor and methodologist of Children’s Municipal Polyclinc No. 115 (branch ofMunicipal Polyclinic No. 79), candidate of Public Health and Healthcare chair, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov of Ministry of Health of the Russian Federation

ANNOTATION

The article examines the process of hospitalization in a multidisciplinary hospital, as well as the specifics of quality management of medical care (QMC) and ensuring patient safety in the emergency departments of multidisciplinary hospitals from the perspective of a process approach.

ABSTRACT

In the article there is examined the process of admission to multi-field hospital as well as the specificity of management of medical care quality and safety precautions of a patient in admissions offices of multi-field hospitals from a perspective of process approach.

Keywords: quality of medical care, quality indicators, process management, resources, emergency department of a multidisciplinary hospital.

Keywords: quality of medical care; quality indicators; management by procedures; resources; admissions office of multi-field hospital.

The successful operation of multidisciplinary hospitals depends largely on the quality of services provided by a medical organization and the timely elimination of defects that arise in the process of their provision.

The hospitalization process is one of the main ones in a multidisciplinary hospital, therefore, for effective work it is important to develop quality indicators for emergency departments

In a large medical organization (MO), the more strongly influences the quality of management (function operational regulation) of the activities of individual departments on the final quality of medical care as a whole and on its financial stability, the larger it is. As an example, we can consider city hospitals with 100-500 and 1000 beds.

The use of process-oriented management of a medical organization should be aimed both at optimizing the activities of current processes and at planning long-term development prospects, and is most effective in implementing the project “Health Development Strategy 2020” at the level of the Moscow Region, taking into account the licensing requirements for carrying out medical activities.

The main advantage of the process approach is the continuous management of processes and their improvement.

What is a process? “A process is a stable, purposeful set of interrelated activities that, using a certain technology, transforms inputs into outputs that are valuable to the consumer.”

The quality of the process depends not only on the quality of the management process, but also on the quality of the resources used. “A process resource is a material or information object that is constantly used to perform a process, but is not an input to the process.”

That. the resources of the main process of activity of the reception department are: accounting and reporting documents; administrative and personnel; logistics; human; intellectual.

In a changing market, multidisciplinary medical organizations of any form of ownership, including state budgetary healthcare institutions, strive to improve their activities, which requires the constant development of new directions, implementation modern technologies management and rational use of existing resources.

In medical activities, when using a business engineering approach, the importance of human resources is not rejected. The MO activity model will function continuously and effectively when the medical staff of a multidisciplinary hospital, which is the main element of the ongoing internal processes, independently develops and accepts new rules and standards of communication that require changes corporate culture, compliance with the rules medical ethics and deontology.

Thus, personnel is one of the strategic factors in ensuring the quality of medical activities and patient safety in production, determining the future of the entire organization, which turns it into a valuable human resource.

In our study, interesting results were obtained when studying the length of service and qualification characteristics of specialists. Thus, the length of experience in the position of head of the admissions department ranged from 1 month to 46 years, on average 9 years, and 78% of respondents had the highest qualification category.

As a result, the data obtained shows that in the majority of 100% of the cases surveyed, the heads of the admissions department can be classified as experienced specialists, which meets the licensing requirements.

One of the most important competitive advantages in the dynamically changing economy of the Russian Federation and modern healthcare processes is not only human resources, but also, above all, service quality management and quality management.

The problem of managing the quality of medical care (QMC) and ensuring patient safety in the emergency departments of multidisciplinary hospitals has its own specifics, since this is where the patient receives first aid in a hospital setting.

First of all, to control its quality, scientifically based criteria for its evaluation are necessary.

Considering that the functions of the emergency department are significantly different from the tasks of other diagnostic and treatment departments of the hospital, a scientifically based approach to the selection of quality indicators using modern management technologies is required, as well as the development of a methodology for clinical expert assessment of clinical care in hospital emergency departments.

We list several main functions of the emergency department of a multidisciplinary hospital:

· reception and registration of patients;

· sorting patients according to the severity and profile of the disease;

· determination of indications for hospitalization (examination by a specialist doctor, examination);

· provision of necessary medical care;

· sanitization, etc.

Consequently, when organizing the activities of emergency departments, take into account the population’s need for emergency care provided not only by emergency medical teams, but also by specialists from emergency departments, ensuring continuity between medical organizations of various profiles and the population.

Therefore, for this purpose, a process description will give the head of a multidisciplinary hospital more accurate knowledge of both the activities of the Ministry of Defense as a whole and its departments, as an example - the emergency department of a multidisciplinary hospital, which will allow the application of process management and the development of a quality strategy that will also allow solving the following tasks (problems) ):

· reduce costs,

· increase the profitability and manageability of a medical organization.

Having introduced management from the perspective of a process approach in a multidisciplinary hospital, the manager will receive answers to the questions:

· where is the problem,

How can this be corrected and optimized?

· and also how to manage rationally.

Modern concepts of quality management make it possible to develop criteria for assessing the effectiveness of medical institutions, in particular, quality indicators for the admission departments of multidisciplinary hospitals to improve the quality of medical services and eliminate defects in the hospitalization process, as well as to improve the management of this process.

The assessment of the CMP is of particular importance in the context of the functioning of the compulsory medical insurance system and the transition to single-channel financing.

Currently, the assessment of ICU in the emergency department of a multidisciplinary hospital of any level and form of ownership should be based on Federal legislation Russian Federation, State Guarantees Program and others normative legal acts in the field of ILC management.

In many ways, the function and process of evaluating the hospital depends on the availability of resources (personnel, material, financial, information) and on the desire of the hospital management and its structural divisions to changes in the quality management system.

Thus, the most promising and scientifically sound is the model of continuous quality improvement, which includes activities carried out at all stages of the provision of medical services in order to increase the efficiency of all involved treatment, diagnostic and auxiliary processes.

Taking into account the licensing requirements for the implementation of medical activities, when creating a system for assessing the quality of activities of the emergency department of a multidisciplinary hospital, it becomes of great importance right choice technologies, resources and indicators that may depend on the object being assessed and be specific to various stages and types of medical care.

Consequently, KMP indicators must necessarily relate to the process being assessed and reflect its specific goals and final results.

Thus, the development of ICM indicators in the emergency department should be preceded by a deep analysis of the process of providing medical services.

To achieve the planned quality results, it is advisable to comply with the requirements of the ISO 9000 series of standards, which require constant monitoring of processes, and quality indicators should:

· reflect the professional qualities of a particular medical worker in the profiles of medical care provided.

· be easy to use when conducting an ILC examination.

· reflect the resource intensity of diagnosis and treatment, taking into account the characteristics of the emergency department.

· determine the labor costs of the doctor and other unit personnel in relation to the patient, taking into account the severity of the condition and the profile of the disease.

· allow assessing the completeness of the process of continuity of treatment between health care facilities.

· take into account patient satisfaction with the volume of medical care provided in the emergency department.

· assess the communication skills of all participants in the hospitalization process at the admission department level.

· reflect the cost indicators of services by disease and cost structure both in the compulsory medical insurance system and in other methods of payment for services.

· evaluate external and internal communications in the activities of the reception department.

It is most effective to use a process approach to identify ILC indicators in the activities of the emergency department of a multidisciplinary hospital.

Having analyzed the processes in a multidisciplinary hospital and determined the boundaries of the hospitalization process, the manager needs to document the process ( guidelines, regulations, instructions, orders, job descriptions).

And to justify the composition of the documents, you need to once again turn to the goals and objectives of the multidisciplinary hospital, and in particular the emergency department.

Therefore, from the point of view of the process approach, we will consider life cycle the process of developing quality indicators for the emergency department of a multidisciplinary hospital.

The main goal of the head of a medical institution or a system of medical institutions when developing indicators of clinical medical care in the emergency department is to provide high-quality medical care to the population.

Thus, the converted resource (the patient’s need for quality medical care in the emergency department) enters the process input.

Thus, at the output we get:

· analytical information for making management decisions at various levels

· indicators of the quality of medical care for a given medical institution

· formalized expert map.

Consequently, descriptions of processes within the framework of process management are the main type of information for determining the boundaries of processes and maintaining in working order all ongoing processes in the emergency department of a multidisciplinary hospital and a medical organization as a whole.

The hospitalization process, at first glance, is very simple.

However, his analysis showed that it is necessary to evaluate and determine the tasks for the development of the quality management system in order to ensure its operability, adequacy to changing conditions, and identify opportunities for improving performance.

From the perspective of the process management approach, the main events of the hospitalization process can be presented as follows:

1. Upon admission to the emergency department, the medical registrar accepts and registers documents, draws up the cover page of the inpatient’s medical record and sends it to the specialist’s office;

2. The next event of the main hospitalization process is an examination by a specialist, preparation of medical documentation and evacuation of the patient to a specialized department;

3. However, depending on the severity of the patient's condition and the channel of admission, variations in events are possible;

Based on the above, for each event during the hospitalization process, it is necessary to develop quality indicators taking into account the resource capabilities of the medical organization.

But in general, to effectively manage the activities of the reception department, the owner of the process (department manager) must carry out:

· monitoring the progress of the process;

· analyze factors influencing the process and leading to variations, including conflict ones;

· develop proposals for improving the process and organize their discussions and approvals;

· manage internal processes.

The complexity of managing the activities of the admission department is due to the fact that the hospitalization process is an “end-to-end process”, and the owner of the process must have sufficient resources and authority.

· Participants in the process are employees of various structural divisions;

· It is possible to organize control of operational activities in the process and the results obtained by ONE manager;

· The result of the process is important from the point of view of achieving the goals of the organization as a whole, or meeting the needs of external consumers;

· There is an opportunity to significantly improve the performance of the emergency department by optimizing cross-functional interaction within the process of admission and medical care in the emergency department of a multidisciplinary hospital.

Thus, the use of this technology (process approach) will make it possible to describe the model of activity of the admission department and effectively perform the functions of the admission department of a multidisciplinary hospital during hospitalization.

conclusions

1. For the head of a medical organization, for effective management and development, it is advisable to analyze and evaluate the activities of the admission department from the perspective of a process approach.

2. Taking into account the capabilities of the medical organization and the current regulatory framework, it is necessary to identify and implement quality indicators for the activities of the emergency department, including as a motivating factor in remuneration.

Bibliography:

1.Eliferov V.G., Repin V.V. Business processes: Regulation and management. Textbook. - M.: INFA - M, 2011. 319 p. - Textbook for the MBA program).

2. Management by notes: Technology for building effective companies / Edited by L.Yu. Grigorieva. - M.: Alpina Publishers, 2010. - 692 p.

3. Starodubov V.I., Sidorov P.I., Konopleva I.A. Organizational personnel management. Textbook for universities / Edited by V.I. Starodubova. - M.: GEOTAR - Media, 2006. - 1104 p.

4. Inpatient medical care. Author: E.A Loginova, edited by A.G. Safonova. - M.: Medicine, 1989, pp. 137-138.

5. Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation.” - M.: Eksmo, 2012. - 160 p.

6.[Electronic resource] - Access mode. - URL: https://www.rosminzdrav.ru/health/72 “Order of the Government of the Russian Federation No. 2511-p dated December 24, 2012 approved the “State Program for the Development of Healthcare of the Russian Federation” (date of access July 18, 2013).

"I affirm"

Chief physician

GKP at PVC "Atbasarskaya IMB"

Abdrakhmanov A.N.

Strategic health development plan

GKP at the RPV "Atbasar Multidisciplinary Interdistrict Hospital" under the Health Department of the Akmola region

for 2018-2022.

Section 1

Mission of the organization: provision of high-quality and effective medical care to the population based on a friendly attitude towards patients and mutual trust.

Our vision is:

An effective and accessible healthcare system that meets the needs of the population.

Our values ​​are:

Goal 1. Equal participation and access of patients to a guaranteed volume of free medical care in order to strengthen the health of the population of the region and create a competitive environment to ensure the rights of the patient to freely choose a medical organization and doctor.

Goal 2. Sustainable and continuous improvement of the quality of medical care provided to the population of the region. The focus of professional qualities on achieving the target indicators of the Densaulyk Program 2016 – 2019.

Goal 3 . Strengthening the material and technical base and introducing innovative advanced technologies in order to improve the provision of medical services to the population.

Goal 4. Improvement of the management system, continuous creation of the system postgraduate education medical personnel State Public Enterprise "Atbasarskaya IMB".

Goal 5. Improving the provision of medicines to the population of the region in order to increase the availability and quality of medicines.

The main tasks of the IMB:

1. Implementation of the State program “Densaulyk for 2016 – 2019” on the protection of public health.
2. Strengthening the health of citizens and reducing the mortality rate.
3. Improving management and financing of the organization.
4. Decrease in overall mortality, incl. from BSK, oncological diseases, injuries, accidents and poisonings, tuberculosis.
5. Reducing infant mortality, preventing maternal mortality.
6. Reducing the incidence of tuberculosis
7. Maintaining the prevalence of HIV/AIDS infection in the age group 15-49 years by no more than 0.6.
8. Increase in the proportion of cancer detected at stages 1-2.
9. Increase in the proportion of five-year survival of cancer patients.
10. Introduction of new innovative technologies into the activities of the hospital.
11. Increasing the volume of inpatient care.
12. Increasing income from paid medical services.
13. Increasing employee motivation for high labor productivity aimed at the quality of medical services provided.
14. Further improvement of the internal audit service.

Values.

Main value- human health.

The main principle is that the patient is the center of attention.

General values:

• Ø mercy;
• Ø respect for personal dignity, human rights and freedoms;
• Ø professionalism – constant work on self-improvement and improvement of professional knowledge;
• Ø introduction of innovative technologies and modern methods diagnosis and treatment;
• Ø mentoring – transfer of experience and instilling work culture and corporate values;
• Ø collegiality, teamwork - joint responsibility for the final results of activities;
• Ø high professional ethics.

Section 2

Analysis of the current situation.

The first year of implementation of the state health development program of the Republic of Kazakhstan “Dexaulyk” for 2016-2019 is being completed. In the activities of the Atbasar IMB State Enterprise, certain positive dynamics have been achieved in certain indicators. There is a continuous process of improving the quality of medical services.

Health structure. Medical assistance is provided to the population: Total 49384, Children 11205, Adolescents 1843, Adults 36230, Women 25389, women of fertile age 11949.

The district's healthcare structure is represented by a multidisciplinary interdistrict hospital consisting of hospitals and primary health care organizations. Total 24-hour hospital beds 163, day stay – 119. The total bed capacity is 282 beds Bed structure: Therapeutic department – ​​37 beds: therapeutic – 13, cardiological – 7, neurological – 7, neurological rehabilitation – 5, cardiac rehabilitation – 5; Surgical department - 24 beds, including by profile: surgical - 17, gynecological - 7; Trauma department - 16 beds: traumatology - 11, trauma rehabilitation - 5; Mother and child - 19, including by profile: for pregnant women and women in labor - 9, pathologies of pregnant women - 7, pathologies of newborns and nursing of premature babies - 3; Children's (pediatric) – 32; Infection – 35, including by profile: infectious adults – 10, infectious children – 25. Primary health care in the region is provided by the district clinic for 500 visits per shift as part of the children's clinic, antenatal clinic, emergency department, 8VA, 5FAP, 17MP.

The volume of financing increases annually, from 1,040,377.0 thousand tenge in 2015 to 1,474,690.5 thousand tenge in 2017. The material and technical base has improved. In 2017, 12 million were allocated for current repairs. tenge, there were no major repairs.

In 2017, medical equipment worth 435 million was purchased. 311 thousand tenge, including a computed tomograph worth 236 million. tenge, a mobile X-ray diagnostic unit with a C-arm for operating units worth 22 million. 370 thousand tenge, ambulance – 5 million. tenge, endovideo-resistant for block operas worth 55 million. tenge A stroke center with 16 beds has been opened.

Staffing. The total number of employees in the state is 146.25, there are 71 individuals. The number of doctors is 48.5% compared to 39% in 2016. In 2017, 10 young specialists arrived, of which 6 were GPs. There is an acute demand for medical personnel in 18 specialties (endocrinologist - 1, infectious disease specialist - 1, neurosurgeon - 1, anesthesiologist-resuscitator - 3, traumatologist - 1, ophthalmologist - 1, psychiatrist - 1, dermatovenerologist - 1, neonatologist - 2, mammologist - 1, laboratory doctor, laboratory assistant - 1, radiologist - 1, obstetrician-gynecologist - 2).

The category of doctors is 48.5%: highest category – 9 – 12.7%, first category – 22 – 31.0%. The categorization of construction and installation work is 91.2%: highest category – 57 – 16.5%, first category – 68 – 19.7%, second category – 35 – 10.1%. In 2017, 43 doctors (60%) underwent advanced training, and 130 (37%) SMRs.

Low percentage of young specialists arriving due to an insufficiently formed social package, lack of lifts and housing in urban areas.

Demographics.

In 2017, there were positive dynamics in the birth rate - an increase of 6%, the overall mortality rate increased by 6.2% compared to 2016, a decrease in infant mortality by 28.6% from 11.1 in 2016 to 7.4 in 2017, maternal mortality There is no mortality observed within 5 years.

Positive dynamics are noted for a number of socially significant diseases. Reduction in the incidence of tuberculosis by 25% from 48.1 in 2016 to 37.0 in 2017. Reducing the incidence of cancer by 30%. Reduction in the incidence of syphilis by 23.5%. Reduction in morbidity associated with the use of psychoactive substances by 13.8%. Reducing the incidence of diabetes by 5%. Reduced incidence of injuries by 18%.

The plan for fluoroscopic examination of the district population was 100% completed. 8035 people were examined using a mobile fluorograph – 102%.

12,156 people were covered by the PMC medical examination. 3405 diagnostic studies were carried out.

The screening examination covered 30,235 people. The plan is 91% fulfilled. The detection of diseases in childhood, the detection of diseases of the circulatory system, and cancer have improved.

Patients with diseases of the cardiovascular system are selected for surgical treatment. 26 people received cardiac surgical care: stenting – 15, CABG – 11.

Thrombolysis is successfully performed at the hospital stage. In total, 14 thrombolysis were performed in 2017.

Work on the Unified Center for Significance continued.

5267 people were treated in the AMMB hospital in 2017, 5121 people were treated in 2016. According to the Hospitalization Bureau Portal, 1432 people were treated. 317 people were sent to the republican centers of Astana and Almaty.

Indicators have not been achieved in a number of areas:

There is an increase in mortality from injuries and accidents by 19.6%;

Increase in overall population mortality by 6.2%;

Increase in mortality from tuberculosis from 2.0 in 2016 to 6.2 in 2017.

To achieve indicators a Roadmap for the implementation of the SPRP indicators has been developed. All GP sites are staffed by GPs, therapeutic and pediatric areas are divided into areas with a population of 2000 people, pediatric areas - 900 people. Preventive and screening examinations are carried out with high quality for early detection of diseases.

To assess the situation and determine development trends, we will conduct a SWOT analysis in order to identify and strengthen strengths, take advantage of opportunities and minimize weak sides and threats.

To strengthen the organization's strengths and realize opportunities, it is necessary to:

• Further: carrying out repair work on buildings, installing automatic fire alarms, installing video surveillance, equipping with medical equipment; creating favorable, safe and comfortable conditions stay of patients, visitors and staff; creating an accessible environment for disabled people and people with limited capabilities.
• Attracting and retaining medical personnel.
• Training of medical personnel within the framework of continuous professional education using all methods and forms, including distance learning, role-playing games and trainings, self-training.
• Further improvement of the internal audit service, improving the quality of medical services by standardizing processes, training and raising the level of qualifications of personnel, improving material and technical equipment and developing an effective system of motivation for medical staff.
• Conducting awareness-raising work among the population on the organization of medical care and promotion of a healthy lifestyle.

To eliminate the negative influence of external and internal factors it is necessary:

• Measures to increase the level of medical equipment in accordance with the minimum standards of equipment, types and forms of medical care provided, and primarily in the main areas: providing care for injuries, diseases of the circulatory system, strokes, obstetrics and childhood.
• Improving and implementing measures to increase the efficiency of using allocated resources and introducing resource-saving technologies.
• Opening of our own bacteriological laboratory.
• Forming our own housing stock to attract medical personnel, attracting sponsorship to form a social assistance fund for young specialists.
• Attracting additional (extra-budgetary) sources of funding.
• Carrying out measures to comply with the phasing of medical care, improve continuity with primary health care organizations, emergency medical care, increase the level of planned hospitalization and ensure the completeness and quality of pre-hospital examination.
• Further development of inpatient care, reducing the consumption of inpatient care. Managing the structure of hospitalization by redirecting patients with low weight coefficients and patients who do not require round-the-clock medical supervision to the level of day hospital or outpatient treatment.
• Increasing planned surgical activity in surgical and gynecological profiles, including using minimally invasive methods, will increase the average weight coefficient.
• Expanding types of specialized medical care.
• Improving rehabilitation medical care.
• Introduction and development of modern diagnostic and treatment methods, high-tech medical services, increasing the average weight coefficient of treated cases.
• Work to reduce economic impact measures, primarily by eliminating subjective factors.
• Managing the structure of hospitalization, preventing exceeding the maximum volumes within the framework of the state order, and withdrawing funds on a linear scale. Planning of maximum volumes taking into account the seasonality of hospitalization.
• To reduce the costs of the emergency room, it is necessary to strengthen the work on interaction with primary health care on the validity of referrals for hospitalization and strengthen sanitary educational work among the population to reduce visits to the emergency room during clinic hours, primarily with diseases managed at the APO level.
• Conducting awareness-raising work with the population to increase shared responsibility for their health.
• Carrying out systematic work to prevent justified complaints from patients, increasing the level and culture of medical care.

Section 3

Strategic directions, goals, objectives, target indicators, activities and health outcome indicators

Compliance of strategic directions and goals with the strategic goals of the state

• Message from the Head of State Nursultan Nazarbayev to the people of Kazakhstan “Kazakhstan’s path - 2050. Common goal, common interests, common future.”
• Decree of the President of the Republic of Kazakhstan dated January 15, 2016 No. 176 “On approval of the State Health Development Program of the Republic of Kazakhstan “Densaulyk” for 2016 - 2019 and amendments to the Decree of the President of the Republic of Kazakhstan dated March 19, 2010 No. 957 “On approval of the List of State Programs” .

Management of risks.

In the course of its activities, the organization (ASMB) may encounter a number of risks (circumstances that may interfere with the achievement of goals) or external factors beyond the control of the organization that may impede the achievement of the goals of the Strategic Plan.

Budget programs.

UDC 614.2
BBK 65.495

Target. Studying the issues of implementing strategic management in healthcare organizations during the period of change.

Methods. The research is based on systems theory, the theory of organizational development, methods: analytical, comparative, balance sheet, normative, economic and mathematical.

Results. It has been revealed that combining strategies makes it possible to increase the efficiency of health care organizations and the industry as a whole through comprehensive problem solving: planning the volume of medical services based on modern industry norms and standards, reasonable cost standards, methods of economic and mathematical modeling; establishing the necessary proportions in the process of production and resource provision of medical services; creation and implementation of resource-saving models. The results of our research were used in the interregional and interdepartmental fundamental research programs of the Ural Branch of the Russian Academy of Sciences “Factors and mechanisms of acceleration of socio-economic development of Russian regions”, project 12-С-7-1007.

Scientific novelty. A methodological approach to improving the planning system and management process is substantiated, based on a combination of strategies: growth and maintaining sustainable development; organizational changes; innovative; strategic marketing; resource saving, which allows modeling the behavior of a healthcare organization in the context of changes in order to improve operating efficiency. Within the framework of this approach, stages and methods for planning the volume and financing of guaranteed free medical care for the population of the territory are proposed, taking into account the need for it, which allows, under the conditions of changes, to predict the optimal resource provision of healthcare at the regional level. The developed methodological approach is used at the Ural State Medical University in the educational process of management, organization and economics of healthcare, in training cycles for healthcare organizers, in medical institutions when introducing change management.

Based on the results of the study, 3 certificates for the intellectual product were obtained.

In the context of healthcare reform, medical organizations are faced with the task of managing on the basis of anticipating changes in order to anticipate future trends and develop an appropriate strategy for sustainable and effective functioning. The lack of strategic vision in healthcare organizations makes it difficult to predict performance results and the ability to make timely adjustments to the management process.

In the study, we relied on the publications of such famous scientists in the field of strategic management as: M. Mescona, M. Alberta, F. Khedouri, M.A. Chernysheva, R.A. Fatkhutdinova, A.V. Barysheva and others.

According to M.A. Chernyshev: “A number of reasons have led to a sharp increase in the importance of strategic management, the main of which are: the acceleration of changes in the environment; the emergence of new requests and changes in consumer positions; increased competition for resources; the emergence of new unexpected business opportunities opened up by advances in science and technology, etc. There is no strategy that is the same for all companies, just as there is no single universal strategic management. Each firm is unique in its own way, and therefore the strategy development process for each firm is unique.” .

The position of Fatkhutdinov R.A. is of scientific interest. on this issue: “Strategies can be justified only if scientific approaches, methods of systematic analysis, forecasting and optimization are applied to their development.

To develop competitive strategic decisions, systemic, integrated, integration, marketing, functional, dynamic, reproductive, process, regulatory, optimization, administrative, behavioral, situational and other approaches should be applied to the process of their development.” .

Today, there are the following problems in the system of planning and economic support for healthcare:

1. Strategic management is being implemented slowly in industry organizations.
2. At the regional level (mesolevel): when developing territorial programs, demographic indicators, the balance of the population's needs (demand) for types of medical care with the level of its financing, and the capabilities (offers) of medical organizations to provide it are not fully taken into account.
3. Rational forms of interaction between state and market institutions for resource provision of health care have not been determined.
4. There is no strategic vision for the introduction of resource-saving technologies in the industry.

The objectives of this article are:

1. Selecting strategies for organizing healthcare in the context of change.
2. Develop proposals for improving the system of planning and economic support for healthcare at the regional or municipal level (mesolevel) in the context of changes. Among the list of instructions of the President following a meeting on health issues on February 5, 2014. The task was set to develop differentiated standards for the volume of medical care provided in the constituent entities of the Russian Federation, incl. taking into account the gender and age composition of the population, the level and structure of socially significant diseases, etc.
3. Establishing the necessary proportions in the process of production and resource provision of medical services to achieve medical, social, and economic efficiency. In the list of instructions of the President following a meeting on health issues dated February 5, 2014. the task was set: “Ensure the presentation of the implementation plan until 2020 structural changes network of medical organizations, paying special attention to the development of hospital-replacement technologies in hospital institutions.”

The development of a healthcare organization in the context of changes should be based on the implementation of strategic management in order to improve the management process, planning system and economic support. To implement strategic management in healthcare organizations, a choice of strategy is required.

The authors propose a combination of several strategies that are important for a healthcare organization as modeling the behavior of a medical institution for the future in the context of changes. Combining strategies involves the integrated use of various areas of strategies in a healthcare organization and should include (Table 1, compiled by the authors):

Table 1. Combining and integrating strategies in health care

As part of the development (growth) strategy The problems of planning in the industry in the context of changes are considered. Planning in the conditions of a regulated market of medical services - the need for an optimal combination of the roles of planning and market regulators, maintaining the social orientation of goals and objectives, ensuring a balance of sectoral and territorial interests.

The system of state (municipal) tasks for the implementation of volumes of medical care within the framework of the program of state guarantees for the provision of free medical care to the population is one of the main planning tools at the federal, regional, municipal level (at the macro-, meso-, micro level).

At the meso- and micro-level, when planning the activities of healthcare organizations, the following problems exist:

• imperfection of the regulatory framework for the formation of tasks for the provision of medical care;
• insufficient consideration at all levels of planning of the real needs of the population for medical care, depending on the structure of morbidity and the age and sex composition of the population;
• the need to ensure the constitutional rights of citizens to free medical care, regardless of the volume of resource support for the task;
• the need to increase access to medical care;
• the problem of matching the planned volumes of medical care with the volumes of financial resources to provide this assistance;
• planning the volume of medical care not in accordance with the needs of the population, but based on available financial capabilities, etc.

To improve the system of planning and economic support for healthcare at the regional or municipal level (meso level) in the context of changes, we have proposed stages and methods for planning the volume of guaranteed free medical care for the population of the territory and its resource provision:

Planning stages:

1. Analysis and assessment of the demographic situation in a municipality (city, district), forecast of its dynamics in the upcoming planning year. When assessing the demographic situation, a description of the population, its age and sex composition, natural population movements, etc. is given.
2. Analysis and assessment of population morbidity based on data on the population seeking medical care and hospitalization of the population. When analyzing morbidity, its level and structure in different age groups of the population, etc. are assessed.
3. Analysis and assessment of disability of the population.
4. Analysis and assessment of personnel, material and financial resources medical organizations municipality, prospects for their development in the coming year.
5. Analysis and evaluation of the activities of medical organizations.
6. Goals and objectives, priorities for the development of healthcare in the municipality for the planned period are formed.
7. A selection of healthcare standards used in planning the volume of medical care is carried out in accordance with the current Federal (basic) Program of State Guarantees of free medical care provided to the population, the per capita standard for financing healthcare in the region at the expense of the budget of the constituent entity of the Russian Federation and the municipal budget, the Territorial Compulsory Medical Insurance Fund, territorial financial standards for the cost of medical care, taking into account its profiles and levels.
8. Calculation of planned indicators for the volume of guaranteed free medical care for the population of a municipality, taking into account the population’s need to receive it.
9. Calculation of the cost of financial costs for the implementation of the planned volumes of guaranteed free medical care to the population of the municipality in accordance with the recommended cost standards for healthcare.

Methods for planning the volume of guaranteed free assistance to the population:

1. Analytical method allows for a deep and comprehensive analysis of the processes and phenomena occurring in the state of public health and healthcare.
2. Comparative method is used for comparative assessment indicators of population health, resources and activities of health care institutions by comparing them with the average territorial (federal, regional), similar indicators of other administrative territories, over time, etc.
3. Balance sheet method allows you to evaluate and ensure the proportionality of planned capital investments and financial costs in the healthcare of individual territories, the proportionality of the development of a network of healthcare organizations.
4. Normative method is based on the use in planning of a set of health care norms and standards to establish indicators for the development of a network of health care organizations.
5. Economic and mathematical methods make it possible to scientifically substantiate the most optimal options for healthcare development plans and make forecasts for the short and long term.
6. Extrapolation method used to identify trends in changes in indicators, allows you to make forecasts of the dynamics of population health indicators and healthcare development.

Calculation of planned indicators for the volume of guaranteed free medical care for the population of a municipality, taking into account the population’s need to receive it:

1. Calculation of territorial standards for the volume of inpatient medical care, taking into account the actual age structure of the population, the profile of hospital departments and the level of medical care.
2. Calculation of territorial standards for the number of outpatient and polyclinic visits for children and adults, the entire population according to specialty profiles.
3. Various methods for calculating volumetric indicators for the planning period.

   Along with traditional methods, we propose an alternative method for calculating volumetric health care indicators for the planned period, based not on the traditional approach of calculating planned indicators depending on population size, but on the real need for emergency medical care, taking into account the level of injuries. The calculation of the required bed capacity is made using economic and mathematical methods; the admission of emergency patients for emergency hospitalization is taken as an input random flow in accordance with the theory of queuing. The given example of calculating the required bed capacity proves the feasibility of using economic and mathematical methods as an alternative way of calculating volumetric health care indicators for the planned period, based on the real structure of morbidity, admission of emergency patients for emergency hospitalization.

4. Calculation of financial support for the planned volumes of free medical care to the population.

A balanced SGBP can be achieved by establishing tariffs for medical care that are adequate to the real costs of providing it, increasing the efficiency of existing health care financing mechanisms, and specifying state guarantees of free medical care.

As part of the strategy to maintain(sustainable functioning of a medical institution), a special role is played by establishing the necessary proportions in the process of production and resource provision of medical services to achieve medical, social, and economic efficiency.

Recently, foreign scientists dealing with problems of the development of economic theory adhere to “ incremental planning concepts, which suggests, instead of searching for optimal system parameters, positions bounded rationality.

According to K.V. Pavlov, “one of the promising and very relevant directions for the further development of economic theory is the development concepts about rational structures and combinations of social elements". The principle of a rational combination of economic models is a development of the position on the optimal balance between market and government methods economic regulation.

Despite the diversity of health care systems in developed countries, all have in common a high percentage of GDP allocated to health care and a significant share of public funds in financing the industry (from 70% and above in most economically developed countries). Examples from a number of developed Western countries confirm the correctness of the action principle golden ratio», at which the ratio of population expenditures and budgets is close to the formula 0,38:0,62 . In countries where the share of the public sector in healthcare financing is 0.62 or higher in relation to the private sector, favorable trends in the social sphere are observed. Compliance with this principle allows us to achieve harmonious development of the industry. The health care of countries with an inverse ratio of the share of personal expenditures of the population and public investment is characterized by crisis phenomena.

Our analysis made it possible to identify the dependence of the level of development of healthcare and demographic indicators in countries with different socio-economic systems on the share of state participation in financing the industry and to conclude that it is necessary to increase public investment in all types of medical care in an amount of at least 62% of the cost of medical services. In this case, the funding gap will be 38%, which can be filled from extra-budgetary sources (private, public).

Using the formula golden ratio (0.38:0.62= 0.612) when considering the issue of a rational relationship between state and market participation in the financing of the most important sector of the social sphere - healthcare, it allows us to ensure harmony and comply with the ideas of spatial proportionality of interconnected parts. This proposal is confirmed by receipt of a certificate for an intellectual product (Krivenko N.V., Kuznetsova N.L.).

“According to the calculations of academician Reimers N.F. to ensure 1% population growth and reproduction work force capable of joining the production process, the country must ensure a 4 percent increase in the gross national product. It is impossible not to take into account that under the influence of a set of recommended measures, the mortality rate of the population is noticeably reduced and life expectancy increases.”

An example of the relationship between increasing financing costs and improving demographic indicators is the implementation since 2006 of the national project “Health”, aimed at increasing the level of material, technical and personnel support for the industry, and on this basis creating conditions for improving health indicators.

Sheiman I.M., Shishkin S.V. note: “So, as a result of the implementation of the “Birth Certificate” program, the maternal mortality rate over these years decreased by 13%, perinatal mortality - by 10.8%. Thus, the additional funds that antenatal clinics, maternity hospitals, and children’s clinics received from the federal budget became a factor that positively influenced maternal and infant mortality.”

“In general, as a result of the implementation of the national project “Health”, regional health care modernization programs, overall mortality decreased by 16.1%, infant mortality - by 32.7%, mortality from diseases of the circulatory system - by 17.1%, from strokes - by 28.4%, from tuberculosis - by 36.9%, from transport injuries - by 26.3%."

An important role in ensuring national demographic security is played by the redistribution of financial flows within the health care system in favor of those types of medical care for which there are the highest mortality rates among the population of working age and which are controllable factors. Thus, based on the research conducted, rational forms of interaction between state and market institutions for resource provision of healthcare have been identified and defined.

As part of the organizational change strategy In order to improve the management process, it is proposed:

• introduction of innovative organizational models for providing medical care to the population;
• the use of targeted and interdepartmental approaches to ensure conditions for sectoral and interdepartmental coordination of measures to comprehensively address medical and social problems of public health at all levels of management , incl. development and financing of targeted programs for the rehabilitation of disabled people, allowing patients of working age who participate in the formation of GDP to return to work.

The innovation strategy provides constant introduction of organizational, medical, information, economic innovations in the activities of healthcare organizations.

Strategic Marketing: It is advisable to use the marketing tools built into the change management mechanism based on the concept of “holistic marketing”, as well as the “blue ocean” marketing strategy, the main idea of ​​which is to create demand for a service based on value innovation to increase the competitiveness of a healthcare organization.

As part of the resource saving strategy the creation of resource-saving models is required to achieve medical, social, and economic efficiency.

Taking into account the uncertainty of the impact of external and internal environmental factors during the period of change and possible deviations from planned targets, we have developed models using economic and mathematical methods that allow us to simulate changes in indicators under various development scenarios.

For the first time, we have developed an economic and mathematical model of resource-saving technologies in order to increase economic sustainability medical institutions, which is confirmed by the received certificate for the intellectual product (Krivenko N.V., Kuznetsova N.L.). We believe that the Center for Outpatient Surgery, due to a lack of funding, would be advisable to organize in a multidisciplinary hospital.

The combination of round-the-clock and day hospitals allows:

• reduce the costs of transferring patients to other medical institutions;
• rational use of all available hospital resources;
• introduce technology for conducting outpatient surgical operations in all areas of surgery (purulent surgery, maxillofacial surgery, traumatology, hand surgery, otolaryngology, ophthalmology), relieving intensive care beds for those in need of hospitalization.

The more departments are involved in the implementation of this technology, the greater the share of saved funds that can be used for the development of an intensive care hospital.

During the research process, for the first time, we set the task of constructing an economic and mathematical model of the functioning of a medical institution in the structure of municipal healthcare, combining traditional and alternative forms of medical care and allowing us to achieve self-sufficiency in the conditions of multi-channel financing. To achieve self-sufficiency, the share of patients at the Ambulatory Surgery Center must be at least 0,25 and 24-hour hospital 0,75 in the total volume, with a constant number of patients in a 24-hour hospital, an increase in the number of outpatients will lead to an increase in the economic sustainability of medical institutions in the municipal healthcare system, which is confirmed by the received certificate for an intellectual product (Krivenko N.V., Kuznetsova N.L., Tatarkin A.I. .) . The developed economic and mathematical model of resource-saving technologies was used:

• during the organization of a multidisciplinary day hospital at the Interregional Trauma Center of the Ural Russian Academy of Natural Sciences on the basis of the Central City Clinical Hospital No. 23 of Yekaterinburg in 2004.
• during the implementation of the model of the Ambulatory Surgery Center in healthcare institutions in Perm in 2006 - 2010.
• when introducing the model of the Medinvest Ambulatory Surgery Center in Yekaterinburg in 2013.

Thus, combining strategies when making changes makes it possible to improve the planning system, management process, and optimize costs, which ultimately helps to improve the efficiency of a healthcare organization. In the future, a healthcare organization can develop its own version of combining strategies, taking into account its uniqueness.

Our proposed methodological approach to improving the system of planning and economic support for the industry allows healthcare authorities in market conditions to study the demand for types of assistance, supply, based on available capabilities, predict the development of the industry, and, using self-regulatory mechanisms, plan all the necessary technologies with optimal distribution among medical institutions , to increase the efficiency of the resource potential used in the field of medical services in terms of state guarantees at the meso level, at the micro level - to assess the real capabilities of health care organizations to implement the program of state guarantees of providing free medical care to the population using the existing resource potential.

Testing of the models we have developed confirms them practical significance and efficiency: with significant savings in resources, good therapeutic results have been achieved.

The results of our research were used in the interregional and interdepartmental fundamental research programs of the Ural Branch of the Russian Academy of Sciences “Factors and mechanisms of acceleration of socio-economic development of Russian regions”, project 12-С-7-1007.

Literature

1. Strategic management. Fundamentals of strategic management / M.A. Chernyshev et al.]. Rostov n/d: Phoenix, 2009. 506 pp. (Higher education).
2. Fatkhutdinov R.A. Strategic management: textbook. 9th ed., revised and supplemented. M: Publishing House "Delo" ANKh, 2008. 448 p.
3. Pavlov K.V. On the issue of rational socio-economic structures // National interests. Priorities and safety. M. No. 2(35). 2009. P.5-9.
4. Krivenko N.V., Kuznetsova N.L. The optimal share of government investment in the industry, flexible models of medical-economic and minimum social standards, theoretical justification of payment coefficients for treatment in a day hospital. Intelligent product. Certificate for an intellectual product No. 73200400020 dated February 12, 2004-C.1.
5. Tishuk E.A. Medical and demographic processes in modern Russia // Doctor. 2000. No. 1. P.36-39.
6. Sheiman I.M., Shishkin S.V. Russian healthcare: new challenges and new tasks. Part 1 // Healthcare manager. 2009. No. 6.
7. Resolution of the First National Congress of Doctors of the Russian Federation // Healthcare. Journal of working situations of the chief physician. M: MCFR 2012. No. 11.
8. Krivenko N.V., Kuznetsova N.L. An economic and mathematical model of resource-saving technologies using queuing theory, which makes it possible to increase the availability of medical care and ensure the preservation of its quality for the population. Intelligent product. Certificate for an intellectual product No. 73200400022 dated February 12, 2004. C.1.
9. Krivenko N.V., Kuznetsova N.L., Tatarkin A.I. An economic and mathematical model that optimizes the combination of high-cost and resource-saving technologies in terms of cost recovery for medical institutions and creating conditions for increasing the economic sustainability of the functioning of municipal healthcare in a market economy. Intelligent product. Certificate for an intellectual product No. 73200400021 dated February 12, 2004, p.1

Bibliography

1. Strategic management. Basics of strategic management / M.A. Chernishev and . Rostov-on-Don: Feniks, 2009. 506 p. (Visheye obrazovaniye).
2. Fathutdinov R.A. Strategic management: study book. 9th edition, revised and added. M.: Izdatelstvo “Delo” AHN, 2008. 448 p.
3. Pavlov K.V. On the question on rational social-economic structures // Nationalniye interesy. Priority and safety. M. No. 2(35). 2009. P.5-9.
4. Krivenko N.V., Kuznetsova N.L. Optimal share of state investing of the branch, flexible models of medical-economic and minimal social standards, theoretical substantiation of indicators of health fees in a day hospital. Intellectual product. Certificate for intellectual product No. 73200400020 dated 02/12/2004-R.1.
5. Tishuk E.A. Medical-demographic processes in modern Russia // Vrach. 2000. No. 1. P.36-39.
6. Sheiman I.M., Shishkin S.V. The Russian Health care system: new challenges and new tasks. Part 1 / Manager zdravoohraneniya. 2009. No. 6.
7. Resolution of the First National Assembly of the RF doctors // Health care system. Zhurnal rabotchikh situatsiy glavnogo vracha. M: MTsFER 2012. No. 11.
8. Krivenko N.V., Kuznetsova N.L. Economic-mathematical resource-saving technologies using theories of mass-service allowing increasing availability of medical service and providing for its quality preservation for the population. Intellectual product. Certificate for intellectual product No. 73200400022 dated 02/12/2004 P.1.
9. Krivenko N.V., Kuznetsova N.L. Economic-mathematical model optimizing the combination of high-cost and resource-saving technologies in the context of investment return of hospitals and formation of conditions for increasing economic stability municipal health care system functioning in the market economy. Intellectual product. Certificate for intellectual product No. 73200400021 dated 02/12/2004 P.1.

Development strategy of a medical organization in an updating period

Purpose. To study issues of implementation of strategic management in health care organizations in an updating period.

Methods. The research is based on the theory of systems, theory of organizational development, methods: analytical, comparative, balance, normative, economic-mathematical.

Results. The authors found out that combination of strategies allows to increase the efficiency of activity of health care organizations and the branch in general at the expense of complex problem solving: planning of volumes of care delivery on the basis of modern branch norms and regulations, substantiated cost regulations , methods of economic-mathematical modeling; determination of necessary proportions in the production process and resource provision of medical services; development and implementation of resource saving models. Results of the ongoing research are used in programs of inter-regional and inter-governmental fundamental research UrO RAN “Factors and acceleration mechanisms of social-economic development of the Russian regions development”, project 12-С-7-1007.

Scientific novelty. The authors substantiated the methodological approach to improvement of a planning system, managerial process, based on strategies combinations: growth and maintaining of stable development; innovative strategic marketing; resource saving which allows modeling behavior of a health care organization in conditions of updating increasing the efficiency of functioning. Within the framework of this approach the authors proposed stages and methods of planning volumes and funding secured free medical treatment for the population of the territory taking into account demands of its use. It allows forecasting optimal resource provision of health care on a regional level in conditions of updating. The developed methodological approach is used in the Ural state medical university in studying process on management, organization and health economics, at improvement courses for health care executives, medical organizations in change management implementation.

Using the results of the research conducted there are 3 certificates for an intellectual product.

MODERN STRATEGIES FOR THE DEVELOPMENT OF A MULTIDISCIPLINARY MEDICAL INSTITUTION AT THE FEDERAL LEVEL

L.V. LAKTIONOVA

Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical

technologies of FMBA of Russia

Annotation. The article presents the results of applying modern strategies for the development of inpatient care as part of the modernization of a federal specialized multidisciplinary clinic. The problems of healthcare development in the Russian Federation and possible ways to solve them at the level of medical institutions are discussed in order to improve the quality and accessibility of medical care.

Key words: healthcare development strategies, healthcare organization, healthcare management, reform of a multidisciplinary clinic.

MODERN STRATEGIES OF DEVELOPMENT OF FEDERAL MEDICAL INSTITUTION

Federal Research Clinical Center FMBA of Russia, Moscow

Abstract. The results of application of the modern strategies of development of inpatient care within the process of modernization of Federal specialized multi-profile clinic are presented in the article. This paper covers the problems of development of public healthcare of the Russian Federation and possible ways of their solutions at the level of medical-preventive institutions with the purpose of improving the quality and accessibility of medical care.

Key words: strategies of development of public healthcare, public healthcare organization, restructuring of multi-profile clinic.

Russian healthcare is going through a difficult period. In conditions of chronic underfunding, an aging workforce, and a lack of professional standards, the work of doctors is under close public attention and the demands on our industry are increasing many times over. Mandatory conditions are the quality of medical services provided and the efficient use of resources.

In recent years, our country has been modernizing its healthcare system. Adopted federal laws and documents, such as: Concept of long-term socio-economic development of the Russian Federation, federal law of November 29, 2010 No. 326-FZ “On compulsory health insurance in the Russian Federation”, federal law of November 21, 2011 No. 323- The Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” is intended to legislatively ensure the rights of citizens to receive quality medical care.

The Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the FMBA of Russia (FSC FMBA of Russia) includes: Research Institute of Cardiology, Research Institute of Clinical Surgery, Institute of Space Medicine, Research Institute of Sports Medicine and Rehabilitation, experimental laboratories, a multidisciplinary hospital with 810 beds, consultative and diagnostic center. The scientific divisions of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia carry out research and educational activities in various fields: regenerative technologies, molecular genetic research, personalization of treatment tactics, medical support for space flights and others. Clinical units provide care to patients in virtually all medical specialties.

The following was chosen as a global strategy for the development of a medical institution: creation of

the basis of systemic transformations of a modern specialized scientific and practical complex, combining a wide range of inpatient, outpatient and emergency medical care with the formation of conditions for scientific and pedagogical activities in the development and implementation of new medical technologies through the intensive development of a diagnostic and treatment base, the introduction of organizational and management changes. Thus, the main goals of the planned strategic development of the Federal Scientific Research Center FMBA of Russia included:

1. increasing the competitiveness of the institution based on ensuring a high level of quality and accessibility of specialized medical care, the use of unique diagnostic and treatment technologies;

2. providing the assigned contingent with types and volumes of medical care that meet their needs, developing high-tech types of medical care, expanding opportunities for servicing patients on a contractual basis;

3. providing integrated medical care to patients - organizing the treatment and diagnostic process at all stages in accordance with the “closed cycle” principle and under a single professional leadership;

4. innovative development of the institution in the following areas: cardiology, pulmonology, neurology, traumatology-orthopedics, surgery based on the development of partnerships with the clinical departments of the Federal State Educational Institution of the Institute for Advanced Studies of the Federal Medical and Biological Agency of Russia, MMGU named after. Sechenov, FPDO MGMSU named after. A.I. Evdokimova;

4. increasing the competence level of employees in professional and legal aspects;

5. ensuring effective management of the medical and business activities of the institution based on the optimal development and rational use of resources, the introduction of modern management technologies.

To solve these problems, the following strategies for the development of the institution were formulated:

Structural reorganization, including a review of the composition and capacity of departments, increasing the efficiency of using basic resources, creating a consultative and diagnostic outpatient center, expanding the laboratory and diagnostic base, strengthening intra-institutional interaction between departments;

Carrying out a personnel policy built on modern principles of human resource management, including changing the remuneration system, investing in the development of human resources, increasing labor efficiency based on increasing its technical and technological equipment;

Development of innovative potential - development and use of standards of medical care, expansion of high-tech types of care, development and implementation of new treatment methods and organizational technologies based on the use of patient routing, the principles of “single attending physician”, “closed loop”, etc.;

Improving the efficiency of the management system - implementation marketing approach, principles of strategic planning, quality management, application of organizational and management technologies, development entrepreneurial activity, introduction of an informatization system for the basic processes of organizing work and managing an institution.

An important prerequisite for carrying out the planned system of transformations was the presence of the clinic’s initial high personnel and material and technical potential.

The implementation of the selected strategies was carried out on the basis of a systematic approach using the principles of strategic management, including the priority of selected areas, justification of mechanisms for solving problems, systematic resource provision, planned implementation of planned activities, the team principle of management, attracting and increasing the initiative of the entire team to rationalize the process of their own work, constant informing the team about the results of transformations, as well as providing external conditions for carrying out transformations based on strengthening interaction with governing bodies (FMBA), departmental enterprises, patients and funding organizations.

Structural reorganization. The structural reorganization was based on bringing the clinic’s bed capacity in line with the needs of the assigned contingent, taking into account the required types and volumes of assistance, developing types of assistance unique to the existing medical services market in order to expand opportunities for attracting additional sources of funding (budgetary for primary medical care, within the framework of VHI , personal funds of citizens) as the basis for further development. The dynamics of the creation of new divisions are presented in table. 1.

Table 1

Dynamics of creation of new divisions of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia in 2008-2012

Years Medical Units Auxiliary Units

2008 Consultative and Diagnostic Center Clinical Diagnostic Laboratory Cardiology Department 2 Department of Traumatology and Orthopedics

2009 Center for Anesthesiology and Resuscitation Department of X-ray surgical methods for diagnosing and treating complex cardiac arrhythmias Emergency Department Dental Department Temporary wards for patients with suspected infectious disease Hospitalization Department Epidemiology Department Pharmacy

2010 Department of Thoracic Surgery Oncology Center KB No. 83 Center for Rehabilitation Medicine and Rehabilitation Information Center Department of Drug Supply and Procurement

2011 Department of Traumatology (sports injury)

2012 Department of Therapy -2 Department of Oncology

At the same time, the reorganization of the laboratory service (including the centralization of activities, re-equipment, optimization of the processes of collecting biological material, informatization of the documentation process), reduce the time for performing planned clinical, biochemical tests to 4 hours (for an express laboratory up to 2 hours), implement in period since 2008 to 2012 78 new laboratory techniques, establish a research quality control system, significantly increase the volume of diagnostic tests, and increase the efficiency of equipment use. Almost complete replacement of paralaboratory equipment with modern autoanalyzers, as a result of which the share of manual methods in CDL practice has decreased from 90% to 30%. Computerization of basic laboratory processes and the introduction of the prescribing subsystem of the COTEM information system into the practice of the Center after 6 months made it possible to increase the efficiency of equipment use by 2.7 times and reduce the load on employees involved in the delivery of biomaterial and result forms by 1.8 times.

Considering that the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia is actively involved in the treatment of victims in emergency situations and accumulates severe, clinically unclear patients in need of specialized care from all clinical hospitals and medical units of the Federal Medical and Biological Agency, the fulfillment of these functions and responsibilities required the creation in 2009. specialized emergency medical services.

In 2008 in the Federal Scientific and Clinical Center, the FMBA of Russia had significant personnel, material, technical and modern technological potential to provide specialized consultative and diagnostic care on an outpatient basis to the contingent of the Federal Medical and Biological Agency and the Moscow region, which required the creation in March 2008. a consultative and diagnostic center was created, which made it possible to solve the following problems: rational organization of medical care for patients at all stages (preliminary examination, as well as follow-up treatment after hospital treatment), increasing the availability of highly qualified assistance from specialized specialists (the principle of rotation of medical personnel), selection for hospitalization, conducting preoperative preparation of patients, providing medical preventive examinations and medical examinations for clinic staff, and in-depth medical examination of athletes. As a result of the activities carried out, the volume of advisory assistance per year at the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia increased in 2011. compared to 2007 6.6 times. The CDC plays a great role in attracting patients on a paid basis. The increase in the number of patients treated under an individual contract in a hospital was 41.8%, of which 95% were referred by specialists of the center.

Implementation of personnel policy. In the field of personnel policy, the mechanisms of employee motivation related to the optimization of wages, the provision of a social package, and the creation of conditions for continuous training of personnel were chosen as priorities.

The location of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia in the capital region creates significant difficulties in terms of providing medical personnel and maintaining personnel potential. The key point is the level of wages, which in Moscow institutions is supported by regional allowances. Being in competitive environment requires increased attention to this problem. The introduction of a new personnel remuneration system was carried out in 2008. in accordance with the government decree, orders of the Ministry of Health and Social Development of the Russian Federation and the Federal Medical and Biological Agency of Russia, which determined the new procedure for remuneration of employees of federal budgetary institutions. As a result of the measures taken, there was an increase in employee salaries, which allowed us in 2012. achieve the roadmap targets for 2014.

Optimization problems organizational culture in the institution were reflected in the acceptance by the staff in 2009. Code of Ethics for Physicians and Code of Ethics for Nurses.

As innovations in the organization educational activities:

Since 2009 on the basis of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia, thematic conferences are held with the invitation of leading specialists and analysis of the clinic’s work in certain areas;

Since 2010 clinical discussions are carried out with Internet broadcast on medical institutions FMBA of Russia:

Using the KOTEM medical information system, an internal file server and Internet access, and a legal reference system.

A comparison of indicators reflecting the professional level of medical personnel in the Federal Scientific Center of FMBA of Russia and federal institutions (Table 2) showed that the proportion of certified specialists and medical workers with a qualification category was significantly higher in the Federal Scientific Center of FMBA of Russia.

table 2

The share of specialists who had a certificate and qualification category in 2010-2011. (V %)

Federal institutions 2010 2011

Certified Availability of qualification category Certified Availability of qualification category

Federal Scientific Center FMBA of Russia 92.5 53.0 94.5 52.5

Russian Federation 61.5 34.1 62.0 32.8

Central Federal District 67.2 31.7 69.2 30.4

Moscow 69.9 28.5 72.8 27.0

The effectiveness of the educational program is also evidenced by the growth qualification level medical personnel, which can be judged based on the trend of increasing the number of specialists with scientific degrees and titles (Table 3).

Table 3

Dynamics of the number of persons with scientific degrees and titles

Key employees 2007 2008 2009 2010 2011

Professor 2 3 4 5 5

Doctor medical sciences 9 12 15 16 18

Candidate of Medical Sciences 46 61 68 72 74

The prerequisites for the intensive innovative development of the Center are, first of all, the status of a scientific and clinical institution (order of the Ministry of Health and Social Development of Russia No. 1060 of September 21, 2011), as well as twenty-five years of joint work with scientific and teaching teams of the country. The development of innovative potential includes three key components - science, education, practice and is implemented through:

1. own original developments, attracting new specialists to the institution who know new methods or are their developers, training their specialists, exchanging experience with the world's leading clinics, acquiring and mastering new equipment;

2. participation in international clinical trials of drugs, testing of medical equipment and consumables.

3. publication since 2010 of our own journal “Clinical Practice”, the main idea of ​​which is the description and analysis of cases of severe, rare, diagnostically difficult diseases in patients,

who underwent treatment in clinics of the Federal Medical and Biological Agency.

4. Conducting and participating in scientific conferences, incl. international

For 2008-2012 263 new medical technologies were introduced into therapeutic and surgical activities, laboratory and instrumental diagnostics, in 2012 alone. - 70 innovations.

As organizational and management technologies, elements of a quality management system were introduced into the work of the institution, a division of marketing activities was organized, a system of rotation of specialists was made, changes were made to the organization of the work of the admission department, to the operating hours of the hospital (transfer to a 24-hour mode), the organization of sanitary and epidemiological care, the system drug supply, the KOTEM information system was created (Fig. 1).

ORGANIZATION OF MEDICAL CARE

Emergency

Rice. 1. Ensuring continuity in the treatment of patients in the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia

The rotation of qualified specialists and unified management at the outpatient and inpatient stages made it possible from 2007 to 2012 to reduce the average length of a bed-day in a hospital by 30.6% and increase the number of outpatient consultations by 6.6 times.

A set of measures related to increasing the efficiency of the management system included the creation of a local regulatory framework that determines the work of the institution and divisions, the use of modern organizational technologies, and optimization of the management decision-making process, including the use of information technology.

The introduction of the COTEM medical information system into the practice of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia made it possible to implement the main areas of information support for activities:

Automate the maintenance of electronic medical records, which improves the quality of medical documentation, and, consequently, the level of awareness of the patient and other specialists;

Reduce the processing time of medical documentation and provide prompt access to medical information to patients and medical staff;

Carry out full-fledged statistical, financial accounting and analysis of services provided by the institution, individual departments and specific performers, which allows optimizing the planning and use of resources (control of bed stock, hospitalization plan, discharge plan, drawing up work schedules for doctors, schedules for the use of premises and equipment, appointment patients during an appointment with a doctor or undergoing a procedure, etc.);

Generate reporting and analytical documentation for the entire database of available data to make timely management decisions.

In conclusion, it is important to note that the strategic development of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia was carried out within the framework of the main directions of state policy to improve the quality and accessibility of medical care, the innovative development of treatment, diagnostic and management processes based on new clinical, organizational, structural and organizational and managerial methods and technologies. The activities carried out made it possible in 2012 to achieve the target indicators for the use of hospital beds of the 2018 Road Map, the average length of stay in a bed in the Federal Scientific Clinical Center

FMBA of Russia was 10.7, and bed occupancy was 344 (the planned indicators of the Road Map for 2018 were 11.7 and 331, respectively).

The reorganization of the activities of the FCSC FMBA of Russia was carried out on the basis of the consistent introduction of a wide range of new organizational and management technologies: the principle of a single doctor, the institute of freelance chief specialists, rotation of specialists, elements of the quality management system, marketing tools, as well as through reorganization organizational structure institutions, transfer of the hospital to round-the-clock operation, reorganization of the emergency department, sanitary and epidemiological service, drug supply system, entrepreneurial activity.

The comprehensive nature of the reorganization of the activities of the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia made it possible to provide a solution to the accumulated problems of rationalizing the use of the institution’s resources, increasing its resource potential in terms of strengthening the material and technical base, developing personnel, and ensuring sustainable financing.

Literature

1. The concept of long-term socio-economic development of the Russian Federation for the period until 2020. Order of the Government of the Russian Federation of November 17, 2008 No. 1662-r. - 188s.

2. Decree of the Government of the Russian Federation of August 5, 2008. No. 583 "On the introduction of new systems of remuneration for employees of federal budgetary institutions and federal government bodies, as well as civilian personnel of military units, institutions and divisions of federal executive authorities, in which the law provides for military and equivalent service, the remuneration of which is currently carried out on the basis of the Unified tariff schedule for remuneration of employees of federal government institutions" Published on August 13, 2008 in "RG" - Federal issue No. 4727.

3. Order of the Ministry of Health and Social Development of Russia No. 425n dated August 14, 2008. "On approval of Recommendations for the development by federal government bodies and institutions - the main managers of federal budget funds - of approximate provisions on the remuneration of employees of subordinate federal budgetary institutions."

4. Order of the Government of the Russian Federation No. 2599-r dated December 28, 2012. “On approval of an action plan for changes in sectors of the social sphere aimed at increasing the efficiency of healthcare”, http://medvestnik.ru/9/47/42833.html.

5. Siburina, T.A. Healthcare development strategies implemented in the world / T.A. Siburina, O.S. Mishina // Electronic journal “Social aspects of public health”. -2011. -No. 2 (18).

6. Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation.”

7. Khabriev, R.U. Indicators of the quality of medical care (regional level) / R.U. Khabriev, P.A. Vorobyov, A.S. Yuryev, E.L. Nikonov, M.V. Avksentieva // “Problems of standardization in healthcare.” - 2005. -No. 10.

8. Osnovy politiki. Planirovaniye okazaniya meditsinskoy pomoshchi. Obzor mezhdunarodnogo opyta. Stefanie Ettelt, Ellen Nolte, Nicholas Mays, Sarah Thomson, i International Healthcare Comparisons Network. Evropeyskaya Ob-servatoriya po sistemam i politike zdravookhraneniya. - M.: Real Taym, 2009. - 64 p.

9. Lyublyanskaya khartiya po reformirovaniyu zdravookhraneniya. . Copenhagen: WHO Regional Office for Europe; 1996. Available from: http://www.euro.who.int/_data/assets/pdf_file/0012/113304/E55363R.pdf.

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